Solubility tests and the peripheral blood film method for screening for sickle-cell disease: A cost benefit analysis

Objective. To determine the cost benefit of screening for sicklecelldisease among infants at district health centres in Uganda using sickling, solubility tests and the peripheral blood film method.Methods. Pilot screening services were established at districthealth centres. Cost benefit analysis (CBA) was performed in four scenarios: A1 – where there are no sickle-cell screening services at district health centres and all children are referred either to Mulago national referral hospital or A2 – a regional hospital for haemoglobin (Hb) electrophoresis; B1 – when there are screening services at district health centres, only positive samples are taken either to Mulago Hospital or B2 – the regional hospital for confirmation using haemoglobin electrophoresis. Calculations were done in Uganda shillings (USh).Results. Initial operational costs were high for all scenarios but variably reduced in the subsequent years. Scenarios A1 and A2 were very sensitive compared with B1 and B2. Scenario A1 had the highest screening costs in the subsequent years, costing over 62 000 USh per test in both eastern and western Uganda. Scenario B2 was sensitive and cheaper when using the sickling test, but was expensive and insensitive when using the solubility test and more insensitive though cheaper when using the peripheral blood film method.Conclusions and recommendation. Screening children in Mulago hospital using haemoglobin electrophoresis (A1) was very expensive although it was sensitive. Screening the children at four health centres using the sickling method and confirming positive samples at a regional hospital (B2) was both cheap and sensitive and is therefore recommende

Determinants of acceptability of cricket consumption and adoption for improved food security among riparian communities of the Victoria Basin, Kenya

overburdened environment; malnutrition is likely to be on the rise with human population growth projected at 9.7 billion by 2050. This has seen cricket consumption for household food security increasing in the past decade. Cricket (acheta domesticus) farming can contribute positively to solving malnutrition problems being experienced among the riparian communities in the Kenyan Lake Victoria Basin. Cricket farming presents a livelihood diversification strategy that can help buffer rural households against food insecurity and provide an alternative source of income. However, its adoption as an alternative source of protein for improved household food security has remained low among smallholder farmers. The study investigated determinants of acceptability of cricket consumption and its influence on adoption for farming as an alternative source of food. The study employed a mixed methods research approach to collect quantitative and qualitative data from 120 trained cricket farmers from selected riparian counties including Siaya, Kisumu and Homa Bay in Kenyan Victoria basin. Descriptive statistics and logistic regression model were used to summarize quantitative data while content analysis was used to analyze qualitative data by thematic arrangements and similarities across different investigation areas. Based on data analyzed, the results indicated that cultural beliefs, perception and attitude such as cultural value attached to cricket consumption (p = 0.021), crickets are sweet and tender than poultry (p = 0.037) as well as age with a p<0.028, had statistical significance on acceptability to cricket consumption. On the other hand, regression β coefficient of awareness, access and availability were found to have no association with the adoption of cricket farming. The study recommended that: first, the government formulates a policy on farming edible insects as mini-livestock and improved food security. Secondly, further study is needed to determine possible strategies for changing attitude towards cricket consumption for increased adoption by smallholder farmers

The reliability of sickling and solubility tests and peripheral blood film method for sickle cell disease screening at district health centers in Uganda.

Bien que les analyses hématies falciformes, la solubilité et le film sanguin périphérique soient aujourd’hui disponibles pour le dépistage de la maladie drépanocytaire en Ouganda, leur fiabilité et aisance d’applicabilité n’ont pas été déterminées. Cette étude a été, par conséquent réalisée pour déterminer la fiabilité de la méthode de dépistage des analyses des hématies falciformes et de la solubilité ainsi que le film sanguin périphérique pour la SCD (sigle anglais pour Sickle cell disease) en Ouganda. Ceci a été une étude descriptive basée au laboratoire et réalisée par le Collège des Sciences de la Sante de l’Université de Makerere. Les 200 prélèvements des enfants ages de 6 mois à 5 ans ont été analysés de façon indépendante en utilisant la méthode des analyses d’hématies falciformes, la solubilité et le film sanguin périphérique. L’acétate de cellulose de l’électrophorèse de l’hémoglobine a été utilise comme échantillon. Les analyses des hématies falciformes et de solubilité ont eu la sensibilité de 65,0% et 45,0%, respectivement, et le film sanguin périphérique a eu 35,0%/. Les hématies falciformes, la solubilité et le film sanguin périphérique ont eu les spécifications de 95,6%, 90,0% et 96,7% respectivement. Les hématies falciformes ont eu la précision diagnostique de 92,5%, la solubilité – 85,5% et le film sanguin périphérique – 90,5%. Les hématies falciformes ont eu le Kappa de Cohen de 0,6, la solubilité – 0,3 et le film sanguin périphérique – 0,4. L’analyse des hématies falciformes a eu une période de rotation de 38 minutes, la solubilité – 70 minutes et le film sanguin périphérique – 44 minutes. En conclusion, l’analyse des hématies falciformes a été plus fiable et plus facile à exécuter que l’analyse de la solubilité et la méthode de film sanguin périphérique. Elle serait, par conséquent, une analyse recommandée pour le dépistage préliminaire des enfants pour la SCD aux centres de santé IV au niveau de districts et confirmer seulement les résultats positifs en utilisant l’électrophorèse de l’hémoglobine.KEY WORDS: Screening - Sickling and solubility tests -Peripheral blood film - Sickle cell disease - Uganda

PCR Detection of Entamoeba histolytica in Microscopically Positive Stool Samples of Hospital Patients in Soroti, Eastern Uganda

Amoebiasis is an infection caused by water borne protozoan parasite Entamoeba histolytica. In Uganda where sanitation infrastructure and health education was not adequate, amoebiasis was thought to be still an important health problem. However there was little or no data on prevalence of this very important protozoan infection. In addition, microscopy remained the main method for the diagnosis of amoebiasis but could not differentiate between Entamoeba dispar/moshkovskii and Entamoeba histolytica infections. This made determination of true prevalence of Entamoeba histolytica infections difficult. It was against this background that this study was designed to carry out species specific diagnosis of Entamoeba histolytica and Entamoeba dispar/moshkovskii in Uganda where these species had been reported to be endemic. This study used microscopy and polymerase chain reaction amplification of Serine-rich Entamoeba histolytica (SREHP) gene. It was shown that 36.7% (n=22) of the samples initially diagnosed as positive by microscopy were positive by PCR. The true prevalence of E. histolytica and E.dispar/ moshkovskii was found to be 7.31% and 12.6% respectively. It was concluded that Entamoeba infection in Soroti, Eastern Uganda is more frequently due to E. dispar /moshkovskii (13.3%) the non-pathogenic forms than to E. histolytica, the pathogen (7.31%).Key words: Entamoeba histolytica, Microscopy, Polymerase chain reaction, Prevalence

Foodborne hazards in the scientific literature: Results of a systematic literature review in East African countries

Introduction We conducted systematic literature reviews (SLR) of zoonotic hazards (including foodborne hazards) in two main value chains: the dairy value chain in Tanzania and the pork value chain in five countries in East Africa. The SLR sought to extract data and information related to the prevalence, risk factors, control and impacts of a list of hazards in each value chain. Materials The review was conducted through systematic searches in four online databases (PubMed, Cab direct, Web of Science, and Africa journals online), using pre-determined search criteria. Data were extracted using a standardized data form. The SLRs included 10 foodborne hazards in the dairy value chain in Tanzania and 18 foodborne hazards in the pork value chain in East Africa. Results Compared to other zoonotic hazards, foodborne hazards were under-represented in the published literature. Most literature focused on prevalence and risk factor studies, with very few papers investigating control options and impact. The scarcity of publications, linked with the diversity of methods used and inconsistent scientific reporting makes it difficult to combine results. In Tanzania, most literature focused on Brucella and Mycobacterium bovis. Although the dairy value chain includes many players and supply steps, most studies focused on the farm and retailer levels, with very few including consumers. Wildlife was the focus of some studies, primarily looking at their role as pathogen reservoirs. Presence of relevant foodborne hazards was confirmed at retailer level, suggesting potential risk for milk consumers. In the pork value chain, porcine cysticercosis was the most frequently studied foodborne hazard. Studies on important pork related parasites (e.g. T. hydatigena and Trichinella) are lacking in East Africa. Studies on humans have focus on Toxoplasma gondii, but its relation to pork consumption has not been investigated. Other important pork related hazard such as Salmonella are also lacking in the scientific literature. Many of the studied hazards were not the focus of any of the published reports, despite its presence in humans is well known in the target countries. Conclusion Reasons for the underrepresentation of foodborne hazards in the literature are discussed and suggestions for expanded investigation and reporting presented

Implementation of herd health program to improve survival of Boer goats in Malaysia.

A Boer goat breeding farm with 800 heads of breeder females, 50 breeder males, and 400 growing goats of various ages in Sabah, Malaysia was selected to study the effect of implementing herd health program. This included vaccination program against pneumonic mannheimiosis; fecal monitoring for helminthiasis, coccidiosis, and colibacillosis; and introduction of modified feeding regime comprised of day-time grazing and feeding of cut grass and supplemented feed. The herd health program was implemented in September 2007 and the impact was observed on body weight gains, body scoring, and annual mortality among adults and kids. It was found that implementation of herd health program significantly (p<0. 05) increased the average body weight gains in both adults and kids from 1. 8 g per kid and 0. 6 g per adult in 2006 to 3. 7 g per kid and 2. 2 g per adult in 2008. The percentage of adults with body scoring of <3 was significantly (p<0. 05) reduced from 82. 3% in 2006 to 77. 6% in 2007 and 4% in 2008. Similarly, the annual mortality rate was significantly (p<0. 05) reduced from 6. 5% among kids and 58. 2% among adults in 2006 to 12. 1% among kids and 10. 4% among adults in 2007, and to 9. 1% among kids and 1. 1% among adults in 2008. Therefore, it was concluded that implementation of herd health program significantly improved the survival and performance of goats

The burden and spatial distribution of bovine African trypanosomes in small holder crop-livestock production systems in Tororo District, south-eastern Uganda

African animal trypanosomiasis (AAT) is considered to be one of the greatest constraints to livestock production and livestock-crop integration in most African countries. South-eastern Uganda has suffered for more than two decades from outbreaks of zoonotic Human African Trypanosomiasis (HAT), adding to the burden faced by communities from AAT. There is insufficient AAT and HAT data available (in the animal reservoir) to guide and prioritize AAT control programs that has been generated using contemporary, sensitive and specific molecular techniques. This study was undertaken to evaluate the burden that AAT presents to the small-scale cattle production systems in south-eastern Uganda. Randomised cluster sampling was used to select 14% (57/401) of all cattle containing villages across Tororo District. Blood samples were taken from all cattle in the selected villages between September-December 2011; preserved on FTA cards and analysed for different trypanosomes using a suite of molecular techniques. Generalized estimating equation and Rogen-Gladen estimator models were used to calculate apparent and true prevalences of different trypanosomes while intra cluster correlations were estimated using a 1-way mixed effect analysis of variance (ANOVA) in R statistical software version 3.0.2.ResultsThe prevalence of all trypanosome species in cattle was 15.3% (95% CI; 12.2-19.1) while herd level trypanosome species prevalence varied greatly between 0-43%. Trypanosoma vivax (17.4%, 95% CI; 10.6-16.8) and Trypanosoma brucei rhodesiense (0.03%) were respectively, the most, and least prevalent trypanosome species identified. The prevalence of bovine trypanosomes in this study indicates that AAT remains a significant constraint to livestock health and livestock production. There is need to implement tsetse and trypanosomiasis control efforts across Tororo District by employing effective, cheap and sustainable tsetse and trypanosomiasis control method that could be integrated in the control of other endemic vector borne diseases like tick-borne diseases

Improvements on Restricted Insecticide Application Protocol for Control of Human and Animal African Trypanosomiasis in Eastern Uganda

African trypanosomes constrain livestock and human health in Sub-Saharan Africa, and aggravate poverty and hunger of these otherwise largely livestock-keeping communities. To solve this, there is need to develop and use effective and cheap tsetse control methods. To this end, we aimed at determining the smallest proportion of a cattle herd that needs to be sprayed on the legs, bellies and ears (RAP) for effective Human and Animal African Trypanosomiasis (HAT/AAT) control.; Cattle in 20 villages were ear-tagged and injected with two doses of diminazene diaceturate (DA) forty days apart, and randomly allocated to one of five treatment regimens namely; no treatment, 25%, 50%, 75% monthly RAP and every 3 month Albendazole drench. Cattle trypanosome re-infection rate was determined by molecular techniques. ArcMap V10.3 was used to map apparent tsetse density (FTD) from trap catches. The effect of graded RAP on incidence risk ratios and trypanosome prevalence was determined using Poisson and logistic random effect models in R and STATA V12.1 respectively. Incidence was estimated at 9.8/100 years in RAP regimens, significantly lower compared to 25.7/100 years in the non-RAP regimens (incidence rate ratio: 0.37; 95% CI: 0.22-0.65; P>0.001). Likewise, trypanosome prevalence after one year of follow up was significantly lower in RAP animals than in non-RAP animals (4% vs 15%, OR: 0.20, 95% CI: 0.08-0.44; P>0.001). Contrary to our expectation, level of protection did not increase with increasing proportion of animals treated.; Reduction in RAP coverage did not significantly affect efficacy of treatment. This is envisaged to improve RAP adaptability to low income livestock keepers but needs further evaluation in different tsetse challenge, HAT/AAT transmission rates and management systems before adopting it for routine tsetse control programs