Communication Media Advancement in Sustainable Development

Communication via the media is the reflection of the societal issues by reporting events and happenings, normally for economic, political, social, and aesthetic purposes. The study set out to investigate the role that media plays in shaping the public’s perception of the pastoralist communities and its resultant impact on the development. In particular, it aimed to investigate the role of the print media in shaping public’s perception of the pastoralist communities, Pokot community in particular. It also assessed the impact of print media portrayal on the development of the Pokot community and identified the various communication barriers that have hindered accurate projection of information. The research finally explored on the various media approaches that can promote neutral reporting by the print media. The study embraced the agenda-setting theory developed by McCombs & Shaw (1968) which states that, mass media (print) sets the agenda for public opinion by highlighting ‘certain issues’ considered important (news) by the mainstream media. The study shades light on the reality and the media’s selection reality and the influence of this selectivity on public’s perception. The study was carried out in West Pokot County. The research adopted a case study design with a sample size of 300 participants selected from the target population through purposive sampling. Questionnaires were administered and purposive interview schedules were also employed to key respondents to gather special and valuable response from fields of interest. Data analysis and interpretation was done quantitatively. Findings, conclusions and recommendations to the relevant authorities were finally made. Keywords: Print Media, perception, Pastoralists, Pokot, Pokatusa

Monitoring hydropower reliability in Malawi with satellite data and machine learning

Hydro-climatic extremes can affect the reliability of electricity supply, in par-ticular in countries that depend greatly on hydropower or cooling water andhave a limited adaptive capacity. Assessments of the vulnerability of the powersector and of the impact of extreme events are thus crucial for decision-makers,and yet often they are severely constrained by data scarcity. Here, we intro-duce and validate an energy-climate-water framework linking remotely-senseddata from multiple satellite missions and instruments (TOPEX/POSEIDON.OSTM/Jason, VIIRS, MODIS, TMPA, AMSR-E) and field observations. Theplatform exploits random forests regression algorithms to mitigate data scarcityand predict river discharge variability when ungauged. The validated predic-tions are used to assess the impact of hydroclimatic extremes on hydropowerreliability and on the final use of electricity in urban areas proxied by night-time light radiance variation. We apply the framework to the case of Malawifor the periods 2000-2018 and 2012-2018 for hydrology and power, respectively.Our results highlight the significant impact of hydro-climatic variability anddry extremes on both the supply of electricity and its final use. We thus showthat a modelling framework based on open-access data from satellites, machinelearning algorithms, and regression analysis can mitigate data scarcity and im-prove the understanding of vulnerabilities. The proposed approach can supportlong-term infrastructure development monitoring and identify vulnerable pop-ulations, in particular under a changing climate

Influence of attendance at a clinic service for high-risk women on HIV prevention: A longitudinal study in Kampala, Uganda

Background: HIV/AIDS continues to be a major public health threat. Globally, there has been notable progress towards reaching people for HIV testing and treatment, as well as in the development of effective prevention tools. But preventing new HIV infections remains a key challenge, particularly among populations at the most risk including female sex workers and their sexual partners. Reducing HIV transmission in these populations requires combined HIV prevention options not only to be available, but also sufficiently used over time. However, regular attendance at clinic facilities, and use of HIV services by female sex workers is affected by persistent and common barriers including high mobility, stigmatisation, and discrimination in health-care settings. The aim of this thesis is to examine the effect of irregular exposure to a package of HIV prevention interventions among women at high risk of HIV in Uganda. Methods: A cohort of HIV-negative women at high risk of HIV was scheduled to attend dedicated clinic services once every three months within the Good Health for Women Project in Kampala, Uganda. An initial cohort of women was enrolled between April 2008 and May 2009 and followed-up (cohort 1). Alongside cohort 1, a second cohort was enrolled from January 2013, and followed-up (cohort 2). At each scheduled clinic visit, participants were offered a combination HIV prevention package that included risk reduction counselling, STI management, and HIV testing. Based on these data, I analysed (i) trends in HIV incidence following enrolment and the influence of missed scheduled visits on HIV incidence trends. In addition, multiple imputation of time-to-event was used to assess the influence of attrition over time on incidence; (ii) the association of the number of missed scheduled visits with subsequent HIV risk; (iii) the association of the number of missed scheduled visits with subsequent proximate determinants of HIV risk (sexually transmitted infections (STIs), alcohol use, inconsistent condom use with paid sex). The analyses were censored at 29th August 2017. Results: Of the 3084 HIV-negative women enrolled, 2206 (71.5%) had at least one followup visit. HIV incidence declined rapidly following enrolment from 6.1/100 person-years in ≤6 months to 2.0/100 at year 3 in cohort 1 (p-value<0.001), and from 3.8/100 to 1.8/100 in cohort 2 (p-value=0.04). HIV incidence was associated with the prior number of missed scheduled visits (adjusted hazard ratio=1.40; 95%CI 0.93-2.12 for 1-2 missed visits versus none, and 2.00 (95%CI 1.35-2.95) for ≥3 missed visits versus none; p-trend=0.001). Missed visits were associated with increased detection of STIs, and increased reporting of daily 3 alcohol use at the subsequent visit attended, but not with reported consistency of condom use with paid sex. Conclusion: The increased HIV risk when high-risk women interrupted their regular exposure to combination HIV prevention was most likely attributed to untreated STI. But the absence of a concurrent change in pattern of inconsistent condom use with paid sex could additionally suggest influence of contextual factors on HIV risk. HIV programmes need to routinely monitor the individual-level exposure to and use of complementary HIV interventions among high-risk women, as well as actively facilitate their attendance of effective intervention packages at regular intervals. For those unable to regularly attend services at health facilities, HIV programmes must adopt innovative ways to deliver combination intervention packages, incorporating STI management and risk reduction counselling and using mobile clinics, clinic vouchers, or even leveraging technology

The effect of antiretroviral therapy provision on all-cause, AIDS and non-AIDS mortality at the population level--a comparative analysis of data from four settings in Southern and East Africa.

OBJECTIVE: To provide a broad and up-to-date picture of the effect of antiretroviral therapy (ART) provision on population-level mortality in Southern and East Africa. METHODS: Data on all-cause, AIDS and non-AIDS mortality among 15-59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll-out, to 4-6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV-negative and HIV-positive individuals. For Karonga and the Africa Centre, trends in AIDS and non-AIDS mortality are analysed using verbal autopsy data. RESULTS: For all-cause mortality, overall rate ratios (RRs) comparing the period 2-6 years following ART roll-out with the pre-ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person-years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person-years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person-years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person-years) in the Africa Centre DSS. The mortality decline was seen only in HIV-positive individuals/AIDS mortality, with no decline in HIV-negative individuals/non-AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower. CONCLUSIONS: Falls in all-cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important

The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies.

The General Population Cohort (GPC) was set up in 1989 to examine trends in HIV prevalence and incidence, and their determinants in rural south-western Uganda. Recently, the research questions have included the epidemiology and genetics of communicable and non-communicable diseases (NCDs) to address the limited data on the burden and risk factors for NCDs in sub-Saharan Africa. The cohort comprises all residents (52% aged ≥13years, men and women in equal proportions) within one-half of a rural sub-county, residing in scattered houses, and largely farmers of three major ethnic groups. Data collected through annual surveys include; mapping for spatial analysis and participant location; census for individual socio-demographic and household socioeconomic status assessment; and a medical survey for health, lifestyle and biophysical and blood measurements to ascertain disease outcomes and risk factors for selected participants. This cohort offers a rich platform to investigate the interplay between communicable diseases and NCDs. There is robust infrastructure for data management, sample processing and storage, and diverse expertise in epidemiology, social and basic sciences. For any data access enquiries you may contact the director, MRC/UVRI, Uganda Research Unit on AIDS by email to [email protected] or the corresponding author

Atherogenic Risk Assessment among Persons Living in Rural Uganda

Background. Hypertension and dyslipidemia are independent risk factors for coronary heart disease and commonly coexist. Cardiovascular risk can be reliably predicted using lipid ratios such as the atherogenic index, a useful prognostic parameter for guiding timely interventions. Objective. We assessed the cardiovascular risk profile based on the atherogenic index of residents within a rural Ugandan cohort. Methods. In 2011, a population based survey was conducted among 7507 participants. Sociodemographic characteristics, physical measurements (blood pressure, weight, height, and waist and hip circumference), and blood sampling for non fasting lipid profile were collected for each participant. Atherogenic risk profile, defined as logarithm base ten of (triglyceride divided by high density lipoprotein cholesterol), was categorised as low risk (0.24). Results. Fifty-five percent of participants were female and the mean age was 49.9 years (SD± 20.2). Forty-two percent of participants had high and intermediate atherogenic risk. Persons with hypertension, untreated HIV infection, abnormal glycaemia, and obesity and living in less urbanised villages were more at risk. Conclusion. A significant proportion of persons in this rural population are at risk of atherosclerosis. Key identified populations at risk should be considered for future intervention against cardiovascular related morbidity and mortality. The study however used parameters from unfasted samples that may have a bearing on observed results

Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda

BACKGROUND: There is limited evidence on the relationship between sustained exposure of female sex workers (FSWs) to targeted HIV programmes and HIV incidence. We investigate the relationship between the number of missed study visits (MSVs) within each episode of 2 consecutively attended visits (MSVs) and subsequent HIV risk in a predominantly FSW cohort. // METHODS: Women at high risk of HIV are invited to attend an ongoing dedicated clinic offering a combination HIV prevention intervention in Kampala, Uganda. Study visits are scheduled once every 3 months. The analysis included HIV-seronegative women with ≥1 follow-up visit from enrollment (between April 2008 and May 2017) to August 2017. Cox regression models were fitted adjusted for characteristics on sociodemographic, reproductive, behavioral, and sexually transmitted infections (through clinical examination and serological testing for syphilis). // FINDINGS: Among 2206 participants, HIV incidence was 3.1/100 (170/5540) person-years [95% confidence interval (CI): 2.6 to 3.5]. Incidence increased from 2.6/100 person-years (95% CI: 2.1 to 3.2) in episodes without a MSV to 3.0/100 (95% CI: 2.2 to 4.1) for 1-2 MSVs and 4.3/100 (95% CI: 3.3 to 5.6) for ≥3 MSVs. Relative to episodes without a MSV, the hazard ratios (adjusted for confounding variables) were 1.40 (95% CI: 0.93 to 2.12) for 1-2 MSVs and 2.00 (95% CI: 1.35 to 2.95) for ≥3 MSVs (P-trend = 0.001). // CONCLUSION: Missing study visits was associated with increased subsequent HIV risk. Although several factors may underlie this association, the finding suggests effectiveness of targeted combination HIV prevention. But exposure to targeted interventions needs to be monitored, facilitated, and sustained in FSWs

COHORT PROFILE: The Complications of Long-Term Antiretroviral Therapy study in Uganda (CoLTART), a prospective clinical cohort.

BACKGROUND: Antiretroviral therapy (ART) improves the survival and quality of life of HIV-positive individuals, but the effects of long-term ART use do eventually manifest. The Complications of Long-Term Antiretroviral Therapy cohort study in Uganda (CoLTART) was established to investigate the metabolic and renal complications of long-term ART use among Ugandan adults. We describe the CoLTART study set-up, aims, objectives, study methods, and also report some preliminary cross-sectional study enrolment metabolic and renal complications data analysis results. METHODS: HIV-positive ART naïve and experienced adults (18 years and above) in Uganda were enrolled. Data on demographic, dietary, medical, social economic and behaviour was obtained; and biophysical measurements and a clinical examination were undertaken. We measured: fasting glucose and lipid profiles, renal and liver function tests, full blood counts, immunology, virology and HIV drug resistance testing. Plasma samples were stored for future studies. RESULTS: Between July 2013 and October 2014, we enrolled 1095 individuals, of whom 964 (88.0%) were ART experienced (6 months or more), with a median of 9.4 years (IQR 7.0-9.9) on ART. Overall, 968 (88.4%) were aged 35 years and above, 711 (64.9%) were females, 608 (59.6%) were or had ever been on a Tenofovir ART regimen and 236 (23.1%) on a Protease Inhibitor (PI) regimen. There were no differences in renal dysfunction between patients on Tenofovir and Non-Tenofovir containing ART regimens. Patients on PI regimens had higher total cholesterol, lower high density lipoprotein, higher low density lipoprotein, higher triglycerides, and a high atherogenic index for plasma than the non-PI regimen, p = 0.001 or < 0.001. Patients on Non-PI regimens had higher mean diastolic hypertension than patients on PI regimens, p < 0.001. CONCLUSIONS: Our finding of no differences in renal dysfunction between patients on Tenofovir and those on Non-Tenofovir containing ART regimens means that Tenofovir based first line ART can safely be initiated even in settings without routine renal function monitoring. However, integration of cardiovascular risk assessment, preventive and curative measures against cardiovascular disease are required. The CoLTART cohort is a good platform to investigate the complications of long-term ART use in Uganda

Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy.

INTRODUCTION: We investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS: We collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS: We enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI?25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P10% compared to the non PI regimen. CONCLUSION: ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended

The effect of Tenofovir on renal function among Ugandan adults on long-term antiretroviral therapy: a cross-sectional enrolment analysis.

BACKGROUND: WHO recommends using Tenofovir containing first line antiretroviral therapy (ART), however, Tenofovir has been reported to be associated with renal impairment and dysfunction. We compared renal function among individuals on Tenofovir and those on non-Tenofovir containing ART. METHODS: In a cross-sectional study of HIV-Positive adults on ART, at enrolment into a prospective cohort to study the long-term complications of ART in Uganda, information on biophysical measurements, medical history, clinical examination and renal function tests (RFTs) was collected. Fractional Tubular phosphate reabsorption and estimated glomerular filtration rate (eGFR) were calculated. Mean values of RFTs and proportions with abnormal RFTs were compared between non-Tenofovir containing (Non-TDF) and Tenofovir containing (TDF-ART) ART regimen groups using a general linear regression model. Durations of TDF exposure were also compared. RESULTS: Between July 2013 and October 2014, we enrolled 953 individuals on ART for 6 or more months, median duration on ART was 9.3 years, 385 (40.4 %) were on non-TDF and 568 (59.6 %) on TDF-ART regimens. The proportion of participants with Proteinuria (>30 mg/dl) was higher among the TDF-ART group than the non-TDF ART group. However, in multivariable analysis, there were no significant differences in the adjusted mean differences of eGFR, serum urea, serum creatinine, fractional tubular reabsorption of phosphate and serum phosphates when patients on TDF-ART were compared with those on non-TDF containing ART. There were no differences in renal function even when different durations on Tenofovir were compared. CONCLUSIONS: We found no differences in renal function among patients on Tenofovir and non-Tenofovir containing ART for almost a decade. Tenofovir based first line ART can therefore safely be initiated even in settings without routine renal function monitoring