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

Risk factors for recurrent sexually transmitted infections in Uganda

Objective: To identify predictors of recurrent sexually transmitted infections (STIs)Design: A cross-sectional interview survey.Setting: STD Clinic, Old Mulago Hospital, Kampala.Methods: Eligible patients answered questions about their socio-demographic situation; STI symptoms; sexual behaviour; sexual partner referral; health seeking behaviour and whether they had a recurrent infection or not. Bivariate and multivariate stepwise logistic regression models were used to identify independent predictors of recurrent STIs.Results: Fifty two (38%) out of 138 patients had recurrent STIs. On bivariate analysis the predictors of recurrent STIs were: being male; age ³ 25 years; inability to read in English; presenting with genital itching; attributing source of symptoms to sexual partner; not beingasked to refer sexual partners at previous treatment site; having more than five lifetime partners; knowing how to use a condom; ever using a condom; and using a condom at least once in the previous three months. On multivariate analysis, independent risk factors forrecurrent infection were: age ³ 25 years(Adjusted Odds Ratio [AOR] = 2.70, 95 % CI 1.20, 5.88); inability to read English AOR = 3.09, (95% CI 1.38, 6.92); and having more than five, lifetime partners AOR = 2.56 (95 % CI 1.11, 5.88).Conclusion: Reducing the number of sexual partners and targeting people who do not speak English with health education messages in the local language may reduce the frequency of recurrent STIs

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%;

False teeth "ebiino" and millet disease "oburo" in Bushenyi district of Uganda

Background:\"False teeth\" (Ebiino) and \"Millet disease\" (Oburo, Tea-tea) have been reported in Uganda and other countries in Sub-Saharan Africa. These two perceived diseases are commonly reported in children under-five years of age. Anecdotal and published evidence suggests that these conditions are associated with moderate to severe childhood diseases such as malaria, pneumonia and diarrhoea and that most health seeking behaviour for the conditions is from traditional healers. Objectives:To estimate how common the 2 perceived diseases (false teeth and millet disease) are and describe health seeking behaviour for the two diseases. Methods:We did a cross-sectional survey using an interviewer administered questionnaire with closed and open questions in Bushenyi district, Uganda. The participants included 215 heads of households or their spouses obtained by cluster random sampling of 30 villages. Participants answered questions regarding occurrence of false teeth and millet disease disease in the household, treatment sought for false teeth and millet disease, perceived causes of false teeth and millet disease and about social economic situation of the household. Results: More than one in two of the households had a child less than five years who suffered from false teeth or millet disease in the last five years. More than 80% of the respondents used traditional medicine alone or in combination with modern medicine to treat false teeth and or millet disease. Occurrence of false teeth and millet disease disease were favoured by low education status and not living in a house with cemented floor or having a brick wall. Use of traditional medicine was not associated with social economic conditions. Conclusions:The frequency of the perceived diseases false teeth and millet disease disease is high and may be attributed to low access to preventive and curative health services. Keywords: Malaria; Pneumonia; Diarrhoea; health seeking behaviour; access to health facilities; traditional medicine; health beliefs. African Health Sciences Vol. 7(1) 2007: pp. 25-3

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

Willingness to accept use of dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Rakai District, Uganda

Objective: To identify factors associated with willingness to accept use ofdichlorodiphenyltrichloroethane (DDT ) for indoor residual household-spraying (IRS ) in malaria control in Rakai district Uganda.Design: A household survey using multistage sampling.Setting: Rakai, rural district in south central Uganda.Subjects: household heads or their spouses.Main outcome measures: Proportion of those that were willing to accept use of DDT for IRS and factors associated with willingness to accept use of DDT.Results: Almost all (90%) study participants were willing to have IRS in their homes, however only 31% of them were willing to have DDT used for that purpose. The factors influencing willingness to accept use of DDT for IRS ranged from reports of having heard of other chemicals used in IRS other than DDT (AOR= 2.9, 95% CI= 1.3-6.5), reports of malaria in the month prior to interview (AOR= 3.6, 95% CI= 1.6-7.9), if they believed that treated bed nets prevent malaria (AOR= 2.9, 95% CI= 1.3-6.4) and DDT controls mosquitoes (AOR= 2.7, 95% CI= 1.1-6.6). They were unwilling to accept use of DDT if they reported that they had heard that DDT is poisonous/harmful to health (AOR=13.9, 95% CI=5.2-37.0).Conclusions: To improve the willingness to accept use of DDT at the  community level there is need to increase awareness of the high risk of malaria acquisition among the population and address the fears of the risks posed to human health by DDT and how these can be minimised

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

Sexual behaviour among persons living with HIV/AIDS in Kampala, Uganda

Objective:  Design: Setting: Results:  Conclusions:  This study demonstrates that abstinence and use of condoms on their own may not be enough for HIV prevention among PLWHAs who desire children. Additional methods such as use of ART to reduce HIV infectiousness and sperm washing are needed.In the past 12 months 227 (60%) of the PLWHAs were sexually active. Of the sexually active 42 (19%) never used a condom, and 92 (40%) used condoms inconsistently, thus 134 (35%) of PLWHAs engaged in high risk sex. Two hundred and sixty five (70%) said that PLWHAs can have healthy children and 115 (30%) desired more children with 21 (10%) of the women in the reproductive age group reporting a pregnancy and 22 (17%) of the men reporting having caused a pregnancy. Only three (7%) of the pregnancies were unplanned. Desire for more children was a strong independent predictor of engaging in high risk sex (Adjusted Odds Ratio 2.44, 95% CI 1.35-4.42).Joint Clinical Research Centre, Kampala Uganda. Participants: Three hundred and eighty PLWHAs, 50% of whom had initiated antiretro viral therapy (ART). Main outcome measures: PLWHAs answered questions regarding sexual behaviour, number and type of sexual partners, symptoms of sexually transmitted infections, having been pregnant or causing a pregnancy, social demographic characteristics, consumption of alcohol, having biological children, desire for more children and use of condoms.A cross sectional study.To identify sexual behaviour and reproductive health needs of people living with HIV/AIDS (PLWHAs)

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