Bilharzia Induced Pathologies and Techniques of Detection in Uganda: A review

Background: Schistosoma S. mansoni was observed and reported in Uganda in 1902. Schistosoma S. mansoni is widely distributed in Uganda along permanent water bodies. Objective: To review the literature on previous techniques and conventional ones used for the assessment and comparison of morbidity due to schistosomiasis in Uganda. Design: Retrospective study. Setting: Gulu University, Faculty of Medicine, Department of Microbiology and Immunology. Results: Since its first detection in 1902 Schistosomiasis mansoni and later Schistosomiasis haematobium in Uganda, morbidity assessment was based on physical examination and intensity of eggs excretion. The first field study in Uganda of schistosomiasis pathologies using ultrasound was that conducted in West Nile in Obongi, Rhino Camp and Pundu in 1991 and reviewed in 1992. These armless and none invasive method of pathologies detection has the advantage of repeatability. It showed that after treatment there was reversibility of pathological conditions introduced by the parasites in the hosts. Conclusion: Schistosomiasis mansoni pathologies as detected by the none invasive ultrasound findings compared well with those of the more risky invasive liver biopsy. The detection of pathologies by clinical examination was less sensitive. Pathological lesions due to S. haematobium correlated with abnormalities of the urinary tract and intensity of eggs in urine.East African Medical Journal Vol. 87 No. 7 July 201

EVALUATION OF SCHISTOSOMA MANSONI MORBIDITY ONE YEAR AFTER PRAZIQUANTEL TREATMENT IN RHINO CAMP AND OBONGI IN WEST NILE, UGANDA

An evaluation study on reversibility of Schistosoma mansoni induced periportal fibrosis (PF) morbidity following treatment with praziquantel, 40mg/kg body weight after one year, was carried out in Rhino Camp and Obongi all are West Nile districts in northern Uganda. To assess the reversibility of Schistosoma (S) mansoni induced PFs morbidity following treatment with praziquantel, 40mg/kg body weight after one year. The design was a Prospective cohorts study; and the setting was a busy canoe landing sites along Albert Nile in Schistosoma (S) mansoni hyperendemic areas of Rhino Camp and Obongi fishing village were selected for the study. Previously in 2005, 1562 people including fishermen and women, school pupils, teachers, and civil servants were studied in both fishing villages for S. mansoni using Kato/Katz stool smear method. Abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis were performed with Aloka portable ultrasound machine (Hellige, Freiburg, Germany) fitted with a convex probe of 3.5 mega Hertz was also performed in the field clinic on all patients who had S. mansoni eggs in their faeces. The sonomorphological abnormalities of periportal fibrosis were categorised and organomorphometry of liver and spleen was done. One thousand two hundred and seventy three 1273 (81.5%) patients in Rhino Camp and Obongi fishing villages were found to be excreting from 100 to ≥ 500 eggs per gram (epg) of faeces of S. mansoni eggs. Two hundred and eighty nine (18.5%) did not have eggs of S.mansoni in their faeces. All the 1273 patients secreting eggs of S.mansoni in their stool in Rhino Camp and Obongi fishing villages had abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis. Eight hundred and forty 840 (66%) although excreted S. mansoni eggs in their stool had Pf (0); Pf grade (I), n=259 (20.3%); Pf grade (II) n =147 (11.5%); and Pf grade (III) n=27 (2.1%) were observed

Risk factors for road traffic accidents in Gulu municipality, Uganda

Background: Currently Road Traffic Accidents (RTA) are ranked tenth among the leading causes of death and ninth among all leading causes of disability worldwide. There has been no published study on RTA in Gulu municipality. There is a high frequency of RTA in Gulu municipality with poor road design and inadequate knowledge on road safety precaution among road users.Objectives: To establish the causes of Road Traffic Accidents (RTA), establish the safety measures in place to protect road users to avoid RTA and establish people mostly involved and the mechanism of RTA.Design: A cross-sectional studySettings:Four divisions of Gulu Municipality; Layibi, Laroo, Pece and Bardege.Subjects: Two hundred and forty two participants including pedestrians, drivers of different categories of vehicles, motorcyclists and bicyclists locally known as bodaboda and the police were interviewed.Results: Most respondents reported RTA as a problem in Gulu municipality (96%), causing death (48%), financial constraint due to medical treatment (41%) and disability (11%). The following causes of RTA were identified; reckless driving and riding (49%), poor road design (24%), drug abuse (15%) and over loading (12%). According to police records of January to September 2009 RTA involved pedestrians (36.34%), passengers (25.80%), motorcyclists (24.88%), pedal cyclists (11.52%) and drivers (3.68%).Conclusion: RTAs is a substantial burden in Gulu municipality in Northern Uganda with reckless driving or riding, poor road design, overloading, double parking, inadequate road safety signs and knowledge, were major risk factors. Efforts to reduce RTA in Gulu municipality should aim at addressing these problems

Taenia solium metacestode preparation in rural areas of sub-Saharan Africa: a source for diagnosis and research on cysticercosis

Background: Taenia solium metacestodes/cysts obtained from pig carcasses constitute a primary source for diagnostic tools used for the detection of human cysticercosis. Data on T. solium cyst preparation in Africa is still scarce but required to establish independent reference laboratories.Objectives: The aim of the present study is a) to present the likely yield of T. solium cyst material by the use of two different preparation methods in the field and b) to investigate its suitability for immunodiagnosis of human cysticercosis.Methods: In Zambia, Uganda and Tanzania 670 pigs were screened for T. solium infection. Cysts were prepared by `shaking method´ and ‘washing method’. Generated crude antigens were applied in a standard western blot assay.Results: 46 out of 670 pigs (6.9%) were found positive for T. solium  (Zambia: 12/367, 3.3%; Uganda: 11/217, 5.1%; Tanzania 23/86, 26.7%). Mean values of 77.7 ml whole cysts, 61.8 ml scolices/membranes and 10.9 ml cyst fluid were obtained per pig. Suitability of collected material for the use as crude antigen and molecular diagnostic techniques was demonstrated.Conclusion: This study clearly shows that T. solium cyst preparation in African settings by simple field methods constitutes an effective way to obtain high quality material as source for diagnostic tools and research purposes.Keywords: Taenia solium, cysticercosis, neurocysticercosis, antigen, immunoblo

Confirmed malaria cases among children under five with fever and history of fever in rural western Tanzania

The World Health Organization recommends that malaria treatment should begin with parasitological diagnosis. This will help to control misuse of anti-malarial drugs in areas with low transmission. The present study was conducted to assess the prevalence of parasitologically confirmed malaria among children under five years of age presenting with fever or history of fever in rural western Tanzania. A finger prick blood sample was obtained from each child, and thin and thick blood smears were prepared, stained with 10% Giemsa and examined under the light microscope. A structured questionnaire was used to collect each patient's demographic information, reasons for coming to the health center; and a physical examination was carried out on all patients. Fever was defined as axillary temperature ≥ 37.5°C. A total of 300 children with fever or a history of fever (1 or 2 weeks) were recruited, in which 54.3% (163/300, 95%CI, 48.7-59.9) were boys. A total of 76 (76/300, 25.3%, 95%CI, 22.8 - 27.8) of the children had fever. Based on a parasitological diagnosis of malaria, only 12% (36/300, 95%CI, 8.3-15.7) of the children had P. falciparum infection. Of the children with P. falciparum infection, 52.7% (19/36, 95%CI, 47.1-58.3) had fever and the remaining had no fever. The geometrical mean of the parasites was 708.62 (95%CI, 477.96-1050.62) parasites/μl and 25% (9/36, 95%CI, 10.9 -- 39.1) of the children with positive P. falciparum had ≥ 1001 parasites/μl. On Univariate (OR = 2.13, 95%CI, 1.02-4.43, P = 0.044) and multivariate (OR = 2.15, 95%CI, 1.03-4.49) analysis, only children above one year of age were associated with malaria infections. Only a small proportion of the children under the age of five with fever had malaria, and with a proportion of children having non-malaria fever. Improvement of malaria diagnostic and other causes of febrile illness may provide effective measure in management of febrile illness in malaria endemic areas

Relationship between malaria infection intensity and rainfall pattern in Entebbe peninsula, Uganda

Background: This study was to assess malaria prevalence in relation to rainfall pattern in different localities of Entebbe Municipality, Uganda. A cross sectional study was conducted amongst the local community residing in the area from January 2003 to January 2004 to investigate the incidence and intensity of malaria infection. Methods: Thick and thin blood smears were made from each patient with fever (body temperature ≥ 37.5° C). The slides were examined microscopically for malaria parasites. A total of 616 residents aged 2 to 50 years were registered in the study by name, age, sex and residential location. Spearman correlation coefficient (r) was used to evaluate relationship between parasite density, age and body temperature on one hand and rainfall plus parasite density on the other hand. Results: A direct relationship was observed between malaria transmission and monthly rainfall in Entebbe Municipality. About 69.8% of the patients had fever. Parasite density fluctuated according to monthly rainfall pattern. Two peaks of high parasite density was observed, each peak coinciding with a peak rainfall pattern of the bimodal annual rain seasons. There was a negative but significant correlation (r = -0.09271; p < 0.0214) between parasite density and age, suggesting that mature individuals clear parasites more effectively than children. Furthermore, we observed a bimodal peak of mean parasite density in children and adults; peak in children is higher than of adults, each peak coinciding with rainfall pattern. There is also a significant positive correlation between parasite density and body temperature (r = 0.1927; p = 0.0001). However, there is no significant variation in mean parasite densities in the different locations of Entebbe Municipality. Conclusions: Our study confirms rainfall pattern and age influence parasite density and are important determinants of malaria infection and transmission in Entebbe Municipality. Increased parasite density in children is a useful indicator for monitoring intensity of infection. This information is valuable in policy formulation for control of malaria during periods of intense transmission

Relationship between malaria infection intensity and rainfall pattern in Entebbe peninsula, Uganda

Background: This study was to assess malaria prevalence in relation to rainfall pattern in different localities of Entebbe Municipality, Uganda. A cross sectional study was conducted amongst the local community residing in the area from January 2003 to January 2004 to investigate the incidence and intensity of malaria infection. Methods: Thick and thin blood smears were made from each patient with fever (body temperature &#8805; 37.5° C). The slides were examined microscopically for malaria parasites. A total of 616 residents aged 2 to 50 years were registered in the study by name, age, sex and residential location. Spearman correlation coefficient (r) was used to evaluate relationship between parasite density, age and body temperature on one hand and rainfall plus parasite density on the other hand. Results: A direct relationship was observed between malaria transmission and monthly rainfall in Entebbe Municipality. About 69.8% of the patients had fever. Parasite density fluctuated according to monthly rainfall pattern. Two peaks of high parasite density was observed, each peak coinciding with a peak rainfall pattern of the bimodal annual rain seasons. There was a negative but significant correlation (r = -0.09271; p < 0.0214) between parasite density and age, suggesting that mature individuals clear parasites more effectively than children. Furthermore, we observed a bimodal peak of mean parasite density in children and adults; peak in children is higher than of adults, each peak coinciding with rainfall pattern. There is also a significant positive correlation between parasite density and body temperature (r = 0.1927; p = 0.0001). However, there is no significant variation in mean parasite densities in the different locations of Entebbe Municipality. Conclusions: Our study confirms rainfall pattern and age influence parasite density and are important determinants of malaria infection and transmission in Entebbe Municipality. Increased parasite density in children is a useful indicator for monitoring intensity of infection. This information is valuable in policy formulation for control of malaria during periods of intense transmission African Health Sciences Vol. 5 (3) 2005: pp. 235-24