Risk factors for non-communicable diseases in rural Uganda: a pilot surveillance project among diabetes patients at a referral hospital clinic

Introduction: Despite an increasing recognition of non- communicable diseases (NCDs) in sub-Saharan Africa, there is lack of well established surveillance systems for these diseases. In an effort to understand burden of NCDs in low-resource settings, the African Field Epidemiology Network launched a pilot project in 2009 to routinely capture patient data in the diabetes clinic of Mbarara Regional Referral Hospital. The objective of this study was to determine the prevalence and, the gender- and age- specific distributions of common NCD risk factors among diabetic patients attending a referral hospital in rural Uganda. Methods: A relational Access database was designed to collect information on NCD risk factors. These included smoking, alcohol use, family history of diabetes, hypertension and body mass index. Univariate analyses were done and differences in proportions tested using chi-square P-values in STATA version 10.0. Results: A total of 1,383 patient records were analyzed, with 61% being female and mean age of 39.6 years (SD 15.8). About 24% had a family history of diabetes. Smoking and alcohol use were more prevalent among males (16.6 % vs. 8.3%; p<0.0001) and (30.7 vs. 13%; p<0.0001) respectively. Overweight, obesity and hypertension were more prevalent in women (18.6% vs. 9.7%, 8.6% vs. 2.6%; p<0.0001, and 40.3% vs. 33%, p=0.018) respectively. Conclusion: This pilot project shows that use of hospital-based data is a valuable initial step in setting up surveillance systems for NCDs in Uganda. Risk factors for NCDs were both age and gender-specific and predominantly related to lifestyle. This suggests the need to design gender-sensitive prevention interventions that target lifestyle modification in this setting

Birthweight data completeness and quality in population-based surveys: EN-INDEPTH study.

BACKGROUND: Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight. RESULTS: Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02-0.03), neonatal deaths (aOR 0.19(95%CI 0.16-0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33-0.58), aOR 0.30(95%CI 0.22-0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37-19.55) and Dabat (aOR 14.25(95%CI 10.13-20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11-3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight. CONCLUSIONS: Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality

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

“Every Newborn-INDEPTH” (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites

Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths. Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken. Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.Children’s Investment Fund Foundation (CIFF

Residual Nitrogen Benefits of Promiscuous Soybeans to Maize Under Field Conditions

Residual N benefits of incorporated stover of two promiscuous and two specific soybean varieties to a subsequent, unfertilised maize crop were determined at three sites. Soybean stover was either incorporated onto field plots previously under four soybean varieties or removed soon after harvesting. Maize yield increases were higher when promiscuous soybean stover was incorporated compared to where specific soybean stover was incorporated. Yields were higher with stover incorporation compared with stover removal. Plots where soybean stover was removed gave significantly higher maize grain yield (1 - 2 t ha-1) on-farm and 3 - 5 t ha-1 on-station compared to the control (maize after maize) plots which gave 0.4 t ha-1 on-farm and 2 t ha-1 on station. Our results indicate that soybean has significant residual fertility effects for maize and maize-based cropping systems.Les effets r\ue9siduels b\ue9n\ue9fiques de l\u2019azote des fanes de deux vari\ue9t\ue9s de soja non sp\ue9cifiques et de deux vari\ue9t\ue9s de soja sp\ue9cifiques incorpor\ue9s dans une culture ult\ue9rieure de ma\uefs sans apport d\u2019engrais, ont \ue9t\ue9 d\ue9termin\ue9s dans trois sites d\u2019essai en milieu r\ue9el. Les rendements du ma\uef\uefs ont augment\ue9 quand les fanes de vari\ue9t\ue9s non sp\ue9cifiques de soja \ue9taient incorpor\ue9es compar\ue9s aux r\ue9sidux de soja sp\ue9cifiques. Les rendements \ue9taint plus \ue9l\ue9v\ue9s avec l\u2019incorporation de fanes en comparaison de l\u2019enl\ue8vement des fanes. Les parcelles ou les fanes de soja \ue9taient enlev\ue9es ont donn\ue9 de rendements en grains significativement plus \ue9l\ue9v\ue9s en milieu r\ue9el (1 - 2 t ha-1) et station (3 - 5 t ha-1) plus que les parcelles t\ue9moins (ma\uefs sur ma\uefs) qui ont donn\ue9 0.4 t ha-1 en milieu r\ue9el et 2 t ha-1 en station. Nos r\ue9sultats montrent que le soja a des effets r\ue9siduels de fertilit\ue9 significatifs sur le ma\uefs et les syst\ue8mes de cultures \ue0 base du ma\uefs