Land use change, landslide occurrence and livelihood strategies on Mount Elgon Slopes, Eastern Uganda

An investigation of the relationship between the physical, pedological and anthropogenic influences on landslide occurrence on the midslopes within and outside Mt Elgon National Park was carried out. One of the landslides occurred in a protected pristine forest environment within the Park while the other two were located at sites deforested for cultivation within and outside the National Park. Field based surveys, GIS techniques and laboratory tests were used to collect and analyze the data. A household survey was undertaken to establish the main community livelihood strategies, the drivers of land use change and implications for land degradation on the mid slopes of Mt Elgon. Aerial photographs taken in 1960 and orthophoto maps formed the benchmark for the analysis of the respective land use changes between 1995 and 2006, using 30m Landsat TM and 20m SPOT MS images in IDRISI Andes GIS environment. Landslide sites were mapped using a Magellan Professional MobileMapperTMCX and terrain parameters were derived using a 15M Digital Elevation Model. A hybrid supervised/unsupervised classification approach was employed to generate land cover maps from which the areal extent of three land cover classes (agricultural fields, woodlands and forests) was calculated. Particle size distribution and atterberg limits were used to test the hypothesis that soils at the landslide sites are inherently ‘problem soils’ where slope failure can occur even without human intervention. Shear strength parameters (internal of friction and cohesion) were used calculate the slope factor of safety to ascertain slope stability at pristine and disturbed landslide sites. Results from the socio-economic survey revealed that smallholder subsistence agriculture and encroachment on the National Park resources are the main sources of livelihoods for the communities surrounding the Park. The communities also have a strong socio-cultural attachment to the National Park, as it is the source of items used during traditional rituals like circumcision. Encroachment is driven by the high population pressure and the prevalent political climate. Farmers mainly use slash and burn technique to prepare land for cultivation and those close to the National Park are reluctant to adopt appropriate farming and soil conservation practices due to the uncertainties surrounding their future on such plots. Slash and burn iii techniques were observed to accelerate various forms of erosion including rills, gullies and sheet. Soil and water conservation techniques were mainly practiced on privately owned farms. The period 1960 and 1995 was characterized by minimal land use changes and no encroachment into the designated Mount Elgon National Park. Conversely, the period 1995 – 2006 marked a significant loss of woodlands and forest cover particularly on steep concave slopes (36º – 58º) within the National Park. The land use change trends were attributed to the prevalent land politics and exponential population growth in the region. The encroachment onto the critical slopes was noted to have induced a series of shallow and deep landslides in the area. Deforestation on Mt Elgon was reported to have both onsite and offsite climate variability and implications in the form of drought, heat waves, flash floods, economic dislocation, crop failure and associated malnutrition in surrounding low lying areas. The soils on pristine and disturbed slopes contain high amount of clay (>10 percent), are fine textured (>50 percent of the material passing the 0.075mm sieve) and highly plastic. These soil attributes imply low permeability, excessive water retention and high susceptibility to expansion and sliding. The vertic nature of soils at Nametsi was confirmed by the extremely high plasticity indices (averaging 33percent), while, high liquid limits at Buwabwala (53 percent) and Kitati (59 percent) qualified the soils as vertisols which are associated with landslides. The results point to the fact that soils at landslide sites are inherently ‘problem soils’ where slope failure can occur even without human intervention. Therefore, the hypothesis that soils at three landslide sites are inherently ‘problem soils’ where slope failure can occur even without human intervention is accepted. Notwithstanding the fact that the study was focussed on mid-altitude slopes of Mt Elgon, the results are in tandem with investigations carried out earlier on the lower densely populated slopes, thus confirming the widespread nature of problem soils on Mt Elgon. There is an urgent need to control human population growth and restore forest cover on the heavily deforested steep slopes particularly within the National Park, and restrain communities from encroaching on the pristine slopes of Mt Elgon. This will be achieved if the politicians, Park Authorities and local communities jointly participate in the design and implementation of CFMs. Future research could focus on climate change implications of deforestation of Mt Elgon environments and quantification of carbon loss related to deforestation and soil degradation in the mountain environments

Households experiencing catastrophic costs due to tuberculosis in Uganda : magnitude and cost drivers

Funding: This survey was funded by CDC (grant number 3U2GGH001180-03S1) toWHO, a USAID Uganda WHO Grant (PIO grant AID-617-10-17-00001) and alsofunding from Doctors with Africa, CUAMM.Background: Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. Methods: A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. Results: Of the 1178 respondents, 62.7% were male, 44.7% were aged 15-34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. Conclusion: Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.Publisher PDFPeer reviewe

A global perspective on soil science education at third educational level; knowledge, practice, skills and challenges

The pivotal role of soil as a resource is not fully appreciated by the general public. Improving education in soil science represents a challenge in a world where soil resources are under serious threat. Today’s high school students, the world’s future landowners, agriculturalists, and decision makers, have the potential to change society’s apathy towards soils issues. This research aimed to compare the level of soil education in high and/or secondary schools in forty-three countries worldwide, together comprising 62% of the world's population. Comparisons were made between soil science content discussed in educationally appropriate textbooks via a newly proposed soil information coefficient (SIC). Interviews with teachers were undertaken to better understand how soil science education is implemented in the classroom. Statistical analyses were investigated using clustering. Results showed that gaps in soil science education were most commonly observed in countries where soil science is a non-compulsory or optional subject. Soil science concepts are predominantly a part of geography or environmental science curricula. Consequently, considerable variability in soil science education systems among investigated countries exists. Soil information coefficient‘s outcomes demonstrated that a methodological approach combining textbooks and the use of modern digitally based strategies in the educational process significantly improved soil education performances. Overall, soil science education is under-represented in schools worldwide. Dynamic new approaches are needed to improve pivotal issues such as: i) promoting collaborations and agreements between high school and universities; ii) encouraging workshops and practical exercises such as field activities; and, iii) implementing technology tools. This, in turn, will prepare the next generation to contribute meaningfully towards solving present and future soil problems

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Summary Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Tobacco smoking clusters in households affected by tuberculosis in an individual participant data meta-analysis of national tuberculosis prevalence surveys: Time for household-wide interventions?

Tuberculosis (TB) and non-communicable diseases (NCD) share predisposing risk factors. TB-associated NCD might cluster within households affected with TB requiring shared prevention and care strategies. We conducted an individual participant data meta-analysis of national TB prevalence surveys to determine whether NCD cluster in members of households with TB. We identified eligible surveys that reported at least one NCD or NCD risk factor through the archive maintained by the World Health Organization and searching in Medline and Embase from 1 January 2000 to 10 August 2021, which was updated on 23 March 2023. We compared the prevalence of NCD and their risk factors between people who do not have TB living in households with at least one person with TB (members of households with TB), and members of households without TB. We included 16 surveys (n = 740,815) from Asia and Africa. In a multivariable model adjusted for age and gender, the odds of smoking was higher among members of households with TB (adjusted odds ratio (aOR) 1.23; 95% CI: 1.11–1.38), compared with members of households without TB. The analysis did not find a significant difference in the prevalence of alcohol drinking, diabetes, hypertension, or BMI between members of households with and without TB. Studies evaluating household-wide interventions for smoking to reduce its dual impact on TB and NCD may be warranted. Systematically screening for NCD using objective diagnostic methods is needed to understand the actual burden of NCD and inform comprehensive interventions

The Public –Private Sector Approach to Municipal Solid Waste Management : How does it Work in Makindye Division, Kampala District, Uganda?

It has been argued that the partnering of public and private sectors lead to improvement and betterment in the delivery of municipal social services. The purpose of this study was therefore to find out if, how and why the involvement of the private sector has led to better municipal solid waste management in Kampala’s Makindye Division. I try to analyze the roles and relationships between the public and private actors, the constraints hampering success and finally suggest mechanisms of bettering the partnership. A qualitative approach involving interviews, Focus Group Discussions, observations and photography was used to gather the necessary primary data, while reference to relevant literature provided me with the much needed secondary data. Key informants from the public sector included officials from Kampala City Council, Makindye Division and The National Environment Management Authority; while those from the formal private sector included the Director and field staff of HOMEKLIN Limited and DOT services Limited. The scavengers at the Kiteezi landfill were my informal private respondents. The Director of Urban Community in Development Association (a local Community Based Organization), the Local Council II Chairpersons together with some of the local community members of Katwe I and Luwafu parishes represented the civil society. The study was based on the Actor-Oriented Approach theory as well as on governance perspectives. The study reveals that despite the lack of measures that ensure reduction, reuse and recycling of solid wastes by the respective actors, an improvement in the management of domestic solid wastes in Makindye Division has resulted from the partnership. Metal recycling and organic waste compositing is privately undertaken by a local Community Based Organization which is not in any way supported by the Division authority. The introduction of waste transfer points and smaller vehicles supplemented by the use of wheelbarrows has increased access to areas that were previously unreachable. Also the adherence to the collection schedule by HOMEKLIN Limited has greatly contributed to an efficient collection of waste from the medium to high income communities of Luwafu parish where there are numerous paying subscribers. However, the low commitment of Makindye Administration in ensuring that it meets its financial obligations of subsidizing waste collection in the low income areas, corruption and patronage of some Division Officials are hindering the success of the programme. This is particularly common in the low income areas of Katwe I parish. The study further reveals that despite being perceived as an ethnic and low caste activity, waste scavenging plays a very crucial role of recovering and reusing materials and ultimately reduce the amount of waste that is finally disposed of. However, the existing legislation does not recognize scavengers as important actors. Much as it deals with a mixture of hazardous and non hazardous waste, the waste disposal operations of DOT Services Limited are meeting acceptable environmental standards. However, the absence of effluent gas monitoring and tapping equipment at the landfill is posing a potential environmental hazard. The study makes a number of recommendations ranging from administrative overhauls at Makindye Division, waste management policy amendments in regard to reduction, recycling and reuse of materials together with the recognition of informal private waste collectors and scavengers, technical improvements by the private waste collectors and finally economic investments by the Division as a way of reducing dependence on central government remittances

The centrality of water resources to the realization of Sustainable Development Goals (SDG). A review of potentials and constraints on the African continent

Africa is endowed with vast water resources including but not limited to lakes, rivers, swamps and underground aquifers. However, the way of life in Africa does not reflect this kind of wealth owing majorly to degradation and underutilization of these water resources. This review discusses the centrality of water resources in Africa's pursuit of the Sustainable Development Goals (SDGs). Following the Sustainable Development Model, the paper thematically examines and synthesizes the importance and potentials of water resources to Africa's development through exploring their contributions and limitations to the various economic sectors namely; agricultural and livestock production, energy, manufacturing and processing, tourism, health, fisheries, trade and other institutional mechanisms such as payment for ecosystem services (PES), mutual cooperation and economic cooperation. Data were collected by review of online peer-reviewed and grey literature published between the year 2000 and 2015. It is observed that sustainable management of water and sanitation for all (SDG 6) will be central to the attainment of all the other SDGs (particularly SDG 1 (No poverty), 2 (No hunger), 3 (Good health), 14 (life below water) and 15 (life on land)) across Africa. African states should therefore increase their commitment to water conservation and management as this will significantly decide Africa's future development paths