Elemental composition and potential health impacts of phaseolus vulgaris L. ash and its filtrate used for cooking in Northern Uganda

Ash from burnt crop residue of common bean (Phaseolus vulgaris L.) is typically used to generate filtrate in rural Northern Uganda. The filtrate is added to hard-to-cook foods, like dried legumes, to decrease cooking time and improve flavor. However, the elemental composition of ash filtrate and health implications of its use is poorly understood. This study aimed to determine the elemental composition of Phaseolus vulgaris L. ash and its filtrate, to identify variation among study sites, and to assess the potential health impact of ash filtrate consumption in Northern Uganda. Dried ash and ash filtrate samples of P. vulgaris from Dog Abam, Telela, Arok, and Tit villages in Northern Uganda were analyzed for chemical composition. Ash filtrate samples were procured from ash according to local methods. Nutritional impact was assessed by comparing recommended daily intake (RDI) guidelines for Canada and Uganda. Potassium (K), sodium (Na), magnesium (Mg), manganese (Mn), and iron (Fe) concentration in dry crop ash samples varied significantly among study sites. Ash filtrate contained lower concentrations of all elements, suggesting considerable losses through filtration; but showed an alkaline pH (10.1 to 10.8). Elemental concentration present in probable daily intake of ash filtrate (approximately 15 milliliters/person) was within acceptable RDI ranges for elements of known dietary importance. The alkaline pH levels of the ash filtrate may have potential negative effect on diet by decreasing bioavailability of specific minerals (for example, Fe and Zn) and/or having destructive effects on various nutrients (for example thiamine). Further research should be conducted in Northern Uganda and other areas where ash filtrate is in use to determine the specific health effects of this cultural practice. Such studies could include, but not limited to, biological analysis, detailed nutritional studies, and/or long-term monitoring of filtrate consumers. The information gathered from such studies could be critical in formulating appropriate policies regarding the use of ash filtrate.Key words: Food composition, nutrients, Phaseolus vulgaris L. ash filtrate, potential health problem, Ugand

ELEMENTAL COMPOSITION AND POTENTIAL HEALTH IMPACTS OF Phaseolus vulgaris L. ASH AND ITS FILTRATE USED FOR COOKING IN NORTHERN UGANDA

ABSTRACT Ash from burnt crop residue of common bean (Phaseolus vulgaris L.) is typically used to generate filtrate in rural Northern Uganda. The filtrate is added to hard-to-cook foods, like dried legumes, to decrease cooking time and improve flavor. However, the elemental composition of ash filtrate and health implications of its use is poorly understood. This study aimed to determine the elemental composition of Phaseolus vulgaris L. ash and its filtrate, to identify variation among study sites, and to assess the potential health impact of ash filtrate consumption in Northern Uganda. Dried ash and ash filtrate samples of P. vulgaris from Dog Abam, Telela, Arok, and Tit villages in Northern Uganda were analyzed for chemical composition. Ash filtrate samples were procured from ash according to local methods. Nutritional impact was assessed by comparing recommended daily intake (RDI) guidelines for Canada and Uganda. Potassium (K), sodium (Na), magnesium (Mg), manganese (Mn), and iron (Fe) concentration in dry crop ash samples varied significantly among study sites. Ash filtrate contained lower concentrations of all elements, suggesting considerable losses through filtration; but showed an alkaline pH (10.1 to 10.8). Elemental concentration present in probable daily intake of ash filtrate (approximately 15 milliliters/person) was within acceptable RDI ranges for elements of known dietary importance. The alkaline pH levels of the ash filtrate may have potential negative effect on diet by decreasing bioavailability of specific minerals (for example, Fe and Zn) and/or having destructive effects on various nutrients (for example thiamine). Further research should be conducted in Northern Uganda and other areas where ash filtrate is in use to determine the specific health effects of this cultural practice. Such studies could include, but not limited to, biological analysis, detailed nutritional studies, and/or long-term monitoring of filtrate consumers. The information gathered from such studies could be critical in formulating appropriate policies regarding the use of ash filtrate

Mitigating Greenhouse Gas and Ammonia Emissions from Swine Manure Management : A System Analysis

PMID: 28318241. We thank all our colleagues for their recommendations and support during this extensive study. Funding for the study was provided by the National Basic Research Program of China (2012CB417104), the Non-Profit Research Foundation for Agriculture (201303091), China Agriculture Research System (CARS-36), and UK-China Virtual Joint Centres on Nitrogen “N-Circle” and “CINAg” funded by the Newton Fund via UK BBSRC/NERC (BB/N013484/1 and BB/N013468/1, respectively).Peer reviewedPostprintPostprintPostprin

Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

The sonographic pattern of diseases presenting with scrotal pain at Mulago hospital, Kampala, Uganda

Background: Scrotal pain is a common presentation in the male patient. There is a wide overlap of symptoms and signs making differentiation at clinical diagnosis difficult. Ultrasound has been documented to improve the accuracy of diagnosis of scrotal diseases. This study was aimed at determining the sonographically detectable diseases in patients with scrotal pain, describe their sonographic appearances and to relate the diseases to the sociodemographic and clinical characteristics of the patients presenting at Mulago hospital.Patients and Methods: This was a Cross sectional descriptive study done at Mulago Hospital, between May 2003 and March 2004. Consecutive patients with scrotal pain referred for ultrasound evaluation and consented were scanned using an ATL HDI 1500 machine model 2000 with a 5-12 MHz linear probe.Results: Of the seventy-three patients, 19 had acute epididymitis, 19 chronic nonspecific epididymitis, 12 testicular torsion, and 7 tuberculous epididymo-orchitis diagnosed at ultrasound. The entire epididymis was more often involved and there was no significant difference in pattern of involvement in acute and tuberculous epididymitis except that the frequency of calcifications was significantly higher in tuberculous  epididymo-orchitis lesions than in those of either acute epididymitis  (p=0.0017) or chronic epididymitis (p=0.0017).Testicular torsion was more  common in adolescents and young adults. Acute epididymitis was seen in all age-groups and was associated with anomalies of the genitourinary tract at the extremes of age and sexual activity in young adults. Clinical assessment had low accuracy in diagnosis of cause of scrotal pain.Conclusion: Scrotal ultrasound gave added information in the diagnosis of patients with scrotal pain. This expedites proper patient management and reduces morbidity. Infections and testicular torsion are the commonest cause of scrotal pain at Mulago hospital. Tuberculous epididymo-orchitis is still a problem at Mulago Hospital

The good, the bad, and the unknown: quality of clinical laboratories in Kampala, Uganda.

BACKGROUND: Clinical laboratories are crucial in addressing the high rates of communicable and non-communicable diseases seen in sub-Saharan Africa (SSA). However, the most basic information, such as the number and quality of clinical laboratories in SSA, is not available. The objective of this study was to create a practical method for obtaining this information in SSA towns and cities using an initial survey in Kampala, Uganda. METHODS: Kampala city was divided into 5 partially-overlapping regions. Each region was assigned to 2-3 surveyors who identified and surveyed laboratories in their respective regions; in person and on foot. A modified version of the World Health Organization - African Region (WHO/AFRO) Laboratory Strengthening Checklist was used to obtain baseline measures of quality for all clinical laboratories within Kampala city. The surveyors also measured other attributes of each laboratory, such as their affiliation (government, private etc), designation (national hospital, district hospital, standalone etc), staff numbers, and type of staff. RESULTS: The survey team identified and surveyed 954 laboratories in Kampala city. 96% of laboratories were private. Only 45 (5%) of the laboratories met or surpassed the lowest quality standards defined by the WHO/AFRO-derived laboratory strengthening tool (1-star). These 45 higher-quality laboratories were, on average, larger and had a higher number of laboratory-specific staff (technologists, phlebotomists etc) than the other 909 laboratories. 688 (72%) of the 954 laboratories were not registered with the Ministry of Health (MoH). CONCLUSIONS: This comprehensive evaluation of the number, scope, and quality of clinical laboratories in Kampala is the first published survey of its kind in sub-Saharan Africa. The survey findings demonstrated that laboratories in Kampala that had qualified personnel and those that had higher testing volumes, tended to be of higher-quality

Development and utilization of a decision support tool for the optimization of fertilizer application in smallholder farms in Uganda

This paper presents the development and pilot of the Fertilizer Optimization Tool (FOT), a decision support tool for use by extension agents in  advising smallholder farmers in Uganda in applying optimum (rather than maximum) fertilizer by considering the farmers’ financial abilities. The FOT is made up of three components which includes, the optimizer tool, the nutrient substitution table, and a fertilizer calibration tool. The FOT was developed using field trial data collected on specific agro-ecological zones and mapped using global positioning systems in 13 Sub-Saharan Africa countries. The FOT provides site- and farmer-specific fertilizer recommendations, providing both economic and environmental benefits. Results are based on a survey of 241 households, 57 technical personnel and tracking of 33 FOT users over a 3-season period. Results show a progressive shift in farmers’ attitude towards the value of fertilizer. More FOT users (71%) disagreed with the statement that fertilizers destroy soils, compared with  non-FOT users (52%). Crop yields (tons/ha) were significantly higher for crops receiving fertilizers compared to those not. While it is generally accepted that using fertilizer improves crop response and achieves better yields, the value of FOT was reported in terms of rationalization of investment by farmers. The average seasonal investment was approx. $43, giving a return on investment of over 107%. Given the evidence  generated from Uganda, there is a need for considering out scaling the FOT technology to other countries in Africa, which are faced with the same challenges of low fertilizer use among smallholder farmers. Using the mobile FOT app provides a further cost-effective opportunity to out scale the approach to benefit more smallholder farmers in sub-Saharan Africa. Further development of the FOT is suggested, particularly in the wake of increased focus on multi-nutrient fertilizer blends, and the need to adjust for soil PH, moisture, and long-term impacts of nutrient substitution. Key words: decision support tool, fertilizer optimization tool, precision agriculture, site-specific fertilizer recommendation

Global, regional, and national levels of maternal mortality, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantifi ed eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIVrelated maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specifi c reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profi le. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.GBD 2015 Maternal Mortality Collaborators ...Nicholas J Kassebaum ... Azmeraw T Amare ... Liliana G Ciobanu ... James Hancock ... Ratilal Lalloo ... Yohannes Adama Melaku ... John Nelson Opio ... G A Tessema ... et.al

Community pharmacists' contribution to public health: assessing the global evidence base

In the UK, community pharmacies are more accessible to the general population than general practices. Therefore, government white papers and briefing documents from pharmacy professional bodies have advocated the expansion of the role of community pharmacists, particularly in relation to the provision of services that contribute to disease prevention and health improvement. It is unknown whether the same evidence exists globally for the expansion of these roles. This article attempts to appraise and summarise the global evidence for the public health roles that community pharmacists play. Barriers, as well as strategies that can enhance these roles, are also discussed. Electronic databases were searched to retrieve relevant literature published since 1 January 2000. The selected literature included 2 meta-analyses, 7 literature reviews, 23 interventional studies and 41 descriptive studies. These were assessed according to health topics (i.e. smoking cessation, weight management, health promotion, disease screening and preventive activities, vaccination and immunisation, alcohol dependence advice and drug misuse, emergency hormonal contraception, and sexual health services). The effectiveness of community pharmacy-based public health interventions was shown in smoking cessation, health promotion, disease screening and preventive activities, provision of emergency hormonal contraceptive, and vaccination services. Although there was mixed evidence with respect to weight management and alcohol dependence advice interventions, the available data suggest feasibility and acceptability of these services due to the perceived ease of access and convenience