Biliary Atresia – An Easily Missed Cause of Jaundice amongst Children in Uganda

Back ground: Biliary atresia is characterized by biliary obstruction, it has an incidence of 1:15000 and presents with jaundice, acholic stools / dark urine and hepatomegaly. This disease rapidly leads to liver cirrhosis and liver failure if untreated surgically. The main objective was to establish the epidemiology of patients presenting with biliary atresia and immediate surgical outcome. Methods: A review of a prospective data base for pediatric surgical admissions from January 2012 to December 2015 was made and examined all the entries for children admitted with biliary atresia. Results: In this study 46 patients were recruited with an age range at admission of 2 weeks to 3.5 years and a peak age of 2 months. During the four years, 14 Patients had portoenterostomy done and of these 5 died within 7 days after surgery. Thirty two (32) patients were not operated, 18 of them died and 13 were still alive by the close of 2015. Conclusion: A big number of children with biliary atresia presented late with decompensated liver functions having lost time in peripheral health facilities being managed for medical jaundice.Key words: Biliary atresia, Uganda, Jaundic

Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda.

The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention ("Make The Cut") among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised "coaches" who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches' circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Bioproductivity and Decomposition of Waterhyacinth in Uganda

The biological invasion of the waterhyacinth (Eichhornia crassipes (Mart.) Solms) into lakes and rivers of East Africa forced the implementation of mechanical harvesting around key harbours and dams, resulting in subsequent difficulties of waste disposal. Utilising these wastes assists in minising the costs of waste management. Estimates of waterhyacinth biomass were made by randomly deploying 1 m2 buoyant sampling frames across four sites on the Ugandan shores of Lake Victoria and determining the weight within the frame. Single plants ranging from 0.3 - 0.9 kg were placed within similar buoyant frames and their productivity monitored over a period of 16 weeks in a sheltered bay at Bugiri and a pond at Kajjansi. Nutrient contents and mineralisation patterns of harvested waterhyacinth wastes were characterised. Whole chopped plants and tissues were separated into leaves, petioles and roots, placed into litter bags, deployed as surface mulch and recovered over 16 weeks. Fresh biomass at the four sites was between 300 to 610 t ha-1. Productivity ranged from 58 to 228 t ha-1 yr-1 resulting from rapid production of daughter plants (108 to 237 plants m-2 yr-1). Decomposition of the waterhyacinth was rapid but with significant differences between plant tissues. Time to 50% decomposition of whole plants, leaves and roots was 21, 31 and 45 days, respectively. Waterhyacinth applied as surface mulch to fields may offer opportunity as an organic input to soils because of the relatively rich nutrient contents and rapid decay pattern but the large bulk of fresh plants (92% water) may offset these advantages.L\u2019invasion de l\u2019eau par la jacinthe (Eichhornia crassipes (Mart.) Solms) dans les lacs et rivi\ue8res de l\u2019Afrique de l\u2019Est a forc\ue9 l\u2019application des recoltes m\ue9caniques au tour d\u2019entr\ue9es importantes et de digues r\ue9sultant aux difficult\ue9s cons\ue9quentes des ordures. L\u2019utilisation de ces ordures aide \ue0 differer les co\ue9ts de contr\uf4le. Les estimations de la biomasse vivante ont \ue9t\ue9 faite al\ue9atoirement par des cadres flottables d\u20191m2 d\u2019\ue9chantillonnage dans 4 sites sur les rives du lac Victoria en Uganda et le poids des mauvaises herbes a \ue9t\ue9 d\ue9termin\ue9 \ue0 l\u2019interieur du cadre. Des plantes individuelles d\u2019environ 0.3-0.9 kg ont \ue9t\ue9 plac\ue9es \ue0 l\u2019int\ue9rieur de cadres semblables flottables et leur productivit\ue9 suivie pour une p\ue9riode de plus de 16 semaines sous l\u2019abri de baie \ue0 Bugiri et dans un \ueatang artificiel \ue0 Kajjansi. Le contenu nutritif et la tendance de min\ue9ralisation des d\ue9chets de la jacinthe recolt\ue9c ont \ue9t\ue9 caracteris\ue9s, toutes les plantes d\ue9coup\ue9es et tissus ont \ue9t\ue9 s\ue9par\ue9s en feuilles, p\ue9tioles et racines; plac\ue9es dans des sacs de d\ue9tritus \ue0 la surface comme fumier et r\ue9cuper\ue9 apr\ue8s 16 semaines. La biomasse fr\ue8che dans les 4 sites a \ue9t\ue9 estim\ue9e \ueatre de l\u2019ordre de 390 - 610 t ha-1. La productivit\ue9 variait de 58 - 228 t ha-1 yr-1 venant de la reproduction de 108 - 237 plantes ha-1 yr-1. Ces donn\ue9es sugg\ue8rent que la performance \ue9tait associe\ue9e aux differentes qualit\ue9s de syst\ue8mes aquatiques. La d\ue9composition de la jacinthe \ue9tait rapide mais avec de differences significatives entre les tissus des plantes. Le temps de d\ue9composition de 50% de toutes les plantes, feuilles et racines \ue9tait de21, 31 et 45 jours respectivement. La jacinthe utilis\ue9e comme paille de couverture en champs est avantageuse comme une resource organique aux sols \ue0 cause du contenu nutritif relativement riche et de sa d\ue9composition rapide

Bioproductivity and decomposition of waterhyacinth in Uganda

(African Crop Science Journal 1999 7(4): 433-440

Exploring gender and partner communication: Theory of Planned Behavior predictors for condom use among young, urban adults in Zambia

Objective: To understand how knowledge and perceptions of condoms and partner communication influence use of condoms in a high HIV prevalence setting and gender‐specific differences. Methods: A cross‐sectional study was conducted in Zambia from 2015 to 2016. The survey included questions on demographics, sexual behavior contraceptive perceptions, and behaviors. We constructed multivariate regression models using the Theory of Planned Behavior to determine associations between knowledge, perceptions, and perceived control with intended, communicated, and reported use of condoms by gender. Results: The participants were 2388 sexually active urban residents aged 18–24 years. In the sample, 1646 (69%) were female, 841 (35%) married, and 1894 (61%) unemployed. Partner communication was the predictor most associated with use of condoms. Among women, partner communication was associated with over three times higher odds of condom use (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65–4.65) but being married reduced the odds of condom use by 76% (OR 0.24, 95% CI 0.17–0.33). For men, a network of friends that was supportive of the use of contraception was associated with increased odds of 55% for use of condoms (OR 1.55, 95% CI 1.10–2.18). Conclusion: Public health programs aimed at increasing safer sexual behavior and use of condoms must consider improving gender equity and partner communication as knowledge of contraceptives and positive perceptions are not enough to ensure their use