Pathogenic variation of colletotrichum lindemuthianum causing anthracnose of beans (phaseolus vulgaris) in Uganda

Colletotrichum lindemuthianum is a highly variable pathogen of common beans that easily overcomes resistance in cultivars bred with single-gene resistance. To determine pathogenic variability of the pathogen in Uganda, samples of common bean tissues with anthracnose symptoms were collected in eight districts of Uganda, namely Kabarole, Sironko, Mbale, Oyam, Lira, Kapchorwa, Maracha and Kisoro. 51 isolates sporulated successfully on Potato Dextrose Agar and Mathur’s media and were used to inoculate 12 differential cultivars under controlled conditions. Five plants per cultivar were inoculated with each isolate and then evaluated for their reaction using the 1 – 9 severity scale. Races were classified using the binary nomenclature system proposed by Pastor Corrales (1991). Variation due to cultivar and isolate effects was significant (P≤0.001) for severity. The 51 isolates from eight districts grouped into 27 different races. Sironko district had the highest number of races followed by Mbale and Kabarole. Races 2047 and 4095 were the most frequently found, each with 10 isolates grouped under them. Race 4095 was the most virulent since it caused a susceptible (S) reaction on all 12 differential cultivars and the susceptible check. This was followed by races 2479, 2047 and 2045 respectively. Two races, 4094 and 2479, caused a susceptible reaction on the differential cultivar G2333, which nevertheless, showed the most broad spectrum resistance followed by cultivars Cornell 49-242, TU, and AB136 respectively. These cultivars are recommended for use in breeding programs aiming at breeding for broad spectrum resistance to bean anthracnose in Uganda

A randomized, double-blind, placebo-controlled trial of the use of prednisolone as an adjunct to treatment in HIV-1-associated pleural tuberculosis.

BACKGROUND: Active tuberculosis may accelerate progression of human immunodeficiency virus (HIV) infection by promoting viral replication in activated lymphocytes. Glucocorticoids are used in pleural tuberculosis to reduce inflammation-induced pathology, and their use also might reduce progression of HIV by suppressing immune activation. We examined the effect that prednisolone has on survival in HIV-1-associated pleural tuberculosis. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of prednisolone as an adjunct to tuberculosis treatment, in adults with HIV-1-associated pleural tuberculosis. The primary outcome was death. Analysis was by intention to treat. RESULTS: Of 197 participants, 99 were assigned to the prednisolone group and 98 to the placebo group. The mortality rate was 21 deaths/100 person-years (pyr) in the prednisolone group and 25 deaths/100 pyr in the placebo group (age-, sex-, and initial CD4+ T cell count-adjusted mortality rate ratio, 0.99 [95% confidence interval, 0.62-1.56] [P =.95]). Resolution of tuberculosis was faster in the prednisolone group, but recurrence rates were slightly (though not significantly) higher, and use of prednisolone was associated with a significantly higher incidence of Kaposi sarcoma (4.2 cases/100 pyr, compared with 0 cases/100 pyr [P =.02]). CONCLUSIONS: In view of the lack of survival benefit and the increased risk of Kaposi sarcoma, the use of prednisolone in HIV-associated tuberculous pleurisy is not recommended

Quantifying and valuing community health worker time in improving access to malaria diagnosis and treatment

Background: Community health workers (CHWs) are members of a community who are chosen by their communities as first-line, volunteer health workers. The time they spend providing healthcare and the value of this time are often not evaluated. Our aim was to quantify the time CHWs spent on providing healthcare before and during the implementation of an integrated programme of diagnosis and treatment of febrile illness in three African countries. Methods: In Burkina Faso, Nigeria and Uganda, CHWs were trained to assess and manage febrile patients in keeping with Integrated Management of Childhood Illness recommendations to use rapid diagnostic tests, artemisinin-based combination therapy and rectal artesunate for malaria treatment. All CHWs provided healthcare only to young children usually under 5 years old, and hence daily time allocation of their time to child healthcare was documented for one day (in the high malaria season) before the intervention and at several time points following the implementation of the intervention. Time spent in providing child healthcare was valued in earnings of persons with similar experience. Results: During the high malaria season of the intervention, CHWs spent nearly 50 minutes more in daily healthcare provision (average daily time 30.2 minutes before the intervention versus 79.5 minutes during the intervention; test for difference in means p< 0.01). On average, the daily time spent providing healthcare during the intervention was 55.8 minutes (Burkina Faso), 77.4 minutes (Nigeria) and 72.2 minutes (Uganda). Using the country minimum monthly salary, CHWs time allocated to child healthcare for one year was valued at USD 52 in Burkina Faso, USD 295 in Nigeria and USD 141 in Uganda. Conclusion: CHWs spend up to an hour and a half daily on child healthcare in their communities. These data are informative in designing reward systems to motivate CHWs to continue providing good quality services

Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment

This work was supported by the UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID number A80553 [Burkina Faso]; A80550 [Nigeria]; and A80556 [Uganda]) through funds made available by the European Commission (FP7) for research to improve community access to health interventions in Africa

Impact of Improving Community-Based Access to Malaria Diagnosis and Treatment on Household Costs

Financial support. This work was supported by UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID numbers A80553; [;Burkina Faso], A80550; [;Nigeria], and A80556; [Uganda]) through funds made available by the European Commission (FP7) for research to improved community access to health interventions in Africa. Supplement sponsorship. This article appears as part of the supplement “Malaria in Highly Endemic Areas: Improving Control Through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment,” sponsored by the World Health Organization

Impact of improving community-based access to malaria diagnosis and treatment on household costs

Background: Community health workers (CHWs) were trained in Burkina Faso, Nigeria and Uganda to diagnose febrile children using malaria rapid diagnostic tests (RDTs), treat positive malaria cases with artemisinin combination treatment (ACTs) and those who could not take oral medicines with rectal artesunate. We quantified the impact of this intervention on private household costs for childhood febrile illness. Methods: Households with recent febrile illness in a young child in previous two weeks were selected randomly before and during the intervention and data obtained on household costs for the illness episode. Household costs included consultation fees, registration costs, user fees, diagnosis, bed, drugs, food and transport costs. Private household costs per episode before and during the intervention were compared. The intervention’s impact on household costs per episode was calculated and projected to district-wide impacts on household costs. Results: Use of CHW increased from 35% of illness episodes before the intervention to 50% during the intervention (p<0.0001) and total household costs per episode decreased significantly in each country from 4.36 to 1.54 dollars in Burkina Faso, from 3.90 to 2.04 dollars in Nigeria and from 4.46 to 1.42 in dollars Uganda (all p<0.0001). There was no difference in the time used by the child’s caregiver to care for a sick child (59% before intervention vs. 51% during intervention spent 2 days or less). Using the most recent population figures for each study district, we estimate that the intervention could save households a total of 29,965, 254,268 and 303,467 dollars, respectively in the study districts in Burkina Faso, Nigeria and Uganda. Conclusions: Improving access to malaria diagnostics and treatments in malaria endemic areas substantially reduces private household costs. The key challenge is to develop and strengthen community human resources to deliver the intervention, and ensure adequate supplies of commodities and supervision. We demonstrate feasibility and benefit to populations living in difficult circumstances

Impact of improving community-based access to malaria diagnosis and treatment on household costs

Background: Community health workers (CHWs) were trained in Burkina Faso, Nigeria and Uganda to diagnose febrile children using malaria rapid diagnostic tests (RDTs), treat positive malaria cases with artemisinin combination treatment (ACTs) and those who could not take oral medicines with rectal artesunate. We quantified the impact of this intervention on private household costs for childhood febrile illness. Methods: Households with recent febrile illness in a young child in previous two weeks were selected randomly before and during the intervention and data obtained on household costs for the illness episode. Household costs included consultation fees, registration costs, user fees, diagnosis, bed, drugs, food and transport costs. Private household costs per episode before and during the intervention were compared. The intervention’s impact on household costs per episode was calculated and projected to district-wide impacts on household costs. Results: Use of CHW increased from 35% of illness episodes before the intervention to 50% during the intervention (p<0.0001) and total household costs per episode decreased significantly in each country from 4.36 to 1.54 dollars in Burkina Faso, from 3.90 to 2.04 dollars in Nigeria and from 4.46 to 1.42 in dollars Uganda (all p<0.0001). There was no difference in the time used by the child’s caregiver to care for a sick child (59% before intervention vs. 51% during intervention spent 2 days or less). Using the most recent population figures for each study district, we estimate that the intervention could save households a total of 29,965, 254,268 and 303,467 dollars, respectively in the study districts in Burkina Faso, Nigeria and Uganda. Conclusions: Improving access to malaria diagnostics and treatments in malaria endemic areas substantially reduces private household costs. The key challenge is to develop and strengthen community human resources to deliver the intervention, and ensure adequate supplies of commodities and supervision. We demonstrate feasibility and benefit to populations living in difficult circumstances

A randomized, double-blind, placebo-controlled trial of the use of prednisolone as an adjunct to treatment in HIV-1-associated pleural tuberculosis.

BACKGROUND: Active tuberculosis may accelerate progression of human immunodeficiency virus (HIV) infection by promoting viral replication in activated lymphocytes. Glucocorticoids are used in pleural tuberculosis to reduce inflammation-induced pathology, and their use also might reduce progression of HIV by suppressing immune activation. We examined the effect that prednisolone has on survival in HIV-1-associated pleural tuberculosis. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of prednisolone as an adjunct to tuberculosis treatment, in adults with HIV-1-associated pleural tuberculosis. The primary outcome was death. Analysis was by intention to treat. RESULTS: Of 197 participants, 99 were assigned to the prednisolone group and 98 to the placebo group. The mortality rate was 21 deaths/100 person-years (pyr) in the prednisolone group and 25 deaths/100 pyr in the placebo group (age-, sex-, and initial CD4+ T cell count-adjusted mortality rate ratio, 0.99 [95% confidence interval, 0.62-1.56] [P =.95]). Resolution of tuberculosis was faster in the prednisolone group, but recurrence rates were slightly (though not significantly) higher, and use of prednisolone was associated with a significantly higher incidence of Kaposi sarcoma (4.2 cases/100 pyr, compared with 0 cases/100 pyr [P =.02]). CONCLUSIONS: In view of the lack of survival benefit and the increased risk of Kaposi sarcoma, the use of prednisolone in HIV-associated tuberculous pleurisy is not recommended