The challenge of chloroquine-resistant malaria in sub-Saharan Africa.

For the last decade chloroquine-resistant Plasmodium falciparum (CRPF) has spread explosively in sub-Saharan Africa. In some areas of the continent, CRPF is so intense that chloroquine can hardly be said to have any efficacy. There is emerging evidence that CRPF is linked with increased incidence of mortality, severe disease and emergence of epidemics. Whereas the normal response to this trend of events would be replacing chloroquine with another effective drug, such a decision is hampered by the limited number of antimalarials currently available. There is a fear that changing too early would lead to depletion of available drugs. Yet a delay may be costly and catastrophic. Since the development of new antimalarials is deemed commercially unviable by high-income countries, there is need for a pan-African project aimed at the development of new antimalarials. Such a project could be jointly funded from African governments and the donor community under the coordination of either the World Health Organization or the Organization of African Unity. To delay the emergence and spread of resistance by P. falciparum to new and old drugs, there is need for: improving rational drugs use; limiting mass use of drugs as in chemoprophylaxis and in medicated salt; and increasing the use of impregnated bed nets

Community chloroquine distribution for malaria control in Bushenyi district of Uganda.

OBJECTIVE: To document successful community chloroquine distribution for malaria control in Bushenyi district, southwestern Uganda. DESIGN: A cross sectional survey immediately after a four-month community chloroquine distribution exercise. One hundred sixty seven distributors in 140 out of 166 parishes in Bushenyi district did the chloroquine distribution during the 2001 malaria epidemic. PARTICIPANTS: A cluster random sample of 215 heads of households or their spouses were interviewed using a pre-tested questionnaire. MAIN OUTCOME MEASURES: Socio-demographic characteristics, malaria/fever morbidity, health seeking behaviour in the previous four months, knowledge about chloroquine distribution, opinions about the chloroquine distribution exercise and whether the household had used the service of the chloroquine distributors. RESULTS: Thirty per cent of the people surveyed had suffered from malaria in the previous four months. Seventy per cent of the households were aware of the chloroquine distribution and 56% of the patients who had malaria in the previous four months accessed the services of chloroquine distributors. People who were aware of chloroquine distributors were less likely to use services where a fee is levied. The total cost of chloroquine distribution was about 20,000 United States dollars. CONCLUSIONS: Community chloroquine distribution can increase access to treatment and can be done in a short time at an affordable cost

Adherence to feeding guidelines among HIV-infected and HIV-uninfected mothers in a rural district in Uganda

Objective: To describe the infant feeding behaviour of HIV-infected and HIV-uninfected mothers, and identify factors influencing adherence to infant feeding guidelines.Design: Analytical cross-sectional study.Setting: Bushenyi, rural district in South-western UgandaParticipants: One hundred and ninety four mothers who had a child less than 12 months of age. About half, 94(48.5%), of these were HIV -infected.Main outcome measures: Proportion of mothers who exclusively breastfed,complementary fed, replacement fed, and adhered to feeding guidelines.Results: Most (84.5%, 164/194) of the mothers had ever breastfed their infants, the rest had exclusively replacement fed since birth. Among children less than six months who were breastfeeding, 31.5% (34/108) were exclusively breastfeeding and the rest were mixed feeding. HIV-infected mothers were more likely than HIV-uninfected mothers to exclusively breastfeed (Crude Odds Ratio [COR], 3.61, 95% Confidence Interval [CI] 1.42-9.21). For infants older than six months, complementary feeding was more common among HIV-uninfected (100%) than HIV-infected mothers (41.7%;

National immunisation days for polio eradication in Uganda: Did immunisation cards increase coverage?

Objective: To analyse the effect of cards and of vitamin A supplementation on coverage for National Immunisation Days (NIDs).Design: A retrospective ecological study.Setting: A countrywide NIDs coverage before and after introduction of the NIDs cards and vitamin A supplementation in all districts of Uganda.Methods: NIDs for polio eradication commenced in Uganda in 1996. Two rounds, one month apart are implemented yearly. During the second round of 1998 NlDs, cards were introduced nationally and vitamin supplementation was introduced in 24 of the 45 districts. Wecompared NIDs coverage before and after NIDs cards and NIDs coverage in districts that implemented vitamin A to those that did not.Results: After introduction of NIDs cards, the national coverage rose from 97.7% to 106.9%, an increase of 9.2%. In those districts that implemented vitamin A supplementation, the NIDs coverage rose from 100.1%. to 111.5%, an increase of 10.4 %. In those districts thatdid not implement vitamin A, the NIDs coverage rose by 6.7% from 94.5% to 102.2%. Before the introduction of cards and vitamin A in 1996 and 1997, the NIDs coverage was between 92-96%.Conclusion: NIDs cards and vitamin A supplementation could have increased the NIDs national coverage

Factors associated with delayed diagnosis of HIV infection in Mukono district, Uganda

Objective: To identify factors associated with delayed diagnosis of HIV infection.Design: Cross sectional study.Setting: Mukono district, Uganda.Subjects: Newly diagnosed HIV positive clients at ten HIV testing centres. Late testers were HIV positive clients who had AIDS according to World Health Organisation AIDS case definition. Early-testers did not have AIDS at diagnosis.Main outcome measures: Late testers were compared to early testers on socio-demographic characteristics, sexual behaviour, access of testing services, knowledge of care and support services for HIV/AIDS and attitude towards knowing HIV-status.Results: Delayed diagnosis of HIV infection was independently associated with being over 25 years (adjusted odds ratio (AOR), 4.3; Confidence Interval (CI) 1.7-11.1), not being married (AOR, 2.4; CI 1.3-4.4), having no knowledge of testing services (AOR, 2.4; CI, 1.2 4.7), spending at least one hour travelling to a testing centre (AOR, 2.1; CI, 1.0-4.2), paying for HIV testing (AOR, 3.4; CI, 1.7-6.9) having had an illness two months before testing AOR 9.49; CI, 4.84-18.64) and having negative beliefs towards knowing one’s HIV sero status (AOR, 5.7; CI, 1.0-30.8).Conclusion: Factors associated with delayed diagnosis of HIV infection in Mukono District of Uganda are; age over 25 years, not being married, having no knowledge of testing services, paying for HIV testing, travelling for at least one hour to a testing centre and having negative beliefs towards knowing one’s HIV status. In order to increase access to testing there is need to offer free HIV testing and health education targeting people above 25 years and those not married

Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anaemia among children in urban Malawi

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73394/1/j.1365-3156.2006.01684.x.pd

Why the increase in under five mortality in Uganda from 1995 to 2000? A retrospective analysis

<p>Abstract</p> <p>Background</p> <p>From 1995-2000 the under five mortality rate in Uganda increased from 147.3 to 151.5 deaths per 1000 live births and reasons for the increase were not clear. This study was undertaken to understand factors influencing the increase in under five mortality rate during 1995-2000 in Uganda with a view of suggesting remedial actions.</p> <p>Methods</p> <p>We performed a comparative retrospective analysis of data derived from the 1995 and the 2000 Uganda demographic and health surveys. We correlated the change of under five mortality rate in Uganda desegregated by region (central, eastern, north and western) with change in major known determinants of under five mortality such social economic circumstances, maternal factors, access to health services, and level of nutrition.</p> <p>Results</p> <p>The increase in under five mortality rate only happened in western Uganda with the other 3 regions of Uganda (eastern, northern and central) showing a decrease. The changes in U5MR could not be explained by changes in poverty, maternal conditions, level of nutrition, or in access to health and other social services and in the prevalence of HIV among women attending for ante-natal care. All these factors did not reach statistical significance (P > 0.05) using Pearson's correlation coefficient.</p> <p>Conclusion</p> <p>In order to explain these findings, there is need to find something that happened in western Uganda (but not other parts of the country) during the period 1995-2000 and has the potential to change the under five mortality by a big margin. We hypothesize that the increase in under five mortality could be explained by the severe malaria epidemic that occurred in western Uganda (but not other regions) in 1997/98.</p

More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>The proportion of Ugandan children who are fully vaccinated has varied over the years. Understanding vaccination behaviour is important for the success of the immunisation programme. This study examined influences on immunisation behaviour using the attitude-social influence-self efficacy model.</p> <p>Methods</p> <p>We conducted nine focus group discussions (FGDs) with mothers and fathers. Eight key informant interviews (KIIs) were held with those in charge of community mobilisation for immunisation, fathers and mothers. Data was analysed using content analysis.</p> <p>Results</p> <p>Influences on the mother's immunisation behaviour ranged from the non-supportive role of male partners sometimes resulting into intimate partner violence, lack of presentable clothing which made mothers vulnerable to bullying, inconvenient schedules and time constraints, to suspicion against immunisation such as vaccines cause physical disability and/or death.</p> <p>Conclusions</p> <p>Immunisation programmes should position themselves to address social contexts. A community programme that empowers women economically and helps men recognise the role of women in decision making for child health is needed. Increasing male involvement and knowledge of immunisation concepts among caretakers could improve immunisation.</p