Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin

Background: Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda. Methods and materials: This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant’s medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy fndings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our fndings. Results: We found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30–49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the diferent dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value\u3c0.05). Under weight (Body mass index≤18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value\u3c0.05). Conclusion: Adult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss

Factors associated with the uptake of Covid-19 vaccines: A cross-sectional study among the students of Bishop Stuart University in South-western Uganda.

Background:  Numerous vaccines against coronavirus disease (COVID-19) were approved and distributed globally. However, little information was available on the factors that affect the uptake of COVID-19 vaccines in Uganda. The aim of this study is to find out the Factors associated with the uptake of COVID-19 vaccines among the Students of Bishop Stuart University, Mbarara City. Methodology:  A cross-sectional study design using qualitative and quantitative approaches was employed. Data was collected from a sample of randomly selected 370 respondents from Bishop Stuart University. Qualitative and Quantitative data collection methods were employed. Data was collected between 11th July and 3rd October 2022. Statistical Package for Social Sciences version 26 was used during the analysis. Chi-square and logistic regressions were used to assess factors associated with the uptake of COVID-19 vaccines. Factors with p-values <0.2 at bivariate analysis were entered into multivariate analysis. Factors with p<0.05 were considered significant. Results:  Respondents that reported always being busy with domestic work indicated a lower likelihood for the uptake of Covid-19 vaccines (AOR = 0.6, 95%CI: 0.40-0.99, p = 0.045). Respondents who perceived that the costs in the hospital were too high to manage Covid-19 illness indicated a higher likelihood for uptake of Covid-19 vaccines (AOR = 3.4, 95%CI: 1.93-6.12, p <0.001). Conclusion:  Domestic work has been found to hinder the majority of the respondents from vaccinating against Covid-19. High rates of the uptake of Covid-19 vaccines were registered among those who feared the high costs of Covid-19 illness management in hospitals. The cultural norms associated with being a male or female had impacted the decision to take Covid-19 vaccines.  Recommendation:  Community outreaches should be organized to sensitize communities about the dangers of domestic work and how to strike a balance when it comes to daily activities

Prevalence of the uptake of Covid-19 vaccines: A cross-sectional study among the students of Bishop Stuart University in South-western Uganda.

Background:  Different studies have been carried out on acceptance of Covid-19 vaccines, willingness to be vaccinated against Covid-19, and factors associated with the uptake of Covid-19 vaccines but very few studies have been carried out to find out the prevalence of the uptake of Covid-19 vaccines, especially among university students. The aim of this study, therefore, is to find out the prevalence of the uptake of Covid-19 vaccines among the students of Bishop Stuart University.   Methodology: A cross-sectional study design using qualitative and quantitative approaches was employed. Data was collected from a sample of randomly selected 370 respondents between 11th July and 3rd October 2022 from Bishop Stuart University. Qualitative and Quantitative data collection methods were employed. Statistical Package for Social Sciences version 26 was used during the analysis. Results: The prevalence of uptake of Covid-19 Vaccines among the students of BSU was 57.0% where the majority of the respondents were females, 52.2% (n=193), students aged ≤30 years, 59.2% (n=215), those from middle-income, 57.3% (n=212), Christians, 60.8% (n = 225) and undergraduates, 89.2% (n = 330). Conclusion: More than half of the students of Bishop Stuart University were vaccinated with at least one of the vaccines against COVID-19 vaccine; the general uptake of Covid-19 vaccines among these students with a full dose was low as shown by the results of those who took a full dose of AstraZeneca, Johnson & Johnson or any other Covid-19 vaccine. Recommendation:  The study recommended that effective sensitization and psycho-education should be carried out to educate the general public about the effectiveness of the uptake of Covid-19 vaccines.

UTILIZATION OF ANTENATAL CARE SERVICES AMONG REFUGEE TEENAGE MOTHERS AT NAKIVALE REFUGEE SETTLEMENT IN WESTERN UGANDA. A PHENOMENOLOGICAL STUDY.

Introduction: Antenatal care is crucial for positive pregnancy outcomes and is dependent on the timing and quality of care. It promotes health education and helps identify and manage maternal complications and risk factors. In Sub-Saharan Africa, pregnancy complications and childbirth are the leading cause of death for women aged 10-19. This study examined teenage mothers' experiences and perceptions of accessing and utilizing antenatal care services in the Nakivale refugee settlement, Isingiro district. Methodology: A phenomenological study was conducted on teenage mothers in Nakivale, using a snowball sampling method. Key informant interviews were conducted, lasting 45 minutes -1 hour. Ethical clearance was obtained from Bishop Stuart University REC and informed consent was obtained from participants. Data was analyzed thematically using Nvivo version 12. Results: Teenage mothers face challenges utilizing antenatal care services including negative treatment from family and community members. However, positive feelings of responsibility alleviate stress, making early mothers more resilient. Conclusions: Access to ANC services is closely linked to its utilization, but societal discrimination against teenage mothers affects ANC utilization. Teenage-friendly spaces in Nakivale significantly influenced access and utilization of ANC services. Recommendations: The study suggests establishing customized ANC services for teenage mothers in the Nakivale refugee settlement, Isingiro district, to enhance access and utilization of ANC

The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic

Background: Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices. Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients with UGIB in rural SSA where schistosomiasis is endemic. Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy. Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were 65 4 lifetime episodes of UGIB, prior blood transfusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test). Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa

Epidemiology and control of intestinal schistosomiasis on the Sesse Islands, Uganda: integrating malacology and parasitology to tailor local treatment recommendations

<p>Abstract</p> <p>Background</p> <p>Intestinal schistosomiasis is often widespread among the populations living around Lake Victoria and on its islands. The Sesse Island group (containing some 84 islands), however, is typically assumed to be a low prevalence zone, with limited transmission, but has never been surveyed in detail. Here, we present a rapid mapping assessment, bringing together snail and parasite information, at 23 sites for the presence of intermediate host snails and at 61 sites for the prevalence of intestinal schistosomiasis in school-aged children (N = 905). Two different diagnostic tools were used and compared at 45 of these sites: Kato-Katz thick faecal smears and circulating cathodic antigen (CCA) urine dipsticks.</p> <p>Results</p> <p><it>Biomphalaria </it>snails were found at 11 sites but in low numbers; none was found shedding schistosome cercariae. At 22 out of the 45 sites, local prevalence by urine and/or stool diagnostics was in excess of 50%, although mean prevalence of intestinal schistosomiasis overall was 34.6% (95% confidence intervals (CI) = 31.0-38.3%) by Kato-Katz and 46.5% (95% CI = 42.7-50.4%) by CCA if 'trace' reactions were considered infection-positive (if considered infection-negative, mean prevalence was 28.1% (95% CI = 24.7-31.7%)). Diagnostic congruence between CCA and Kato-Katz was poor and significant discordance in estimated prevalence by location was found, with each often inferring different mass drug administration regimes.</p> <p>Conclusions</p> <p>Accurate estimation of schistosome prevalence is important for determining present and future treatment needs with praziquantel; the wide range of schistosome prevalence across the Sesse Island group requires a treatment regime largely tailored to each island. In high prevalence locations, further malacological sampling is required to confirm the extent of local transmission, especially on the northern islands within the group. The observation that different diagnostic tests can provide varying results in terms of estimating prevalence by location, and hence change treatment recommendations, suggests that care must be taken in interpreting raw prevalence data. In particular, further research into the reasons for the differences in the poorer performance of the CCA test should be pursued.</p

Morbidity due to Schistosoma mansoni: an epidemiological assessment of distended abdomen syndrome in Ugandan school children with observations before and 1-year after anthelminthic chemotherapy

The objectives of this study were to determine the prevalence and distribution of distended abdomens among Ugandan school children across a range of eco-epidemiological settings and to investigate the relationship between distended abdomens and helminth infections, in particular Schistosoma mansoni, before and 1-year after anthelminthic treatment. A cross-sectional survey was conducted on 4354 school children across eight districts, with a longitudinal 1-year follow-up of 2644 children (60.7%). On both occasions, parasitological, biometrical and clinical data were collected for each child. Baseline prevalence of S. mansoni and hookworms was 44.3% and 51.8%, respectively. Distended abdomens, defined as an abdominal circumference ratio (ACR) >1.05, were observed in 2.5% of the sampled children, several of whom presented with particularly severe distensions necessitating hospital referral. ACR scores were highly overdispersed between districts and schools. Multivariate regression analysis revealed that S. mansoni infection accounted for only a small fraction of ACR variation, suggesting that either single point prevalence and intensity measures failed to reflect this more chronically evolved morbidity and/or that other interacting factors were involved, e.g. malnutrition and malaria. At 1-year follow-up, ACR scores showed an overall trend of regression towards the mean, potentially indicative of amelioration following chemotherapy, but geographic overdispersion still remaine

The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review.

OBJECTIVES: Evidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold. METHODS: We identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations. RESULTS: A total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds. CONCLUSIONS: Despite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule

Changes in IgE- and antigen-dependent histamine-release in peripheral blood of Schistosoma mansoni-infected Ugandan fishermen after treatment with praziquantel.

BACKGROUND: Parasite-specific IgE levels correlate with human resistance to reinfection with Schistosoma spp. after chemotherapy. Although the role of eosinophils in schistosomiasis has been the focus of a great deal of important research, the involvement of other Fcepsilon receptor-bearing cells, such as mast cells and basophils, has not been investigated in relation to human immunity to schistosomes. Chemotherapy with praziquantel (PZQ) kills schistosomes living in an in vivo blood environment rich in IgE, eosinophils and basophils. This releases parasite Ags that have the potential to cross-link cell-bound IgE. However, systemic hypersensitivity reactions are not induced by treatment. Here, we describe the effects of schistosomiasis, and its treatment, on human basophil function by following changes in total cellular histamine and in vitro histamine-release induced by schistosome Ags or anti-IgE, in blood samples from infected Ugandan fishermen, who are continuously exposed to S. mansoni infection, before and 1-day and 21-days after PZQ treatment. RESULTS: There was a significant increase in the total cellular histamine in blood samples at 1-day post-treatment, followed by a very significant further increase by 21-days post-treatment. In vitro histamine-release induced by S. mansoni egg (SEA) or worm (SWA) Ags or anti-IgE antibody, was significantly reduced 1-day post-treatment. The degree of this reduction correlated with pre-treatment infection intensity. Twenty-1-days post-treatment, SEA-induced histamine-release was still significantly lower than at pretreatment. Histamine-release was not correlated to plasma concentrations of total or parasite-specific IgE, nor to specific IgG4 plasma concentrations. CONCLUSION: The biology of human blood basophils is modulated by S. mansoni infection and praziquantel treatment. Infection intensity-dependent suppression of basophil histamine-release, histamine-dependent resistance to infection, and similarities with allergen desensitisation are discussed as possible explanations of these observations