CHALLENGES TO IMPLEMENTATION OF NON-PHARMACOLOGICAL STRATEGIES IN MANAGEMENT OF PAIN IN LABOR: A STUDY AMONG MIDWIVES IN LUBAGA HOSPITAL, KAMPALA DISTRICT. A CROSS- SECTIONAL STUDY.

Background: The study investigated the challenges to the implementation of non-pharmacological strategies in the management of pain in labor among midwives in Lubaga Hospital Kampala District. The focus of the research was on midwives, health facilities, and maternal-related challenges. Methodology: The study employed a descriptive cross-sectional study design where a purposive sampling procedure technique was used to obtain a sample of 30 respondents. Data was collected with the use of a questionnaire. Data collected was analyzed quantitatively using Microsoft Excel (2013) and results were presented in the form of tables, figures, and pie charts. Results: The majority, 17(60%) of the midwives expressed no need for reducing such pain and therefore, this is a midwife-related challenge to the use of NPLPM. Few of the respondents, 14(46.7%) revealed that uncooperative staff is a health facility-related challenge, while 19(63.3%) reported that, inadequate staff against the high number of mothers in labor is a health facility challenge, 20(67%) reported lack of special training of staff as a health facility related challenge.  Majority, 27(90%) reported that socio-economic status is a maternal-related challenge to the implementation of NPLPM. Conclusion: Midwives’ believe that there is no need to reduce such pain hence being the greatest midwife challenge. Lack of special training of staff in non-pharmacological pain management is the greatest health facility-related challenge while low socio-economic status is the greatest maternal-related challenge to implementation of NPLPM. Recommendation: CMEs should be done to acquit midwives with the knowledge on the use of NPLPM. Health facilities to employ enough midwives who will be able to work on the number of women in labor to ensure the proper use of NPLPM. Furthermore, midwives should embark on using affordable non-pharmacological strategies in the management of pain women go through during labor hence solving the maternal-related factors affecting the implementation of NPLPM

Yield and Response of Bean Breeding Lines for Drought Tolerance to Field Diseases

Climate change has resulted in an increase in the intensity of droughts and rains, and higher temperatures which are adversely affecting crop production in Africa. It has also influenced the distribution and increased the occurrence of disease and pest epidemics. Common bean (Phaseolus vulgaris L.) is especially sensitive to these changes. Most released varieties are not well adapted to environmental extremes and extended periods of drought in particular has become a major constraint. In this study, 462 advanced breeding lines developed for drought tolerance were evaluated for yield, agronomic traits and disease response in two contrasting agro-ecologies, Kawanda in the Lake Victoria crescent and Kachwekano in the southwestern highlands. Analysis of variance indicated significant differences (P 1500 kg ha-1, the minimum anticipated commercial yield of new varieties, in all the trials, both seasons and in each year; 5.0 % also maintained above average yields. The most outstanding (1629-3944 kg ha-1) were; DAB299, DAB291, DAB234, DAD34, DAB478, DAB487, DAB543, DAB231, SCN20, SCR66, SCR60, and SER335. These are recommended for development of new varieties

Resistance of andean beans and advanced breeding lines to root rots in Uganda

Root rots cause severe yield losses of up to >70% in common bean ( Phaseolus vulgaris L.) in most parts of the world, with devastating effects on the major commercial bean cultivars in East and Central Africa. Increased intensity of droughts and rains, and higher temperatures influence the occurrence and distribution of root rots, resulting in increased epidemics. The causal pathogens tend to occur in a complex, and since most cultivars do not have broad resistance, adverse effects continue to occur. The objective of this study was to evaluate the levels of dual resistance of new breeding lines (BL) developed for root rot resistance, as well as Andean (ADP) genotypes, for resistance to Fusarium (FRR) and Pythium root rots (PRR). Altogether, 316 new BL developed for root rot resistance and 295 ADP bean genotypes were evaluated at Kawanda in Uganda. There were significant differences (P<0.05) among genotypes for both root rots and yield. Thirty and 1.9 percent of the BL and ADP genotypes expressed resistance to both root rots. In addition, more than 80% of ADP genotypes showed susceptibility to both root rots. Yield was generally poor with means of 458 kg ha-1 for ADP, and ranging from 949 to 1075 kg ha-1 for the BL groups. Nonetheless, the 0.3 and 2.4% of the ADP and BL that yielded >2000 kg ha-1 expressed high yield potential, considering that majority of the genotypes yielded below 1000 kg ha-1.Les pourritures des raciness de haricot ( Phaseolus vulgaris L.) causent plus 70% de pertes de rendement allant dans la plupart des r\ue9gions du monde, avec des effets d\ue9vastateurs sur les principaux cultivars de haricots commerciaux en Afrique orientale et centrale. L\u2019 augmentation de l\u2018 intensit\ue9 des s\ue9cheresses et des precipitations et les temp\ue9ratures plus \ue9lev\ue9es influencent l\u2019apparition et la distribution des pourritures des racines, ce qui entra\ueene une augmentation des \ue9pid\ue9mies. Les agents pathog\ue8nes causaux ont tendance d\u2018 appara\ueetre dans un complexe, et comme la plupart des cultivars n\u2019ont pas une large r\ue9sistance, des effets ind\ue9sirables continuent d\u2018 appara\ueetre. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer les niveaux de double r\ue9sistance des nouvelles lign\ue9es de s\ue9lection (BL) d\ue9velopp\ue9es pour la r\ue9sistance \ue0 la pourriture des racines, ainsi que les g\ue9notypes andins (ADP), pour la r\ue9sistance \ue0 la pourriture des raciness caus\ue9e par Fusarium (FRR) et Pythium (PRR). Au total de 316 nouveaux BL d\ue9velopp\ue9s pour la r\ue9sistance \ue0 la pourriture des racines et 295 g\ue9notypes de haricot ADP ont \ue9t\ue9 \ue9valu\ue9s \ue0 Kawanda en Ouganda. Il y avait des diff\ue9rences significatives (P <0,05) entre les g\ue9notypes pour les pourritures des racines et le rendement. Trente et 1,9 pour cent des g\ue9notypes BL et ADP ont montr\ue9 une r\ue9sistance pour deux raciness pourries. De plus, plus de 80% des g\ue9notypes d\u2019ADP ont montr\ue9 une susceptibilit\ue9 pour deux raciness pourries. Le rendement \ue9tait g\ue9n\ue9ralement m\ue9diocre avec des moyennes de 458 kg ha-1 pour l\u2019ADP, et allant de 949 \ue0 1075 kg ha-1 pour les groupes BL. N\ue9anmoins, les 0,3 et 2,4% d\u2019ADP et de BL qui ont donn\ue9 plus de 2000 kg ha-1 ont montr\ue9 un potentiel de rendement \ue9lev\ue9, \ue9tant donn\ue9 que la majorit\ue9 des g\ue9notypes ont produit moins de 1000 kg ha-1

Development of white common beans for the processing industry in East Africa: Adaptability, resistance to selected diseases, cooking time and canning quality

Common bean ( Phaseolus vulgaris L.) provides dietary protein, energy, fiber, and micronutrients, especially iron and zinc to over 800 million people in Africa and Latin America. The crop has various seed types. White beans are very popular for the processing industry. This study aimed to investigate the agronomic performance, canning quality, cooking time (COOKT) and response to root rots ( Fusarium cuneirostrum and Pythium ultimum ) and angular leaf spot (ALS; Pseudocercospora griseola ) diseases among 151 drought tolerant small and large seeded white bean genotypes from trials conducted between 2013 to 2018 in East Africa. Significant (P<0.001) differences existed among the genotypes for response to the three pathogens, COOKT and canning quality traits. Resistance to each of the pathogens was expressed in 24-75% of the genotypes, while dual resistance to any two pairs of the pathogens occurred in 10-44% of the genotypes. Four genotypes; ICNBunsixSxB405/4C-1C-1C-88, RAZ-11, ETSNAP18 and ETSNAP3 expressed resistance to the three pathogens but had COOKT of 46-56 minutes (based on a Matson cooker), and below average canning quality. They are recommended as sources of diseases resistance but could be further improved for COOKT and canning quality. Sixty-eight genotypes had COOKT <50 minutes while 24 expressed good to excellent visual canning quality. Some phenotypes: RAZ-120, RAZ36-Caballero, NavyLine-60, NavyLine-25, ZABR16573-25F22, ZABR16575-60F22, ETSNAP33, Bifortsmallseeded-15 and ZABR16574-37F22, that were cooked in <45 minutes, exhibited good to excellent canning quality and expressed resistant to intermediate diseases resistance responses. These may be used as parental lines and/or fast tracked for variety release through regional trials.Le haricot commun ( Phaseolus vulgaris L.) fournit des prot\ue9ines alimentaires, de l\u2019\ue9nergie, des fibres et des micronutriments, en particulier du fer et du zinc \ue0 plus de 800 millions de personnes en Afrique et en Am\ue9rique latine. La culture a divers types des graines, mais les haricots blancs sont tr\ue8s populaires dans l\u2019industrie de la transformation. Cette \ue9tude visait \ue0 \ue9tudier la qualit\ue9 agronomique et de mise en conserve, le temps de cuisson et la r\ue9ponse des haricots blancs aux pourritures des racines et \ue0 la tache angulaire (ALS, angular leaf spot) qui provoquent des pertes de rendement importantes dans la production des haricots en Afrique de l\u2019Est. Les haricots \ue0 petites et grandes graines am\ue9lior\ue9s pour la tol\ue9rance \ue0 la s\ue9cheresse ont \ue9t\ue9 \ue9valu\ue9s de 2013 \ue0 2018. Des diff\ue9rences significatives (P<0,001) existaient entre les 151 g\ue9notypes pour la r\ue9ponse \ue0 trois agents pathog\ue8nes ( Fusarium cuneirostrum , Pythium ultimum and Pseudocercospora griseola ), le temps de cuisson et les caract\ue9ristiques de qualit\ue9 de mise en conserve. Il \ue9tait possible de s\ue9lectionner une r\ue9sistance \ue0 la maladie simple, double et triple. La r\ue9sistance \ue0 chacun des agents pathog\ue8nes a \ue9t\ue9 exprim\ue9e dans 24 \ue0 75 % des g\ue9notypes ; tandis qu\u2019une double r\ue9sistance \ue0 deux paires des agents pathog\ue8nes s\u2019est produite dans 10 \ue0 44 % des g\ue9notypes. Les quatre g\ue9notypes ; ICNBunsixSxB405/4C-1C-1C-88, RAZ-11, ETSNAP18 et ETSNAP3 qui ont exprim\ue9 une r\ue9sistance \ue0 trois agents pathog\ue8nes ont \ue9t\ue9 cuits en 46-56 minutes et sont recommand\ue9s comme sources de r\ue9sistance pour la reproduction, mais pourraient \ueatre encore am\ue9lior\ue9s pour une cuisson rapide et la qualit\ue9 de la mise en conserve \ue9tant donn\ue9 qu\u2019une qualit\ue9 g\ue9n\ue9rale de mise en conserve inf\ue9rieure \ue0 la moyenne a \ue9t\ue9 observ\ue9e. Les soixante-huit g\ue9notypes ont \ue9t\ue9 cuits en moins de 50 minutes tandis que 24 exprimaient une qualit\ue9 visuelle de mise en conserve bonne \ue0 excellente. Les g\ue9notypes comme RAZ-120, RAZ36-Caballero, NavyLine-60, NavyLine-25, ZABR16573-25F22, ZABR16575-60F22, ETSNAP33, Bifortsmallseed-15 et ZABR16574-37F22, cuits en moins de 45 minutes, pr\ue9sentaient une bonne \ue0 excellente mise en conserve la qualit\ue9 et la r\ue9sistance \ue0 une r\ue9ponse interm\ue9diaire aux maladies \ue9valu\ue9es ont \ue9t\ue9 recommand\ue9es \ue0 des fins de s\ue9lection et pour une \ue9valuation plus approfondie en vue d\u2019une promotion \ue9ventuelle

Gain and performance in yield and micronutrient concentration in common bean improvement

Common bean (Phaseolus vulgaris L.) is a staple and nutritious leguminous food crop for all income categories in Africa. Efforts to improve its yield performance and nutritional components, especially Iron and zinc have resulted in the release of several varieties in the sub-Saharan African region. The objective of this study was to assess genetic progress in varieties released in 12 African countries through the Pan African Bean Research Alliance (PABRA) from 1973 to 2017, to inform current breeding decisions. A total of 214 released varieties, land races and breeding lines, of bush and climbing beans were evaluated for yield, micronutrient (Fe and Zn) concentration, and phenology in three locations (Kawanda and Kachwekano in Uganda, and Kitengule in Tanzania) in 2017–2018. There were significant differences (P 0.01) among genotypes for all traits except days to maturity (DPM). Genotype x environment interaction was also significant (P<0.05) for all assessed traits, except for iron in climbing beans. Across environments, repeatability (H2) was greater than 0.50 for all traits, except for DPM in climbing beans. Annual rates of genetic yield gains were 4.41 and 4.57 kg ha-1 for large and small seed bush beans, and -2.74 and 21.6 kg ha-1 for large and small seeded climbers. Similarly, gains in seed iron (FESEED) were 0.40 and 0.17 ppm for bush and climbing beans, respectively. These represented an annual relative gain over the oldest varieties of 0.6 and 0.7% kg ha-1 for yield of large and small seeded bush beans, -0.3 and 1.6% kg ha-1 for yield of large and small seeded climbers, 0.6 and 0.2% ppm for FESEED of bush and climbers. Overall, genetic progress was slow for both yield and FESEED

Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention

Background: For HIV-serodiscordant couples, integrated delivery of antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners virtually eliminates HIV transmission. Standardized messaging, sensitive to the barriers and motivators to HIV treatment and prevention, is needed for widespread scale-up of this approach. Methods: Within the Partners Demonstration Project, a prospective interventional project among 1013 serodiscordant couples in Kenya and Uganda, we offered ART to eligible HIV-positive partners and PrEP to HIV-negative partners before ART initiation and through the HIV-positive partner's first 6 months of ART use. We conducted individual and group discussions with counseling staff to elicit the health communication framework and key messages about ART and PrEP that were delivered to couples. Results: Counseling sessions for serodiscordant couples about PrEP and ART included discussions of HIV serodiscordance, PrEP and ART initiation and integrated use, and PrEP discontinuation. ART messages emphasized daily, lifelong use for treatment and prevention, adherence, viral suppression, resistance, side effects, and safety of ART during pregnancy. PrEP messages emphasized daily dosing, time-limited PrEP use until the HIV-positive partner sustained 6 months of high adherence to ART, adherence, safety during conception, side effects, and other risks for HIV. Conclusions: Counseling messages for HIV-serodiscordant couples are integral to the delivery of time-limited PrEP as a “bridge” to ART-driven viral suppression. Their incorporation into programmatic scale-up will maximize intervention impact on the global epidemic

Strengthening pharmaceutical systems for palliative care services in resource limited settings: Piloting an mhealth application across a rural and urban setting in Uganda

Background: Medicine availability is improving in sub-Saharan Africa for palliative care services. There is a need to develop strong and sustainable pharmaceutical systems to enhance the proper management of palliative care medicines, some of which are controlled. One approach to addressing these needs is the use of mobile technology to support data capture, storage and retrieval. Utilizing mobile technology in healthcare (mHealth) has recently been highlighted as an approach to enhancing palliative care services but development is at an early stage. Methods: An electronic application was implemented into palliative care services at two settings in Uganda; a rural hospital and an urban hospice. Measures of the completeness of data capture, time efficiency of activities and the changes to medicines stock and waste management were taken pre- and post-implementation to identify changes to practice arising from the introduction of the application. Results: Improvements in all measures were identified at both sites. The application supported the registration and management of 455 patients and a total of 565 consultations. Improvements in both time efficiency and medicines management were noted. Time taken to collect and report pharmaceuticals data was reduced from 7 days to 30 minutes and 10 days to 1 hour at the urban hospice and rural hospital respectively. Stock expiration reduced from 3% to 0.5% at the urban hospice and from 58% to 0% at the rural hospital. Additional observations relating to the use of the application across the two sites are reported. Conclusions: A mHealth approach adopted in this study was shown to improve existing processes for patient record management, pharmacy forecasting and supply planning, procurement, and distribution of essential health commodities for palliative care services. An important next step will be to identify where and how such mHealth approaches can be implemented more widely to improve pharmaceutical systems for palliative care services in resource limited settings

Patients experiences of living with peritoneal dialysis in their daily life : A literature review

Bakgrund: Antal personer som lever med kronisk njursvikt ökar med befolkningsökningen. Peritonealdialys är en vanlig livsuppehållande behandling för patienter som lever med kronisk njursvikt som främst sköts av patienter i hemmet. För att kunna fortsätta leva med sjukdomen under kontroll kräver peritonealdialys införande av nya livsförändringar som på olika sätt kan vara påfrestande för patienterna. Syfte: Syftet var att beskriva patienters upplevelser av att leva med peritonealdialys i sin vardag. Metod: Litteraturöversikten baserades på elva vetenskapliga artiklar med kvalitativa ansatser hämtade från databaserna CINAHL complete och PsyINFO. Sökorden som användes vid artikelsökning var patient experience, living with" och "peritoneal dialysis" som vidare utökades till "perspective", "home dialysis, qualitative study och interview'' med års begränsning 2000- 2017. Resultat: Litteraturöversikten visade att patienternas upplevelser av att leva med peritonealdialys innefattade en livsförändringsprocess med upplevelser av övergång som en besvärlig vändpunkt i livet vilket började redan vid PD- initiering. De första sex månaderna var den svåraste tiden att hitta balansen och anpassa sig till ett nytt levnadssätt, under den perioden hade patienterna stora behov av stöd både från sjukvården och det egna sociala nätverket dels för att bearbeta de olika förluster och begränsningar relaterad till PD- behandlingen, dels för att upprätthålla motivationen för att fortsätta sköta sin behandling. Med tiden ökade patienterna upplevelser av oberoende självständighet i att hantera sin egenvård och deras behov av stöd minskade, stödet från sjukvården minskade till enbart rutinkontroller. Diskussion: Patienters upplevelser av att leva med PD diskuterades och analyserades utifrån Orems teori om egenvårdsbalans och tidigare forskning. Större delen av diskussionen understryker betydelse av sjukvårdpersonalens bemötande som kan såväl positivt som negativt påverka patienters upplevelser. Hur väl en patient lyckades med sin egenvård berodde mycket på bemötandet, anpassad information, typ av stöd i patientens sociala nätverk och vilka vårdinsatser patienten fick under behandlingsprocessen.