Effects of Improved Access to Transportation on Emergency obstetric Care Outcomes in Uganda

Reduction in maternal mortality has not been appreciable in most  low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using ‘Caesarean section rate’ (CSR) and compared with the neighbouring  non-intervention district. Ecological data were collected retrospectively from maternity/theatre registers in October 2010 for 3 years pre and 3 years  intervention period. The average CSR in the intervention district increased from 0.57% before the intervention to 1.21% (p=0.022) during the  intervention, while there was no change in the neighbouring district (0.51% to 0.58%, p=0.512). Hospital deliveries increased by over 50% per year with a slight reduction in the average hospital stillbirths per 1000 hospital births in the intervention district (46.6 to 37.5, p=0.253). Reliable  communication and transport services increased access to and utilization of maternal health services, particularly caesarean delivery services. (Afr J Reprod Health 2014; 18[3]: 87-94)Keywords: caesarean section, emergency obstetric care, ambulance services, accessibility, referral and communication syste

Investigating New Innovations to Detect Small Salt-Water Fraction Component in Mineral Oil and Small Oil Fraction Component in Salt-Water Projects

Abstract: The main purpose of this study is to present the key findings on the effects of small salt-water fraction component, $ expressed in volume % per L on rotation are presented in the temperature range of 19.0 to 24.0ºC. It was found that rotations in oils with low boiling point known as light oils like Final diesel No. 2 were greater than the rotations which occurred in oils with high boiling point called heavy oils such as Esso diesel. Small oil fraction components, ( s expressed in mL/L of salt water down to 10 ppm were detected. The greatest impact on rotation of these oils was found in light oils like Fina No. 2 diesel. At 40 ppm which is the oil content level below which the environment authority considers process water to be free from oil environmental hazards, the observed rotation angles were 23.2º for Esso, 36.7º for Nors Hydro AS, and 71.8º in Fina No. 2 diesel. It was observed that light oils molecules have drastic effect on optical properties of the mixture in which they exist. It was found that for all oils, oil fractions greater than 100 ppm, caused the medium to be optically dense. This technology has shown a very high potential of being used as an environmental monitor to detect oil fractions down to 10 ppm and the technique can use laser beam to control re-injected process water with oil fractions between 100-2000 ppm

Les mécanismes moléculaires du Facteur Trefoil 2 dans le métabolisme énergétique et le développement de l'obésité

L’obésité est une maladie multifactorielle. La prise alimentaire, le mode de vie et la génétique sont les trois facteurs principaux contribuant à son développement. Tff2 est un petit peptide intestinal ayant pour fonction principale, la protection et la maintenance de la muqueuse. Les souris transgéniques déficientes (KO) du gène Trefoil Factor 2 (Tff2) sont viables, fertiles et protégées contre l’obésité induite par l’alimentation riche en gras (HIO) ; leurs comportements alimentaires diffèrent de ceux des souris du type sauvage (WT). Le but de cette étude est d’élucider les mécanismes moléculaires par lesquels le gène Tff2 contribue au développement de l’obésité. Pour ce faire, on a identifié les principaux régulateurs de transcription des gènes sensibles à l’alimentation riche en gras (HF) et de ceux sensibles à l’alimentation faible en gras (LF) dans l’intestin grêle. Ensuite, les souries Tff2 KO et les souries WT ont été nourries avec HF et LF à volonté, leur développement a été suivi. Les organes qui participent dans le métabolisme énergétique tels que le foie, le tissu adipeux et le muscle squelettique ont été prélevés pour y mesurer l’expression des gènes et des protéines impliqués dans ce processus. Les protéines et les gènes tels que CD36/Cd36, NUR77/Nur77 et GLUT4/Glut4 ont été plus fortement exprimés dans les souris Tff2KO que dans les souris WT, tandis qu’aucune différence significative n’a été observée dans les protéines mitochondriales. Nos résultats ont révélé en partie, les voies moléculaires et métaboliques qui mettent en évidence le lien de Tff2 avec les protéines impliquées dans le métabolisme énergétique. Il serait recommandable de mener la même étude sur les tissus humains afin de souligner le rôle de Tff2 dans le développement de l’obésité et le prendre pour la nouvelle cible thérapeutique pour le traitement de l’obésité.Obesity is a multifactorial disease. Food intake, lifestyle and genetics are the three factors that contribute to its development. Tff2 is a small gut peptide playing protective and maintenance functions. Trefoil factor 2 knockout mice (Tff2KO) are viable, fertile and protected from high fat induced obesity (HIO) and their feeding behaviors are different from those of wild type (WT) ones. The purpose of this study is to elucidate the molecular mechanisms by which Tff2 contributes to the development of obesity. To do this, the principal transcriptional regulators for high fat and low fat responsive genes were identified in the small intestine; then Tff2 KO and WT mice were fed ad libitum with high-fat diet (HF) and low-fat diet (LF), their development has been supervised. Thereafter, energy metabolizing organs such as liver, adipose tissue and skeletal muscle have been harvested in order to measure the expression of genes and proteins involved in energy metabolism. Proteins and genes such as CD36/Cd36, NUR77/Nur77, and GLUT4/Glut4 were more expressed in Tff2KO mice than in WT mice, whereas no significant differences were observed in mitochondrial proteins. Our results showed a part of molecular and metabolic pathways that connect Tff2 and energy metabolizing proteins, we hope that Tff2 will be studied in human tissues to emphasize its role in the development of obesity and use it as a new therapeutic target for the treatment of obesity

Nutritional value of selected wild edible plants in Teso-Karamoja Region, Uganda

The use of wild plants for food in the rural communities of Uganda is widespread. This is attributed to food scarcity, perceived nutritional value,  medicinal and health benefits and cultural preservation. However, the claims on the nutritional value of some wild edible plant species have not  been fully validated. In cognizance of this, the macroelement, beta-carotene and ascorbic acid profile of five wild plants commonly used for food in and around eight forest reserves of Teso-Karamoja region, Uganda, were analysed. The plants prioritized for analysis were Vigna kirkii (Baker) J.B. Gillett, Maerua angolensis D.C., Leptadenia hastata (Schumach. & Thonn.) Decne, Senna obtusifolia (L.) H.S. Irwin & Barneby and Dioscorea sp.). The  macro-element, ascorbic acid and beta-carotene composition of these plants was analyzed in triplicate. The variance in parameter means was  analysed using one-way Analysis of Variance in SPSS ver. 16.0. The results showed that all the means of species were significantly different at the p=0.05 level. The highest macro-nutrient means were 80.74±0.34 %/100 g moisture content in V. kirkii, 3.95±0.23 g/100 g ash content in M.  angolensis, 19.04±0.37 Kcal gross energy in M. angolensis, 27.93±0.85 g/100 g dietary fibre in L. hastata, 3.40±0.13 g/100 g crude fat in L. hastata, 65.43±2.91 g/100 g carbohydrate in Dioscorea sp., 36.37±0.42 g/100 g crude protein in M. angolensis. The highest ascorbic acid mean was 14.71±3.56 mg/100 g in M. angolensis while beta-carotene was 1082.1±0.08 μg/100 g in S. obtusifolia. These results show that these wild edible plants have a significantly variable nutritional value. Some of the macro elements can sufficiently meet the Recommended Daily Allowance (RDA) and Adequate Intakes (AI) for certain life stages and groups if consumed in ideal quantities. This information is vital in enhancing food and nutrition security awareness in the community and uplifting the social appeal and acceptability of these plants. This can be enhanced by investigating the micro-nutrients of public health significance, anti-nutrient factors, and toxic compounds in these plants. Key words: Nutritional value, wild edible plants, macro-nutrient, ascorbic acid, betacarotene,Teso-Karamoja, Ugand

Massive structural and compositional changes over two decades in forest fragments near Kampala, Uganda

Private forests harbor considerable biodiversity, however, they are under greater threat than reserved areas, particularly from urbanization, agriculture, and intense exploitation for timber and fuel wood. The extent to which they may act as habitats for biodiversity and how level of protection impacts trends in biodiversity and forest structure over time remain underresearched. We contribute to filling this research gap by resampling a unique data set, a detailed survey from 1990 of 22 forests fragments of different ownership status and level of protection near Kampala, Uganda. Eleven of the 22 fragments were lost over 20 years, and six of the remnants reduced in size. Forest structure and composition also showed dramatic changes, with six of the remnant fragments showing high temporal species turnover. Species richness increased in four of the remaining forests over the resample period. Forest ownership affected the fate of the forests, with higher loss in privately owned forests. Our study demonstrates that ownership affects the fate of forest fragments, with private forests having both higher rates of area loss, and of structural and compositional change within the remaining fragments. Still, the private forests contribute to the total forest area, and they harbor biodiversity including IUCN “vulnerable” and “endangered” species. This indicates the conservation value of the fragments and suggests that they should be taken into account in forest conservation and restoration.publishedVersio

An Investigation of the Relationship between Resistance and Thickness of Deposited Nickel Thin Film Resistors

Abstract: The main purpose of this study is finding the relationship between resistance and thickness of deposited Nickel Thin Film Resistors. It was found that the Sheet Resistance, R s , is inversely proportional to the thickness of the film on the substrate. It was also observed that when the film thickness is greater than 50 nm, films behave like ordinary resistors. In other words in bulk, films obey Ohm's law if other physical quantities remain constant

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study.

BackgroundChronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition.MethodsWe ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m2 or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD.ResultsThe estimated CKD prevalence was 6.8% (95% CI 5.7-8.1%) overall and varied by region, being 12.5% (10.1-15.4%) in eastern Uganda, 3.9% (2.2-6.8%) in southwestern Uganda and 3.7% (2.7-5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9-6.5] compared with age 18-29 years), HIV infection (aPR 1.6 [1.1-2.2]), and residence in eastern Uganda (aPR 3.9 [2.6-5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.ConclusionThe prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa

The age-specific burden and household and school-based predictors of child and adolescent tuberculosis infection in rural Uganda.

BackgroundThe age-specific epidemiology of child and adolescent tuberculosis (TB) is poorly understood, especially in rural areas of East Africa. We sought to characterize the age-specific prevalence and predictors of TB infection among children and adolescents living in rural Uganda, and to explore the contribution of household TB exposure on TB infection.MethodsFrom 2015-2016 we placed and read 3,121 tuberculin skin tests (TST) in children (5-11 years old) and adolescents (12-19 years old) participating in a nested household survey in 9 rural Eastern Ugandan communities. TB infection was defined as a positive TST (induration ≥10mm or ≥5mm if living with HIV). Age-specific prevalence was estimated using inverse probability weighting to adjust for incomplete measurement. Generalized estimating equations were used to assess the association between TB infection and multi-level predictors.ResultsThe adjusted prevalence of TB infection was 8.5% (95%CI: 6.9-10.4) in children and 16.7% (95% CI:14.0-19.7) in adolescents. Nine percent of children and adolescents with a prevalent TB infection had a household TB contact. Among children, having a household TB contact was strongly associated with TB infection (aOR 5.5, 95% CI: 1.7-16.9), but the strength of this association declined among adolescents and did not meet significance (aOR 2.3, 95% CI: 0.8-7.0). The population attributable faction of TB infection due to a household TB contact was 8% for children and 4% among adolescents. Mobile children and adolescents who travel outside of their community for school had a 1.7 (95% CI 1.0-2.9) fold higher odds of TB infection than those who attended school in the community.ConclusionChildren and adolescents in this area of rural eastern Uganda suffer a significant burden of TB. The majority of TB infections are not explained by a known household TB contact. Our findings underscore the need for community-based TB prevention interventions, especially among mobile youth

Factors predictive of successful retention in care among HIV-infected men in a universal test-and-treat setting in Uganda and Kenya: A mixed methods analysis.

BackgroundPrevious research indicates clinical outcomes among HIV-infected men in sub-Saharan Africa are sub-optimal. The SEARCH test and treat trial (NCT01864603) intervention included antiretroviral care delivery designed to address known barriers to HIV-care among men by decreasing clinic visit frequency and providing flexible, patient-centered care with retention support. We sought to understand facilitators and barriers to retention in care in this universal treatment setting through quantitative and qualitative data analysis.MethodsWe used a convergent mixed methods study design to evaluate retention in HIV care among adults (age > = 15) during the first year of the SEARCH (NCT01864603) test and treat trial. Cox proportional hazards regression was used to evaluate predictors of retention in care. Longitudinal qualitative data from n = 190 in-depth interviews with HIV-positive individuals and health care providers were analyzed to identify facilitators and barriers to HIV care engagement.ResultsThere were 1,863 men and 3,820 women who linked to care following baseline testing. Retention in care was 89.7% (95% CI 87.0-91.8%) among men and 89.0% (86.8-90.9%) among women at one year. In both men and women older age was associated with higher rates of retention in care at one year. Additionally, among men higher CD4+ at ART initiation and decreased time between testing and ART initiation was associated with higher rates of retention. Maintaining physical health, a patient-centered treatment environment, supportive partnerships, few negative consequences to disclosure, and the ability to seek care in facilities outside of their community of residence were found to promote retention in care.ConclusionsFeatures of the ART delivery system in the SEARCH intervention and social and structural advantages emerged as facilitators to retention in HIV care among men. Messaging around the health benefits of early ART start, decreasing logistical barriers to HIV care, support of flexible treatment environments, and accelerated linkage to care, are important to men's success in ART treatment programs. Men already benefit from increased social support following disclosure of their HIV-status. Future efforts to shift gender norms towards greater equity are a potential strategy to support high levels of engagement in care for both men and women

HIV Incidence After Pre-Exposure Prophylaxis Initiation Among Women and Men at Elevated HIV Risk: A Population-Based Study in Rural Kenya and Uganda

Author summary Why was this study done? Despite major gains in HIV testing and treatment, there were 1.7 million new HIV infections worldwide in 2019, of which nearly 60% occurred in sub-Saharan Africa. Daily oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is highly effective for HIV prevention and could substantially reduce new HIV infections if offered alongside access to HIV testing and treatment. Little is known about the incidence of new HIV infections among PrEP users in settings with generalized HIV epidemics, particularly when offered broadly across communities where access to HIV testing and treatment have already been scaled up. What did the researchers do and find? In 16 communities in rural Kenya and Uganda, we conducted community-wide HIV testing and offered universal access to PrEP with an inclusive approach to eligibility (for persons in serodifferent partnerships, those identified by an HIV risk prediction tool, or those who self-identified as being at risk of HIV). We offered rapid PrEP start and a flexible care delivery model with follow-up visits at health facilities or community-based sites for HIV testing and PrEP refills. Of 74,541 persons who tested negative for HIV, 15,632 (21%) were assessed to be at elevated HIV risk, of whom 5,447 (35%) started PrEP. Overall, 79% of persons who initiated PrEP engaged in the program for follow-up visits. Among PrEP initiators in the 16 study communities, there were 25 seroconversions over 7,150 person-years of follow-up. HIV incidence was 0.35 per 100 person-years (95% confidence interval [CI] 0.22-0.49). In 8 communities, we compared HIV incidence among PrEP initiators to persons with similar characteristics (matched controls) from the year before PrEP was available. Compared to matched controls, HIV incidence was 74% lower among PrEP initiators overall; 76% lower among women who initiated PrEP; and 40% lower among men who initiated PrEP, although this result among men did not reach statistical significance. What do these findings mean? Providing universal access to PrEP in the context of community-wide HIV testing in rural Kenya and Uganda was associated with lower HIV incidence among persons who initiated PrEP compared to matched recent controls. We found lower HIV incidence after PrEP initiation among women, for whom rates of new HIV infections are higher than in men, including in recent prevention studies without PrEP. These results suggest that PrEP may help to close the gap in new infections between men and women. Universal access to HIV testing, treatment, and prevention, including rapid provision of PrEP with flexible service delivery, could reduce HIV incidence in generalized epidemic settings. Background Oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but data are limited on HIV incidence among PrEP users in generalized epidemic settings, particularly outside of selected risk groups. We performed a population-based PrEP study in rural Kenya and Uganda and sought to evaluate both changes in HIV incidence and clinical and virologic outcomes following seroconversion on PrEP. Methods and findings During population-level HIV testing of individuals \u3e= 15 years in 16 communities in the Sustainable East Africa Research in Community Health (SEARCH) study (NCT01864603), we offered universal access to PrEP with enhanced counseling for persons at elevated HIV risk (based on serodifferent partnership, machine learning-based risk score, or self-identified HIV risk). We offered rapid or same-day PrEP initiation and flexible service delivery with follow-up visits at facilities or community-based sites at 4, 12, and every 12 weeks up to week 144. Among participants with incident HIV infection after PrEP initiation, we offered same-day antiretroviral therapy (ART) initiation and analyzed HIV RNA, tenofovir hair concentrations, drug resistance, and viral suppression (\u3c1,000 c/ml based on available assays) after ART start. Using Poisson regression with cluster-robust standard errors, we compared HIV incidence among PrEP initiators to incidence among propensity score-matched recent historical controls (from the year before PrEP availability) in 8 of the 16 communities, adjusted for risk group. Among 74,541 individuals who tested negative for HIV, 15,632/74,541 (21%) were assessed to be at elevated HIV risk; 5,447/15,632 (35%) initiated PrEP (49% female; 29% 15-24 years; 19% in serodifferent partnerships), of whom 79% engaged in \u3e= 1 follow-up visit and 61% self-reported PrEP adherence at \u3e= 1 visit. Over 7,150 person-years of follow-up, HIV incidence was 0.35 per 100 person-years (95% confidence interval [CI] 0.22-0.49) among PrEP initiators. Among matched controls, HIV incidence was 0.92 per 100 person-years (95% CI 0.49-1.41), corresponding to 74% lower incidence among PrEP initiators compared to matched controls (adjusted incidence rate ratio [aIRR] 0.26, 95% CI 0.09-0.75; p = 0.013). Among women, HIV incidence was 76% lower among PrEP initiators versus matched controls (aIRR 0.24, 95% CI 0.07-0.79; p = 0.019); among men, HIV incidence was 40% lower, but not significantly so (aIRR 0.60, 95% CI 0.12-3.05; p = 0.54). Of 25 participants with incident HIV infection (68% women), 7/25 (28%) reported taking PrEP \u3c= 30 days before HIV diagnosis, and 24/25 (96%) started ART. Of those with repeat HIV RNA after ART start, 18/19 (95%) had \u3c1,000 c/ml. One participant with viral non-suppression was found to have transmitted viral resistance, as well as emtricitabine resistance possibly related to PrEP use. Limitations include the lack of contemporaneous controls to assess HIV incidence without PrEP and that plasma samples were not archived to assess for baseline acute infection. Conclusions Population-level offer of PrEP with rapid start and flexible service delivery was associated with 74% lower HIV incidence among PrEP initiators compared to matched recent controls prior to PrEP availability. HIV infections were significantly lower among women who started PrEP. Universal HIV testing with linkage to treatment and prevention, including PrEP, is a promising approach to accelerate reductions in new infections in generalized epidemic settings