Short communication: Injury Profile in an Emergency Department at a Referral Hospital in Kigali, Rwanda

Injuries constitute a major public health problem, killing more than 5 million people worldwide each year and causing more cases of disability. Countries need baseline information on injury pattern to develop intervention strategies. A quantitative, retrospective, descriptive study was conducted at a referral hospital in Kigali Rwanda. The aim was to identify the causes of injuries, to determine the frequencies and distribution of injuries according to cause, gender, age, location, and categories of injuries, and to assess the probability of injury survival. Out of 101 subjects, 31.7% were female while 68.3% were male. A number of injuries were identified among young males in the age group 16-30 years in the urban area. The major cause of injury was road traffic accidents (RTA)

Illness Perceptions and Depression in Relation to Self-care Behaviour among Type 2 diabetes Patients in a Referral Hospital in Kigali-Rwanda

Background: This paper describes illness perceptions, communication and depression in relation to self-care behaviour among Type 2 diabetes patients, collected from a referral hospital in Kigali, Rwanda between 14 December 2010 and 28 February 2011. Methods: A descriptive cross-sectional study explored the relationships between interpersonal communications assessed using the Interpersonal Processes of Communication of Care in Diverse Population questionnaire; depression assessed using the Centre for Epidemiological Studies Depression Scale; illness beliefs assessed using the Revised Illness Perceptions Questionnaire; and self-care behaviour assessed using the Summary of Diabetes Self-Care Activities questionnaire. Self-regulatory model of illness perceptions, with a focus on cognitive representation, was the conceptual framework used to guide this study. We recruited 86 participants. Results: Participants perceived type 2 diabetes as a cyclical and chronic condition associated with serious but controllable consequences. Time cyclical, personal control and depression were independently associated with self-care behaviour. Conclusion: The findings confirm that depression and illness beliefs influence self-care behaviour.Keywords: Illness perceptions, depression, among type 2 diabetes patient

Contribution of Wetland Resources to Household Incomes of Riparian Communities of Katonga Wetland in Mpigi District, Uganda

Katonga wetland which lies to the western part of Lake Victoria covers an area of 237.4 km2. Although the wetland is known to contain flora and fauna that support livelihoods, there has been lack of information on the economic value of these resources and their contribution to livelihoods particularly of the rural riparian communities. The objective of the study was to generate information on the vital wetland resources, the economic value and contribution of these resources to riparian community livelihoods. The study was carried out in Nkozi and Kituntu sub-counties in Mpigi District-Uganda; it covered six parishes through which the wetland runs and involved 120 respondents. The study established that resources in the wetland are collected for subsistence and direct commercial extraction. The most important resource derived from the wetland for subsistence use was water for rural domestic use with each household using an average of 188l per day (23l per person) and was estimated at an annual economic value of Uganda shillings (Ushs) 490,191 (U$233.4) per person per year. Fisheries were the most important commercial activities undertaken in these parts of the wetland involving 36$ 1,900.6) per person. These activities particularly collection of water and fuel wood are undertaken throughout the year, while harvesting of craft materials is mainly done during the dry season (January-March and June-August). Fishing is done mainly in the wet season (March-May and September-November).he wetland is a source of income for at least 74% of the respondents. The majority of respondents, 57.5%, were among low income groups earning up to Ushs 600,000 per respondent annually. Fishing provides the highest gross incomes per respondent Ushs 200,000 per month hence the high value of the wetland to its riparian communities. It was noted that 30% of respondents depend on both the wetland and other activities with the wetland providing a buffer income source. It is recommended that the wetland hydrology which is vital for the sustainability of these activities be maintained through catchment improvement while sustainable harvesting levels be established for fishing activities. Environment management structures should be strengthened to sustainably manage the wetland. Local communities should also be sensitized about the importance of this wetland so that they can appreciate its ecosystem services and participate in its sustainable management

Potential impact of prickly pear cactus flour and Salix babylonica extract on cecal fermentation and methane production in horses

The cecal gas (GP) and methane (CH4) production and cecal fermentation kinetics when corn grain (CG) was replaced with prickly cactus (PC) in a horse’s diet at different levels of Salix babylonica (SB) extract was investigated. Three total mixed rations where CG was replaced with PC at three levels (/kg): 0 g (Control), 75 g (PC75) or 150 g (PC150) were prepared and SB extract added at four levels: 0, 0.6, 1.2 and 1.8 mL/g dry matter (DM) of substrates. No ration type 9 SB extract dose interaction was observed (P [0.05) for GP kinetics and CH4 production. Increasing the level of PC in the ration quadratically increased (P \0.01) the asymptotic GP and decreased (P\0.01) the rate and lag time of GP. Increasing the level of PC in the ration, increased GP values (P\0.05). Increasing the level of SB extract linearly decreased (P = 0.001) the lag time of GP of all diets without affecting the asymptotic GP or the rate of GP. Ration type and SB level had no effect (P [0.05) on CH4 production; however, at 36 h of incubation, SB extract decreased CH4 production. The rations PC75 and PC150 increased cecal pH compared with the control ration. The PC150 ration had the highest (P\0.05) DM degradability, short chain fatty acids production, and gas yield after 24 h of incubation, with no effect (P[0.05) of SB inclusion on all investigated fermentation kinetic parameters. It is concluded that increasing the level of PC in the diet of horse and replacing CG up to 60%, increased GP and improved cecal fermentation kinetics without affecting CH4 production. Inclusion of S. babylonica extract in the tested rations had weak effects on fermentation kinetics although it decreased the lag time of GP

Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Unravelling the spirits’ message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda

As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers. The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach. Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts. The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries

RISK6, a 6-gene transcriptomic signature of TB disease risk, diagnosis and treatment response

Improved tuberculosis diagnostics and tools for monitoring treatment response are urgently needed. We developed a robust and simple, PCR-based host-blood transcriptomic signature, RISK6, for multiple applications: identifying individuals at risk of incident disease, as a screening test for subclinical or clinical tuberculosis, and for monitoring tuberculosis treatment. RISK6 utility was validated by blind prediction using quantitative real-time (qRT) PCR in seven independent cohorts. Prognostic performance significantly exceeded that of previous signatures discovered in the same cohort. Performance for diagnosing subclinical and clinical disease in HIV-uninfected and HIV-infected persons, assessed by area under the receiver-operating characteristic curve, exceeded 85%. As a screening test for tuberculosis, the sensitivity at 90% specificity met or approached the benchmarks set out in World Health Organization target product profiles for non-sputum-based tests. RISK6 scores correlated with lung immunopathology activity, measured by positron emission tomography, and tracked treatment response, demonstrating utility as treatment response biomarker, while predicting treatment failure prior to treatment initiation. Performance of the test in capillary blood samples collected by finger-prick was noninferior to venous blood collected in PAXgene tubes. These results support incorporation of RISK6 into rapid, capillary blood-based point-of-care PCR devices for prospective assessment in field studies