Case Report: Is it safe to switch from stavudine to zidovudine after developing symptomatic hyperlactatemia?

Introduction: In resource limited settings patients on antiretroviral treatment who develop stavudine induced hyperlactatemia are often switched to zidovudine on the basis of published studies that demonstrate that this agent can be a safe alternative. Case report: We describe here a case of a 60 year old female that experienced a relapse of symptomatic hyperlactatemia after being switched from stavudine to zidovudine and how the case was managed at the Infectious Diseases Institute, Kampala, Uganda. Discussion: This case shows that switching to zidovudine potentially can lead to a hyperlactatemia relapse. Therefore we recommend close follow up for patients that are switched from stavudine to zidovudine and, in case lactate measurement is not possible, free programs should provide safer drugs such as abacavir and tenofovir for patients that develop hyperlactatemia. African Health Science Vol. 8 (2) 2008: pp. 133-13

Rep-PCR reveals a high genetic homogeneity among Ugandan isolates of Xanthomonas campestris pv musacearum

Wilting of plants incited by a bacterium, Xanthomonas campestris pv musacearum (Xcm), was first described on Ensete (Ensete ventricosum) and later bananas (Musa species) in the highlands ofEthiopia in 1968. Although the spread outside Ethiopia remained unreported for several decades, an epidemic of the disease on banana in Uganda was observed in 2001, in the districts of Mukono andKayunga. Since then, the disease has spread into almost three quarters of the major banana growing areas in Uganda. It has also been confirmed affecting banana plantations in the Democratic Republic ofCongo (DRC) and Rwanda. Repetitive sequence based genomic fingerprinting that uses a PCRmediated amplification of DNA sequences located between specific interspersed sequences of highlyconserved elements in prokaryotic genomes was used to characterize a collection of Xcm isolates from banana in Uganda. Fingerprints of bacterial isolates collected from Xcm symptom bearing bananaplants grown in production fields from 10 districts including Kayunga, Masindi, Luwero, Kampala, Kiboga, Lira, Wakiso, Kibale and Nakasongola revealed similar patterns. Cluster analysis of pair wisesimilarity values performed using unweighted pair group method with arithmetic averages clustering technique did not generate any differences in the fingerprint patterns either. The implications of thisgenetic homogeneity on the origin and management of Xcm is discussed here

Insufficient referral practices of sick children in Ethiopia shown in a cross-sectional survey.

AIM: This study aimed at assessing the referral of sick young infants and children from the community, health posts and health centres to higher levels. METHODS: A cross-sectional survey was conducted in four of the largest Ethiopian regions from December 2016 to February 2017. Referral practices were assessed at each level in 46 districts of these regions. Interviews were supplemented by reviews of registers at health posts and health centres. RESULTS: The women's development group leaders, who do not provide health services, referred half of the sick children they visited in the community to the health posts. The health extension workers referred 16% of the sick young infants and 6% of older infants and children to higher levels. From health centres, the health workers referred 6% of sick young infants and 1% of older infants and children to hospital. Many cases of possible severe bacterial infection were not referred to higher levels. A functional ambulance was available for a bit more than a third of the health centres. CONCLUSION: Referral practices of sick young infants and children at all levels were weak that may threaten the continued reduction of child mortality in Ethiopia. Referral logistics were insufficient, which partly could explain the missing referrals of severely ill infants and children

Accroître l’accès des femmes à des marchés ables grâce à la commercialisation collective

English version available in IDRC Digital LibraryCultivate Africa’s Future Fund (CULTIAF

Increasing women’s access to reliable markets through collective marketing

French version available in IDRC Digital LibraryWhile some household challenges emerged from collective marketing, the project enabled women to participate in male-dominated marketing activities and to benefit from the income generated. The project identified 65 mixed farmer groups and linked them to the Community Enterprise Development Organization (CEDO) which supplies bean seed on credit to farmer groups to produce grain on a contractual basis. Group marketing has been identified as one of the most viable ways of increasing women’s participation in agricultural marketing and improving their access to market information, as well as strengthening their bargaining power.Cultivate Africa’s Future Fund (CULTIAF

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

TH2.1: Empowerment without Transformation? A Scoping Review on Women Empowerment, Masculinities and Social norms in Agricultural Research

There is an increasing focus on re-thinking women's "empowerment" strategic interventions in order to achieve meaningful transformation in gender norms. This move is increasingly characterized by initiatives that deliberately seek to engage women and men, highlighting not only how women's lives in agricultural communities are interwoven with men's lives but also calls for ‘involvement' of men in women's empowerment work to address the underlying social norms, attitudes and behaviours that perpetuate gender inequalities. How have social categories "women", "men" and notions of empowerment and masculinities been conceptualized in agricultural research on women's empowerment? How have these concepts been deployed in agricultural research and with what implications? This paper draws from a literature review. Search terms included "Women's empowerment", "masculinities", "gender norms", "agency" "Power relations", "Rural masculinities" "male involvement in agriculture". Drawing on literature within agri food system, seed systems, nutrition sensitive agriculture in different regions of Africa and Asia, the paper argues that conceptualization of categories women, men, masculinities and femininities and the approaches drawn therefrom (the assumptions we work with about women and men) have potential to transform and/or reproduce unequal gender power relations

TH2.1: Who is a man? Understanding the local normative climate for transformative interventions in rural farming communities of Central Uganda

Local gender normative climate refers to how norms in a community interact with men and women agency- their ability to make strategic life choices. Understanding the normative climate includes unpacking the community's expectations of what it means to be a man "masculinity norms". Such normative factors interact with and constrain opportunities for women's equitable participation in agriculture, yet most women empowerment literature focuses on individual women level factors. This ongoing study aims to determine masculinity norms that affect women's ability to make strategic choices within the Sasakawa Africa's Nutrition sensitive agricultural extension project intervention areas in Kiboga District, Central Uganda. The study utilized an interpretive qualitative case study with data collected from sex disagreggated focus group discussions with intervention beneficiaries. Findings indicate that the community expectation of who a man should be are along family formation and provisioning; dominance in household decision making and leadership; and community level participation. The normative structures also exempted men from participating in domestic chores and negative sanctions were experienced by men that did so. Gender roles espousing notions like "vegetable growing is a woman's domain" dissuaded men's engagement in this activity. Consequently, domestic chores on top of additional activities from vegetables growing under the project present an increased labor burden for women. Inability to make strategic life choices like attending training that would build their capacities in areas important for their development curtails their economic investments. This calls for development agents' deliberate efforts to engage both women and men to reframe norms and new behaviors that will foster gender equality and a harmoniously transformed community

Clinic presentation delay and tuberculosis treatment outcomes in the Lake Victoria region of East Africa: A multi-site prospective cohort study

In the Lake Victoria region of East Africa, little is known about delays between tuberculosis (TB) symptom onset and presentation at a clinic. Associations between clinic presentation delay and TB treatment outcomes are also poorly understood. In 2019, we abstracted data from routine TB treatment records for all adults (n = 776) initiating TB treatment in a 6-month period across 12 health facilities near Lake Victoria. We interviewed 301 cohort members and assessed whether they experienced a clinic presentation delay longer than 6 weeks. We investigated potential clinical and demographic correlates of clinic presentation delay and examined the association between clinic presentation delay and an unfavorable TB treatment outcome (death, loss to follow-up, or treatment failure). Clinic presentation delay was common, occurring among an estimated 54.7% (95% CI: 48.9%, 61.2%) of cohort members, though no specific correlates were identified. Clinic presentation delay was slightly associated with unfavorable TB treatment outcomes. The 180-day risk of an unfavorable outcome was 14.2% (95% CI: 8.0%, 20.4%) among those with clinic presentation delay, compared to 12.7% (95% CI: 5.1%, 20.3%) among those presenting earlier. Multi-level community-based interventions may be necessary to reduce clinic presentation delays in communities near Lake Victoria