Nile perch fish processing waste along Lake Victoria in East Africa: Auditing and characterization

Worldwide, fish industry wastes are an important contaminant having an impact on the environment. The recovery of value added products from these residues constitutes an important waste reduction strategy for the industry. In East Africa, Nile perch fish processing into chilled fish fillet for export along Lake Victoria generate large proportions of both solid and liquid wastes. However, no thorough auditing and characterization of the waste has been done that would guide potential value addition through bioconversions and waste management. Auditing by surveying and mapping the fish processing industries was conducted along the lake. Waste quantification was done using specific guidelines for assessment of fish wastes. Analysis of the waste was carried out using standard methods. Annual solid waste and wastewater generation was estimated at 36,000 tonnes and 1,838,000 m3, respectively. The wastewater generated was high strength with a total chemical oxygen demand of 12,400 mg/l and solid content of 5,580 mg/l. The wastewater contained 6,160 mg/l of lipids and 2,000 mg/l of protein. The Nutrient content was 20 mg/l of total phosphorous, 340 mg/l organic nitrogen and 61 mg/l of ammonia nitrogen. The current fish waste management systems in place were found to be neither efficient nor profitable, thus profitable options of fish waste utilization and waste reduction strategies are imperative. Modern and economically viable options of fish waste value addition, decision scheme and waste reduction strategies have been highlighted in this paper. In conclusion, large amounts of fish waste generated are a rich source of lipids and proteins, which could be utilized for production of value added products through bioconversions.Key words: Nile perch, fish waste, auditing, characterization, value addition, utilization

Key factors affecting performance of biogas latrines in urban informal areas: Case of Kampala and Nairobi, East Africa

Large scale application of biogas latrine technology in developing countries faces technical, socioeconomic and financial  challenges. As a result, harnessing its full potential has not been realized. This study examined variables describing the design, construction, operation and maintenance of nineteen biogas latrines in  relation to their performance in Kampala and Nairobi, based on survey and field observations. Pre-tested questionnaires were administered to users, owners and construction  technicians/masons of the biogas latrines. Field observations were also undertaken to assess physical conditions of the biogas latrines. Principal component analysis was then used to establish correlation between variables of design, construction, operation and maintenance in relation to the performance of biogas latrines in terms of burning hours in a day. The design types of all the studied biogas latrine digesters were found to be of fixed dome. Co-digestion of human excreta and cow dung increased the number of biogas burning hours in a day from 0.5 to 1.1. The findings also show that the performance of the biogas latrines was influenced by six of the variables examined describing construction, operation and maintenance: skills of masons, use of standards in construction, training of users on operation and maintenance aspects, number of users/owners and their motivation for installation of biogas plants and physical conditions of the biogas latrines. This  implies that the use of skilled masons,  comprehensive training of users on operation and maintenance aspects and use of cosubstrates are key variables for optimal performance of biogas latrines.Key words: Biogas latrines, Kampala, Nairobi, performance

Modelling study of the ability to diagnose acute rheumatic fever at different levels of the Ugandan healthcare system.

OBJECTIVE: To determine the ability to accurately diagnose acute rheumatic fever (ARF) given the resources available at three levels of the Ugandan healthcare system. METHODS: Using data obtained from a large epidemiological database on ARF conducted in three districts of Uganda, we selected variables that might positively or negatively predict rheumatic fever based on diagnostic capacity at three levels/tiers of the Ugandan healthcare system. Variables were put into three statistical models that were built sequentially. Multiple logistic regression was used to estimate ORs and 95% CI of predictors of ARF. Performance of the models was determined using Akaike information criterion, adjusted R2, concordance C statistic, Brier score and adequacy index. RESULTS: A model with clinical predictor variables available at a lower-level health centre (tier 1) predicted ARF with an optimism corrected area under the curve (AUC) (c-statistic) of 0.69. Adding tests available at the district level (tier 2, ECG, complete blood count and malaria testing) increased the AUC to 0.76. A model that additionally included diagnostic tests available at the national referral hospital (tier 3, echocardiography, anti-streptolysin O titres, erythrocyte sedimentation rate/C-reactive protein) had the best performance with an AUC of 0.91. CONCLUSIONS: Reducing the burden of rheumatic heart disease in low and middle-income countries requires overcoming challenges of ARF diagnosis. Ensuring that possible cases can be evaluated using electrocardiography and relatively simple blood tests will improve diagnostic accuracy somewhat, but access to echocardiography and tests to confirm recent streptococcal infection will have the greatest impact

Socio-Institutional Drivers of Groundwater Contamination Hazards: The Case of On-Site Sanitation in the Bwaise Informal Settlement, Kampala, Uganda

This is a research article which contributes to the development of a socio-institutional assessment framework based on a case study of contamination by on-site sanitation (OSS) in an informal settlement of Bwaise (Kampala, Uganda).Socio-institutional factors are poorly addressed in the risk assessment of groundwater contamination. This paper contributes to the development of a socio-institutional assessment framework based on a case study of contamination by on-site sanitation (OSS) in an informal settlement of Bwaise (Kampala, Uganda). We conducted a snapshot survey of the recent extent of groundwater contamination by OSS using microbial and hydro-chemical indicators. Through transition arenas and key informant interviews, we investigated the socio-institutional drivers of the contamination. Overall, 14 out of the 17 sampled groundwater sources tested positive for Escherichia coli during the wet season. Nitrate concentrations at four sources exceeded the World Health Organization guideline value (50 mg/L), attributed to OSS. Despite the high contamination, the community highly valued groundwater as an alternative to the intermittent municipal water supply. We deduced six drivers of groundwater contamination, including land-use management, user attributes, governance, infrastructure management, groundwater valuation, and the operating environment (“LUGIVE”). Qualitative indicators for each of the drivers were also construed, and their interlinkages presented in a causal loop diagram, representing a socio-institutional assessment framework. The framework can help policymakers and the community to analyze various socio-institutional control levers to reduce the risk of groundwater contamination by OSS in informal settlements

Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: a cross-sectional analysis.

BACKGROUND: There is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. METHODS: We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. RESULTS: Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). CONCLUSION: This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority. TRIAL REGISTRATION: Trial registration: ISRCTN 45461276. Registered on 16 September 2021

Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda

Funding: CARE: COVID-19 and Antimicrobial Resistance in East Africa – impact and response is a Global Effort on COVID-19 (GECO) Health Research Award (MR/V036157/1) funded by UK Research and Innovation (Medical Research Council) and the Department of Health and Social Care (National Institute for Health Research).Background There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania. Methods In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as ‘pre-COVID-19 phase’ (February 2019 to February 2020), ‘COVID-19 phase 1’ (March 2020 to April 2020), and ‘COVID-19 phase 2’ (July 2021 to February 2022). Results In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda. Conclusions There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.Publisher PDFPeer reviewe

Bringing sustainable agricultural intensification practices and technologies to scale through campaign-based extension approaches: lessons from Africa Soil Health Consortium

Open Access Article; Published online: 19 Sep 2021Sustainable agricultural intensification (SAI) practices have been developed with the aim of increasing agricultural productivity. However, most of them are not achieving their potential because of low adoption, linked to limited extension support to make them known and accessible by end-users. This paper reviews the effectiveness of the Africa Soil Health Consortium (ASHC) extension-based campaigns, contributing knowledge for formulating novel and cost-effective extension approaches. Results show that ASHC campaigns achieved scale of farmer reach and spurred adoption of promoted SAI technologies. Adoption levels for a range of practices were at least 20%, which favourably compares with reported adoption rates for the training and visit extension approach; 1-7% and 11-21% for complex and simple practices respectively. In comparison to a single channel, exposure to multiple communication approaches was associated with higher uptake of promoted practices and technologies, and also increased participation of men, women and youth, by addressing inherent differences in access to, proficiency with, and preferences of communication channels. Success factors associated with ASHC campaigns were; the deployment of multiple and complementary information channels; harnessing public-private partnerships to establish sustainable input supply chains; and development of localized content and fit-for-purpose information materials to facilitate information diffusion

Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda

Background Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. Methods A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. Results Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. Conclusion This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures

Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study

Background: PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods: We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results: We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion: The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04066881