Intestinal Schistosomiasis in Mothers and Young Children in Uganda: Investigation of Field-Applicable Markers of Bowel Morbidity

To control intestinal schistosomiasis at a national level in sub-Saharan Africa, there is a need for field-applicable markers to measure morbidity associated with this disease. The purpose of this study was to determine whether fecal calprotectin or fecal occult blood assays could be used as morbidity indicators for intestinal schistosomiasis. The study was carried out in Uganda with a cohort of young children (n = 1,327) and their mothers (n = 726). The prevalence of egg-patent schistosomiasis was 27.2% in children and 47.6% in mothers. No association was found between schistosomiasis infection and fecal calprotectin in children (n = 83, odds ratio [OR] = 1.08, P = 0.881), although an inverse relationship (n = 58, OR = 0.17, P = 0.043) was found in mothers. Fecal occult blood was strongly associated with Schistosoma mansoni infection in children (n = 814, OR = 2.30, P < 0.0001) and mothers (n = 448, OR = 1.95, P = 0.004). Fecal occult blood appears to be useful for measuring morbidity associated with intestinal schistosomiasis and could be used in assessing the impact of control programs upon disease

The Effect of Land Cover Change on Soil Properties around Kibale National Park in South Western Uganda

The change from natural forest cover to tea and Eucalyptus is rampant in protected areas of western Uganda. The objectives were; to examine the trend in land-use /cover change and determine the effect of these changes on the physico-chemical properties of soils around Kibale National Park. The trend in land use/cover change was assessed by analyzing a series of landsat images. Focused group discussions and key informant interviews were used for land-use/cover reconstruction. Three major land uses were included; woodlot (Eucalyptus grandis; 5 years old) ), tea (57 years old) and natural forest used as a control. Each of these land-uses were selected at two different North facing landscape positions and were replicated three times. A total of 36 composite soil samples were taken at 0–15 and 15–30 cm depth from natural forest, Tea plantation and eucalyptus on three ridges. Results showed that small scale farming, tea and eucalyptus plantation and built up area have increased over time, to the expense of woodlot and forest cover. Tea and Eucalyptus have induced changes in: exchangeable Mg and Ca, available P, SOM, pH, and bulk density of sub soil (P<.05). Landscape positions within land use also significantly influenced most soil properties (P<.05). Similar findings were observed by Wang et al. (2006) in commercial tea plantations in China that received nitrogen fertilizers

Chronic hepatosplenomegaly in African school children: a common but neglected morbidity associated with schistosomiasis and malaria.

Chronic hepatosplenomegaly, which is known to have a complex aetiology, is common amongst children who reside in rural areas of sub-Saharan Africa. Two of the more common infectious agents of hepatosplenomegaly amongst these children are malarial infections and schistosomiasis. The historical view of hepatosplenomegaly associated with schistosomiasis is that it is caused by gross periportal fibrosis and resulting portal hypertension. The introduction of ultrasound examinations into epidemiology studies, used in tandem with clinical examination, showed a dissociation within endemic communities between presentation with hepatosplenomegaly and ultrasound periportal fibrosis, while immuno-epidemiological studies indicate that rather than the pro-fibrotic Th2 response that is associated with periportal fibrosis, childhood hepatosplenomegaly without ultrasound-detectable fibrosis is associated with a pro-inflammatory response. Correlative analysis has shown that the pro-inflammatory response is also associated with chronic exposure to malarial infections and there is evidence of exacerbation of hepatosplenomegaly when co-exposure to malaria and schistosomiasis occurs. The common presentation with childhood hepatosplenomegaly in rural communities means that it is an important example of a multi-factorial disease and its association with severe and subtle morbidities underlies the need for well-designed public health strategies for tackling common infectious diseases in tandem rather than in isolation

Oxamniquine resistance alleles are widespread in Old World Schistosoma mansoni and predate drug deployment

Do mutations required for adaptation occur de novo, or are they segregating within populations as standing genetic variation? This question is key to understanding adaptive change in nature, and has important practical consequences for the evolution of drug resistance. We provide evidence that alleles conferring resistance to oxamniquine (OXA), an antischistosomal drug, are widespread in natural parasite populations under minimal drug pressure and predate OXA deployment. OXA has been used since the 1970s to treat Schistosoma mansoni infections in the New World where S. mansoni established during the slave trade. Recessive loss-of-function mutations within a parasite sulfotransferase (SmSULT-OR) underlie resistance, and several verified resistance mutations, including a deletion (p.E142del), have been identified in the New World. Here we investigate sequence variation in SmSULT-OR in S. mansoni from the Old World, where OXA has seen minimal usage. We sequenced exomes of 204 S. mansoni parasites from West Africa, East Africa and the Middle East, and scored variants in SmSULT-OR and flanking regions. We identified 39 non-synonymous SNPs, 4 deletions, 1 duplication and 1 premature stop codon in the SmSULT-OR coding sequence, including one confirmed resistance deletion (p.E142del). We expressed recombinant proteins and used an in vitro OXA activation assay to functionally validate the OXA-resistance phenotype for four predicted OXA-resistance mutations. Three aspects of the data are of particular interest: (i) segregating OXA-resistance alleles are widespread in Old World populations (4.29–14.91% frequency), despite minimal OXA usage, (ii) two OXA-resistance mutations (p.W120R, p.N171IfsX28) are particularly common (>5%) in East African and Middle-Eastern populations, (iii) the p.E142del allele has identical flanking SNPs in both West Africa and Puerto Rico, suggesting that parasites bearing this allele colonized the New World during the slave trade and therefore predate OXA deployment. We conclude that standing variation for OXA resistance is widespread in S. mansoni

Community-acquired soft-tissue pyogenic abscesses in Mulago hospital, Kampala: Bacteria isolated and antibiotic sensitivity

Background: Clinical practice, for a long time, has dwelt on study and management of pyogenic abscesses without distinction between nosocomial and community-acquired types. This study aimed at identifying the bacteria isolated from community-acquired acute subcutaneous and soft tissue pyogenic abscesses. It also determined their sensitivity to a wide range of antibiotics. Methods: The cross-sectional study was conducted in Mulago hospital, between August and December, 2011. Consecutive, convenient sampling was used to attain a sample size of 130 subjects, with all age groups eligible. They were treated for the abscesses by incision and drainage. The pus was subjected to bacterial culturing and drug sensitivity testing. Data was analysed using STATA version 11.2. Results: The median age was 21.6 years; with females constituting 43.9%, and 10.8% were HIV positive persons. The predominant organism isolated was Staphylococcus aureus (53.9%), followed by coliform organisms (14-1%). Mixed infections, mostly with Staphylococcus aureus, constituted 8.6%. Staphylococcus aureus was most susceptible to ciprofloxacin and showed greatest resistance to chloramphenicol. Coliform organisms were most susceptible amikacin and showed greatest resistance to augmentin. Conclusions: The predominant bacterium isolated from these pyogenic abscesses is Staphylococcus aureus. It is most susceptible to ciprofloxacin and resistant to chloramphenicol. There is benefit in conducting a larger study with more antibiotic sensitivity tests and specific bacterial type dentification. Recommendations can then be made for appropriate antibiotic policies

Community-acquired soft-tissue pyogenic abscesses in Mulago hospital, Kampala: Bacteria isolated and antibiotic sensitivity

Background: Clinical practice, for a long time, has dwelt on study and management of pyogenic abscesses without distinction between nosocomial and community-acquired types. This study aimed at identifying the bacteria isolated from community-acquired acute subcutaneous and soft tissue pyogenic abscesses. It also determined their sensitivity to a wide range of antibiotics. Methods: The cross-sectional study was conducted in Mulago hospital, between August and December, 2011. Consecutive, convenient sampling was used to attain a sample size of 130 subjects, with all age groups eligible. They were treated for the abscesses by incision and drainage. The pus was subjected to bacterial culturing and drug sensitivity testing. Data was analysed using STATA version 11.2. Results: The median age was 21.6 years; with females constituting 43.9%, and 10.8% were HIV positive persons. The predominant organism isolated was Staphylococcus aureus (53.9%), followed by coliform organisms (14-1%). Mixed infections, mostly with Staphylococcus aureus, constituted 8.6%. Staphylococcus aureus was most susceptible to ciprofloxacin and showed greatest resistance to chloramphenicol. Coliform organisms were most susceptible amikacin and showed greatest resistance to augmentin. Conclusions: The predominant bacterium isolated from these pyogenic abscesses is Staphylococcus aureus. It is most susceptible to ciprofloxacin and resistant to chloramphenicol. There is benefit in conducting a larger study with more antibiotic sensitivity tests and specific bacterial type identification. Recommendations can then be made for appropriate antibiotic policies

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Bean production areas in sub-Saharan Africa

176 bean production areas were identified and reviewed using a form of the Delphi method of consensus building among experts from almost all bean producing countries of sub-Saharan Africa. Data were collected for: bean production, cropping systems and producers; seed systems; bean use and marketing; bean grain types and varieties; and abiotic and biotic constraints to bean production and storage. Data on harvested area and production were compiled from a variety of sources and allocated among bean production areas using local expert knowledge and/or sub-national statistics. Bean environments were computed and allocated to each bean production area. The dataset includes raw data from each workshop; for some variables the data were later standardised to ensure that the cumulative values were 100%. We recommend using the standardised data. (2019-11-27

Morbidity due to Schistosoma mansoni: an epidemiological assessment of distended abdomen syndrome in Ugandan school children with observations before and 1-year after anthelminthic chemotherapy.

The objectives of this study were to determine the prevalence and distribution of distended abdomens among Ugandan school children across a range of eco-epidemiological settings and to investigate the relationship between distended abdomens and helminth infections, in particular Schistosoma mansoni, before and 1-year after anthelminthic treatment. A cross-sectional survey was conducted on 4354 school children across eight districts, with a longitudinal 1-year follow-up of 2644 children (60.7%). On both occasions, parasitological, biometrical and clinical data were collected for each child. Baseline prevalence of S. mansoni and hookworms was 44.3% and 51.8%, respectively. Distended abdomens, defined as an abdominal circumference ratio (ACR) >1.05, were observed in 2.5% of the sampled children, several of whom presented with particularly severe distensions necessitating hospital referral. ACR scores were highly overdispersed between districts and schools. Multivariate regression analysis revealed that S. mansoni infection accounted for only a small fraction of ACR variation, suggesting that either single point prevalence and intensity measures failed to reflect this more chronically evolved morbidity and/or that other interacting factors were involved, e.g. malnutrition and malaria. At 1-year follow-up, ACR scores showed an overall trend of regression towards the mean, potentially indicative of amelioration following chemotherapy, but geographic overdispersion still remained