Prevalence and Implications of Telecommunication Counselling

ABSTRACT The purpose of the present study was to explore prevalence and implications of telecommunication counselling. Available literature suggests that telecommunication counselling may have far-reaching implications in the mental health practice in general, and particularly in psychology. This study was guided by the social information processing theoretical framework. A total number of 26 mental health practitioners aged from 22 to 45 were selected using purposive sampling. In this study questionnaires were distributed to respondents through email, email was also used to collect the research data. Research ethics, such as confidentiality, anonymity, and voluntary participation, were strictly observed. The Statistical Package for Social Sciences version 23 was used to analyse the data. The analysed data are presented in frequency tables and graphs. This study found that there are effectiveness and efficiency factors associated with the use telecommunication counselling. Furthermore, the findings imply that the popularity of this type of counselling has been growing steadily in the past few years, especially in urban areas. Furthermore, despite the increase and growing popularity in the use of telecommunication counselling, the results suggest the presence of ethical dilemmas that confront the practitioners.Thesis (Masters) -- Faculy of Humanities, Social Sciences and Law, 202

Prevalence and Implications of Telecommunication Counselling

ABSTRACT The purpose of the present study was to explore prevalence and implications of telecommunication counselling. Available literature suggests that telecommunication counselling may have far-reaching implications in the mental health practice in general, and particularly in psychology. This study was guided by the social information processing theoretical framework. A total number of 26 mental health practitioners aged from 22 to 45 were selected using purposive sampling. In this study questionnaires were distributed to respondents through email, email was also used to collect the research data. Research ethics, such as confidentiality, anonymity, and voluntary participation, were strictly observed. The Statistical Package for Social Sciences version 23 was used to analyse the data. The analysed data are presented in frequency tables and graphs. This study found that there are effectiveness and efficiency factors associated with the use telecommunication counselling. Furthermore, the findings imply that the popularity of this type of counselling has been growing steadily in the past few years, especially in urban areas. Furthermore, despite the increase and growing popularity in the use of telecommunication counselling, the results suggest the presence of ethical dilemmas that confront the practitioners.Thesis (Masters) -- Faculy of Humanities, Social Sciences and Law, 202

Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Rationale: Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective: We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda . Measurements: As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results: The median age was 34.2 years; 67.9% were male; and 14.6% were 130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance. Conclusion: Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.Publisher PDFPeer reviewe

Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.

BACKGROUND: Xpert MTB/RIF Ultra (Xpert Ultra) and Xpert MTB/RIF are World Health Organization (WHO)-recommended rapid nucleic acid amplification tests (NAATs) widely used for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum. To extend our previous review on extrapulmonary tuberculosis (Kohli 2018), we performed this update to inform updated WHO policy (WHO Consolidated Guidelines (Module 3) 2020). OBJECTIVES: To estimate diagnostic accuracy of Xpert Ultra and Xpert MTB/RIF for extrapulmonary tuberculosis and rifampicin resistance in adults with presumptive extrapulmonary tuberculosis. SEARCH METHODS: Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, 2 August 2019 and 28 January 2020 (Xpert Ultra studies), without language restriction. SELECTION CRITERIA: Cross-sectional and cohort studies using non-respiratory specimens. Forms of extrapulmonary tuberculosis: tuberculous meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, disseminated tuberculosis. Reference standards were culture and a study-defined composite reference standard (tuberculosis detection); phenotypic drug susceptibility testing and line probe assays (rifampicin resistance detection). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias and applicability using QUADAS-2. For tuberculosis detection, we performed separate analyses by specimen type and reference standard using the bivariate model to estimate pooled sensitivity and specificity with 95% credible intervals (CrIs). We applied a latent class meta-analysis model to three forms of extrapulmonary tuberculosis. We assessed certainty of evidence using GRADE. MAIN RESULTS: 69 studies: 67 evaluated Xpert MTB/RIF and 11 evaluated Xpert Ultra, of which nine evaluated both tests. Most studies were conducted in China, India, South Africa, and Uganda. Overall, risk of bias was low for patient selection, index test, and flow and timing domains, and low (49%) or unclear (43%) for the reference standard domain. Applicability for the patient selection domain was unclear for most studies because we were unsure of the clinical settings. Cerebrospinal fluid Xpert Ultra (6 studies) Xpert Ultra pooled sensitivity and specificity (95% CrI) against culture were 89.4% (79.1 to 95.6) (89 participants; low-certainty evidence) and 91.2% (83.2 to 95.7) (386 participants; moderate-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 168 would be Xpert Ultra-positive: of these, 79 (47%) would not have tuberculosis (false-positives) and 832 would be Xpert Ultra-negative: of these, 11 (1%) would have tuberculosis (false-negatives). Xpert MTB/RIF (30 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 71.1% (62.8 to 79.1) (571 participants; moderate-certainty evidence) and 96.9% (95.4 to 98.0) (2824 participants; high-certainty evidence). Of 1000 people where 100 have tuberculous meningitis, 99 would be Xpert MTB/RIF-positive: of these, 28 (28%) would not have tuberculosis; and 901 would be Xpert MTB/RIF-negative: of these, 29 (3%) would have tuberculosis. Pleural fluid Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity against culture were 75.0% (58.0 to 86.4) (158 participants; very low-certainty evidence) and 87.0% (63.1 to 97.9) (240 participants; very low-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 192 would be Xpert Ultra-positive: of these, 117 (61%) would not have tuberculosis; and 808 would be Xpert Ultra-negative: of these, 25 (3%) would have tuberculosis. Xpert MTB/RIF (25 studies) Xpert MTB/RIF pooled sensitivity and specificity against culture were 49.5% (39.8 to 59.9) (644 participants; low-certainty evidence) and 98.9% (97.6 to 99.7) (2421 participants; high-certainty evidence). Of 1000 people where 100 have pleural tuberculosis, 60 would be Xpert MTB/RIF-positive: of these, 10 (17%) would not have tuberculosis; and 940 would be Xpert MTB/RIF-negative: of these, 50 (5%) would have tuberculosis. Lymph node aspirate Xpert Ultra (1 study) Xpert Ultra sensitivity and specificity (95% confidence interval) against composite reference standard were 70% (51 to 85) (30 participants; very low-certainty evidence) and 100% (92 to 100) (43 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 70 would be Xpert Ultra-positive and 0 (0%) would not have tuberculosis; 930 would be Xpert Ultra-negative and 30 (3%) would have tuberculosis. Xpert MTB/RIF (4 studies) Xpert MTB/RIF pooled sensitivity and specificity against composite reference standard were 81.6% (61.9 to 93.3) (377 participants; low-certainty evidence) and 96.4% (91.3 to 98.6) (302 participants; low-certainty evidence). Of 1000 people where 100 have lymph node tuberculosis, 118 would be Xpert MTB/RIF-positive and 37 (31%) would not have tuberculosis; 882 would be Xpert MTB/RIF-negative and 19 (2%) would have tuberculosis. In lymph node aspirate, Xpert MTB/RIF pooled specificity against culture was 86.2% (78.0 to 92.3), lower than that against a composite reference standard. Using the latent class model, Xpert MTB/RIF pooled specificity was 99.5% (99.1 to 99.7), similar to that observed with a composite reference standard. Rifampicin resistance Xpert Ultra (4 studies) Xpert Ultra pooled sensitivity and specificity were 100.0% (95.1 to 100.0), (24 participants; low-certainty evidence) and 100.0% (99.0 to 100.0) (105 participants; moderate-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 100 would be Xpert Ultra-positive (resistant): of these, zero (0%) would not have rifampicin resistance; and 900 would be Xpert Ultra-negative (susceptible): of these, zero (0%) would have rifampicin resistance. Xpert MTB/RIF (19 studies) Xpert MTB/RIF pooled sensitivity and specificity were 96.5% (91.9 to 98.8) (148 participants; high-certainty evidence) and 99.1% (98.0 to 99.7) (822 participants; high-certainty evidence). Of 1000 people where 100 have rifampicin resistance, 105 would be Xpert MTB/RIF-positive (resistant): of these, 8 (8%) would not have rifampicin resistance; and 895 would be Xpert MTB/RIF-negative (susceptible): of these, 3 (0.3%) would have rifampicin resistance. AUTHORS' CONCLUSIONS: Xpert Ultra and Xpert MTB/RIF may be helpful in diagnosing extrapulmonary tuberculosis. Sensitivity varies across different extrapulmonary specimens: while for most specimens specificity is high, the tests rarely yield a positive result for people without tuberculosis. For tuberculous meningitis, Xpert Ultra had higher sensitivity and lower specificity than Xpert MTB/RIF against culture. Xpert Ultra and Xpert MTB/RIF had similar sensitivity and specificity for rifampicin resistance. Future research should acknowledge the concern associated with culture as a reference standard in paucibacillary specimens and consider ways to address this limitation

Chickpea nitrogen fixation, rhizosphere nutrient concentration and contribution of residual nitrogen to improve maize production in response to biochar application in three different soil types

PhD (Soil Science)Department of Plant and Soil SciencesSoil degradation is a major challenge affecting agricultural production around the world in the twenty-first century. Alternative approaches including the use of biochar and the introduction of legumes that will fix nitrogen though the process of biological nitrogen fixation (BNF) are essential for improving soil quality of current low productive soils, thus increasing crop yields, and maintaining food security while conserving the environment. To address this problem, three experiments were conducted in this study. First, two locally produced biochar from poultry litter and acacia feedstocks were assessed whether they qualify as ‘biochar’ for use as soil amendment according to the international biochar bodies. Secondly, a pot experiment was then conducted to investigate the potential impact of poultry litter biochar (PLB) and acacia biochar (ACB) to improve rhizospheric soil nutrient availability, bacteria abundance and diversity, chickpea growth and total nitrogen fixation in three contrasting soil types. Thirdly, another pot experiment was conducted to determine the contribution of residual N from biochar and N-fixed by chickpea to the following maize crop grown in three contrasting soil type. The treatments consisted of three soil types classified as Fernwood [Arenosol]; Pinedene [Gleyic Acrisol]; Griffin [Helvic Acrisol], sampled from three different smallholder farmers at Dopeni village, Limpopo Province. The two biochars [PLB and ACB] were applied at four application rates of [0% (control), 0.5, 1 and 2% w/w]. The treatments were arranged in a completely randomized design and replicated four times. For the first experiment, chickpea (Cicer arietinum) desi cultivar was inoculated and grown for 65 days in soils with uniformly applied P at 60 kg P/kg in all pots and water maintained at 60% field capacity. For the second experiment, maize (Zea mays) was grown for 95 days in the same soil as chickpea and biochar treatments as well as after harvesting maize that was used as a reference crop. Biochars made from poultry litter and acacia feedstocks meet the International Biochar Initiative (IBI) and European Biochar Certificate (EBC) requirements and qualifies as biochar for use as a soil amendment. Both biochars had C content greater than 50%, with H/C and O/C ratios less than 0.6 and 0.4, respectively, indicating that both biochars are stable for C sequestration and can remain in the soil for about 1000 years. Because poultry litter biochar (PLB) contained more nutrients than acacia biochar (ACB), PLB improved rhizospheric pH, CEC, and nutrient concentration (N, P, K, and Ca) when applied at 0.5-2% in the Griffin and Pinedene soils, resulting in higher biomass production and nutrient uptake of chickpea. In addition, when 2% PLB was applied to those two soils, bacteria capable of fixing N, especially those from the phylum Proteobacteria, were more abundant. Thus, chickpea grown in these soils and at these PLB rates derived more N from the atmosphere, fixed more N, and xvi accumulated more N and C in the shoot, but was less water use efficient. Furthermore, maize grown in 1% residual PLB treatments produced more biomass and accumulated more N and other nutrients than maize grown with 0.5-2% residual ACB treatments. However, when grown after chickpea harvest in residual PLB treatments of 2% in the Griffin and Pinedene soils, maize produced greater biomass and accumulated more N and other nutrients. Application of PLB and ACB at 0.5% in the Fernwood soil was ideal to improve rhizospheric nutrient availability, the abundance of bacteria communities [from the phylum Proteobacteria, Acidobacteria, and Firmicutes which are important for C and N cycling and bioremediation], as well as growth, BNF, and C accumulation of chickpea, including maize growth and nutrient uptake in monocropping or in rotation with chickpea. The greatest variation in relative abundance of bacteria communities and growth of chickpea was due to the substantial change in soil pH and rhizospheric nutrient availability such as N, P, K, and Mg, while biomass production and N accumulation were largely attributed to the improved BNF and C accumulation of chickpea in the clay textured soils. The increased growth and nutrient uptake of the following maize crop in the Griffin and Pinedene soils was attributed to high N inputs through BNF and biochar mineralisation, whereas the variation in bacteria communities, chickpea and maize performance in the Fernwood soil was due to the change in rhizospheric soil pH, P, and K. The findings of this study conclude that biochar made from poultry litter is recommended for use as a soil amendment to improve nutrients and soil quality, although caution should be taken when applied at higher rates (40 t/ha) as it may immobilize N or result in high release of toxic elements. Furthermore, incorporating chickpea into existing maize cropping systems of smallholder farmers and using biochar made from poultry litter will help reduce nitrogen input costs by adding residual nitrogen from biochar mineralisation and through BNF, improving soil quality and maize production. On the other hand, biochar made from acacia feedstock will be excellent for use to improve soil organic carbon and water adsorption, but it should be applied months before planting or supplemented with high organic N and P materials when used as a soil amendment to improve nutrient availability, as it may temporary fix N and P in the soil. When using poultry litter or acacia biochar on a poorly buffered loamy sand soil like the Fernwood, care should be taken to avoid over liming, which can cause nutrient deficiency and negatively affect nutrient uptake. Moreover, to improve chickpea and maize performance in sandy textured, highly leached soils like the Fernwood, biochar should be applied regularly or combined with organic materials to improve soil organic carbon to allow the soil to retain and release nutrients for plant uptake.NR

Intra-household gender division of labour and decision-making on rice postharvest handling practices: A case of Eastern Uganda

Gains in increasing productivity of grain in Sub-Saharan Africa are greatly undermined by the high postharvest losses (PHLs), which compromise the food and income security of households. Rice is one such important food and cash crop experiencing high PHLs. Given the limited mechanization of smallholder farms, PHLs result from practices influenced by knowledge, decision-making power in the household and cultural norms. Gender is an important consideration in the interaction of these factors especially for a duo purpose crop like rice serving both food and income security interests of households. A descriptive cross-sectional survey informed by qualitative focus group discussions was conducted in two major rice producing districts in Eastern Uganda to establish how gender division of labour and decision-making influence PHLs at the household level. The intra-household gender structure, division of labour and decision-making determine the postharvest loses of rice at the household level. Men and boys perform the labour intensive postharvest activities where postharvest losses are high. They also dominate decisions on the practices and technologies used. Due to labour intensity and cultural norms, households without men rely on hired labour, which increases their PHLs resulting from late access to and inadequate supervision of the hired labour. Interventions for reduction of PHLs at the household level must target men with better practices and simple cost-effective technologies

Disseminated Coccidioidomycosis in Africa

Background: Coccidioidomycosis is an endemic disease in the Americas. No cases have been reported in Africa. Patient: A 23-year-old HIV seronegative Ugandan man was referred to Mulago National Referral Hospital in Kampala, Uganda with a 10-month history of haemoptysis and difficulty breathing, and a 6-month history of localized swellings on the extremities. He had associated weight loss and drenching sweats, but no fevers. He had taken anti-tuberculosis medicine for 2 months with no improvement. He had never travelled out of Uganda. On physical examination, he had cystic swellings and ulcerated lesions on the extremities. He had tachypnoea, crackles in the chest and mild hepatomegaly. Bronchoscopic examination showed two masses occluding the right main bronchus. Bronchoscopic biopsy showed findings consistent with coccidioidomycosis. The patient improved with antifungal treatment and was discharged. Conclusion: We report the first case of disseminated coccidioidomycosis with pulmonary and cutaneous manifestations in Africa

Farmers’ Perceptions of Rice Postharvest Losses in Eastern Uganda

Postharvest losses (PHLs) are a threat to efforts aimed at ensuring food and income security. This study aimed at contributing to the efforts to reduce PHLs through examining smallholder farmers’ perceptions about level of PHLs in Eastern Uganda. A descriptive cross sectional survey involved 83 farmers in focus group discussions and 150 individual household interviews. Principal component analysis and logistic regression were used to establish the determinants of farmers’ perceived ability to reduce PHLs. Results indicate that farmers perceive 66% of the losses occurred at the stages of harvesting, heaping and threshing through spillage. Quality deterioration was perceived to be highest at harvesting and drying. Farmers’ perceived ability to reduce PHLs was lowest at those stages where the losses were highest. This implies that the losses are likely to remain high unless farmers’ mindset about their control beliefs is enhanced. Farmers perceived ability to reduce PHLs is significantly influenced by potential for expansion of rice production, awareness of the modes through which losses occur and ways in which rice is used at household level and household characteristics. Any interventions to reduce PHLs should focus on mobilizing and coordinating farmers into commercial rice production and mind shift through intensifying sensitization

Farmers’ Perceptions of Rice Postharvest Losses in Eastern Uganda

Postharvest losses (PHLs) are a threat to efforts aimed at ensuring food and income security. This study aimed at contributing to the efforts to reduce PHLs through examining smallholder farmers’ perceptions about level of PHLs in Eastern Uganda. A descriptive cross sectional survey involved 83 farmers in focus group discussions and 150 individual household interviews. Principal component analysis and logistic regression were used to establish the determinants of farmers’ perceived ability to reduce PHLs. Results indicate that farmers perceive 66% of the losses occurred at the stages of harvesting, heaping and threshing through spillage. Quality deterioration was perceived to be highest at harvesting and drying. Farmers’ perceived ability to reduce PHLs was lowest at those stages where the losses were highest. This implies that the losses are likely to remain high unless farmers’ mindset about their control beliefs is enhanced. Farmers perceived ability to reduce PHLs is significantly influenced by potential for expansion of rice production, awareness of the modes through which losses occur and ways in which rice is used at household level and household characteristics. Any interventions to reduce PHLs should focus on mobilizing and coordinating farmers into commercial rice production and mind shift through intensifying sensitization