Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study.

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications

Finding meaning: HIV self-management and wellbeing among people taking antiretroviral therapy in Uganda

© 2016 Russell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in anymedium, provided the original author and source are credited. The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's selfmanagement of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resourcelimited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': They saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other nonmedical aspects of wellbeing for self-management which ART programmes might explore further and encourage

Fat utilization by chickens of different genetic backgrounds

The objectives of this research were (1) to study the relative ability of genetically different types of domestic chickens to digest and absorb fat of different types, and (2) to relate fat absorbability coefficients to dietary apparent M. E. values obtained with genetically different types of chickens feeding on diets containing the different types of fat, (3) to search for a possible cause of poultry genetic difference in fat absorbability by examining some of the factors most likely to influence fat digestion and absorption in the genetically different types of chickens. Using New Hampshire, White Leghorn and broiler-type birds, it was found that until 6 weeks of age the New Hampshires were significantly (P≤0.05) superior to the others in their ability to utilize animal tallow. Differences among birds in the absorbability of corn oil were small. Differences in dietary M.E. estimates were closely associated with differences in fat absorbability values and on a 12% tallow diet, the R² values computed on a within age between breeds basis, were 0.67, 0.36 and 0.022 at 3, 5, and 9 weeks of age respectively. This general decline in R² values was a reflection of the narrowing of the range of fat absorbability differences among different types of birds as they grew older. The overall conclusion based on these results, is that breed and/or age differences in M.E. estimates are to a large extent attributable to breed and/or age differences in the absorbability of dietary lipid materials. The search for potential causes of the observed breed differences in fat absorbability was therefore the main theme of the subsequent experiments. A study of the feed passage time in birds of different genetic backgrounds failed to provide any conclusive evidence on whether or not breed differences in ingesta transit time are in measureable terms responsible for fat absorbability differences. It was found, however, that with diets containing 12% of animal tallow or corn oil, feed passage time was significantly longer regardless of the type of birds. On the basis of the results of an experiment in which in vitro pancreatic lipase activity was measured, the New Hampshires ranked first followed by Broilers and White Leghorns in that order. However, the magnitude of differences among them was small. Supplementation of the 12% tallow diet with the bile salt, sodium taurocholate, improved fat utilization significantly by the broiler-type and White Leghorn chicks to the extent of 8.6% and 7.2% respectively. The improvement in fat absorbability was associated with a significant reduction in the amount of fecal soap fatty cacids. The effect of the sodium taurocholate suggested that in the Broilers and White Leghorn chicks, the supply of bile salts was below the critical micellar concentration required for efficient tallow fat absorption. Results from a general study on intestinal fatty acid binding protein (FABP) revealed that a fatty acid binding protein in the same molecular weight range as that one demonstrated in the rat, exists in the intestinal mucosa of the adult chickens and in the mesenteric intestine of day-old chicks prior to the ingestion of any feed.Land and Food Systems, Faculty ofGraduat

A Link Fabrication Attack Mitigation Approach (LiFAMA) for Software Defined Networks

In software defined networks (SDNs), the controller is a critical resource, yet it is a potential target for attacks as well. The conventional OpenFlow Discovery Protocol (OFPD) used in building the topological view for the controller has vulnerabilities that easily allow attackers to poison the network topology by creating fabricated links with malicious effects. OFDP makes use of the link layer discovery protocol (LLDP) to discover existing links. However, the LLDP is not efficient at fabricated link detection. Existing approaches to mitigating this problem have mostly been passive approaches that depend on observing unexpected behaviour. Examples of such behaviour include link latency and packet patterns to trigger attack alerts. The problem with the existing solutions is that their implementations cause longer link discovery time. This implies that a dense SDN would suffer from huge delays in the link discovery process. In this study, we propose a link fabrication attack (LFA) mitigation approach (LiFAMA), which is an active mitigation approach and one that minimises the link discovery time. The approach uses LLDP packet authentication together with keyed-hash-based message authentication code (HMAC) and a link verification database (PostgreSQL) that stores records of all known and verified links in the network. This approach was implemented in an emulated SDN environment using Mininet and a Python-based open-source OpenFlow (POX) controller. The results show that the approach detects fabricated links in an SDN in real time and helps mitigate them. Additionally, the link discovery time of LiFAMA out-competes that of an existing LFA mitigation approach

Adjusting to life with HIV on ART.

<p>Adjusting to life with HIV on ART.</p

Hope: a new approach to understanding structural factors in HIV acquisition

This paper presents the first empirical results of a long term project exploring the use of hope as a concept summarising people’s experience of the social, economic and cultural world they inhabit. The work has its roots in attempts to understand socio-economic aspects of HIV/AIDS epidemiology through recourse to the term “structural drivers”. In this paper we recognise the distinguished contribution made by that body of work but adopt a different theoretical approach, one based on the idea of emergent social properties. This is an idea derived from the Durkheim’s notion of a “social current”. One such emergent property is hope and its potential use and applicability as an epidemiological variable is described. The variable is measured using the Snyder scale developed by the late Rick Snyder for quite other purposes in the USA. We use data from the long standing UK MRC/UVRI General Cohort Study in Uganda together with a smaller study of some fishing communities. The results show that the Snyder scale does: (a) measure a real variable; (b) mean something to Ugandan rural populations; (c) can be used to explore some known risk factors for HIV acquisition