Putting the C Back into the ABCs: A Multi-Year, Multi-Region Investigation of Condom Use by Ugandan Youths 2003-2010

A major strategy for preventing transmission of HIV and other STIs is the consistent use of condoms during sexual intercourse. Condom use among youths is particularly important to reduce the number of new cases and the national prevalence. Condom use has been often promoted by the Uganda National AIDS Commission. Although a number of studies have established an association between condom use at one's sexual debut and future condom use, few studies have explored this association over time, and whether the results are generalizable across multiple locations. This multi time point, multi district study assesses the relationship between sexual debut and condom use and consistent use of condoms thereafter. Uganda has used Lot Quality Assurance Sampling surveys since 2003 to monitor district level HIV programs and improve access to HIV health services. This study includes 4518 sexually active youths interviewed at five time points (2003-2010) in up to 23 districts located across Uganda. Using logistic regression, we measured the association of condom use at first sexual intercourse on recent condom usage, controlling for several factors including: age, sex, education, marital status, age at first intercourse, geographical location, and survey year. The odds of condom use at last intercourse, using a condom at last intercourse with a non-regular partner, and consistently using a condom are, respectively, 9.63 (95%WaldCI = 8.03-11.56), 3.48 (95%WaldCI = 2.27-5.33), and 11.12 (95%WaldCI = 8.95-13.81) times more likely for those individuals using condoms during their sexual debut. These values did not decrease by more than 20% when controlling for potential confounders. The results suggest that HIV prevention programs should encourage condom use among youth during sexual debut. Success with this outcome may have a lasting influence on preventing HIV and other STIs later in life

Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda.

BACKGROUND: National or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making. Health facility programme data, collected during service delivery is widely available, but since people self-select for HIV testing, HIV prevalence estimates based on it, is subject to selection bias. We present a statistical annealing technique, Hybrid Prevalence Estimation (HPE), that combines a small population-based survey sample with a facility-based sample to generate district level HIV prevalence estimates with associated confidence intervals. METHODS: We apply the HPE methodology to combine the 2011 Uganda AIDS indicator survey with the 2011 health facility HIV testing data to obtain HIV prevalence estimates for districts in Uganda. Multilevel logistic regression was used to obtain the propensity of testing for HIV in a health facility, and the propensity to test was used to combine the population survey and health facility HIV testing data to obtain the HPEs. We assessed comparability of the HPEs and survey-based estimates using Bland Altman analysis. RESULTS: The estimates ranged from 0.012 to 0.178 and had narrower confidence intervals compared to survey-based estimates. The average difference between HPEs and population survey estimates was 0.00 (95% CI: - 0.04, 0.04). The HPE standard errors were 28.9% (95% CI: 23.4-34.4) reduced, compared to survey-based standard errors. Overall reduction in HPE standard errors compared survey-based standard errors ranged from 5.4 to 95%. CONCLUSIONS: Facility data can be combined with population survey data to obtain more accurate HIV prevalence estimates for geographical areas with small population survey sample sizes. We recommend use of the methodology by district level managers to obtain more accurate HIV prevalence estimates to guide decision making without incurring additional data collection costs

Economic losses associated with respiratory and helminth infections in domestic pigs in Lira district, Northern Uganda.

This study sought to quantify direct economic losses due to respiratory and gastrointestinal (GI) helminth infections in domestic pigs in Uganda. In a longitudinal study design with repeated measures, farm visits were made at 2 month intervals from October 2018 to September 2019. Weaner and grower pigs (n = 288) aged 2-6  months from 94 farms were sampled. The pigs were monitored for growth and screened for exposure to four important respiratory pathogens: porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSv), Mycoplasma hyopneumoniae (M. hyo), Actinobacillus pleuropneumoniae (App) using ELISA tests. Farm management practices were recorded and used to generate management level scores. Treatment expenses incurred were recorded throughout the study. A mixed effects model was fitted to quantify effects of respiratory and helminth infections on average daily weight gains (ADGs), with farm and pig as random effects. Analysis of variance (ANOVA) was used to determine differences in mean treatment costs by farm management standard. Financial losses were estimated from average carcass dressing percentage, ADG reductions during fattening (200  days). Results showed a grower pig in a given farm exposed to PRRSv and Ascaris spp. had significantly lower ADG by 17.10 gr/day and 16.80 grams/day respectively, compared to a similar unexposed pig (p < 0.05). Mean treatment costs per pig declined significantly with increase in management standard scores (MSS), from USD 1.13 per pig in MSS 1 (poor management) farms to USD 0.95 for MSS 3 (better management) farms (p < 0.05). We show that monetary losses due to PRRSv and Ascaris spp. infection amounted to USD 6.6 ± 2.7 and 6.50 ± 3.2 (Mean ± SEM) per pig, respectively during 200 days of fattening. This study strengthens evidence that improving management practices to reduce infections mitigates economic losses. To guide interventions, further studies are required to unravel the full extent of indirect economic losses

Economics of Insecticide use and Potential for Bt Maize Varieties in the Control of Stalkborer in Kenya.

Maize is the staple food crop and source of income for majority of the Kenyan population and many sub-Saharan African countries. The increasing Kenyan population demands an increase in maize production if intermittent food deficits have to be averted. Since the introduction of improved maize varieties in mid-1960, the start of Green Revolution period, maize yields increased drastically up to 1970s and started declining from 1980s to-date. The key contributory factors are nutrient mining, sub-optimal input use and insect pest damage. Of the insect pests, stalk borer is of economic importance. Currently, KARI and CIMMYT are developing maize varieties that are tolerant to stalk borer damage. In order to evaluate the potential impact of these interventions economics of stalk borer control at farm level was evaluated. Surveys complemented with on-farm trials were executed in six major maize growing zones of Kenya. Farmers were randomly selected and a sample-frame established after which a total of 1854 households were randomly selected using random sampling technique. Each household was interviewed using structured questionnaire. Data on method of stalk borer control and the type insecticides used was collected. Partial budget and economic surplus models were used. The results indicated that very few farmers control stalk borer in maize despite significant stalk borer losses of about 15%. Therefore if Bt maize is introduced in Kenya it is likely to reduce these losses. This will benefit many hungry and poor Kenyans with improved household food supply and on farm incomes, in line with Government policy of food security and poverty eradication.Crop Production/Industries,

The role of environmental, structural and anthropogenic variables on underpass use by African savanna elephants (Loxodonta africana) in the Tsavo Conservation Area

Wildlife crossing structures are effective interventions for mitigating fragmentation of habitats by linear infrastructure. The 2017 construction of a new railway cutting through the Tsavo Con- servation Area (TCA), home to the largest elephant population in Kenya, affected wildlife movement and habitat connectivity. Although numerous studies have investigated the use of wildlife crossing structures by a wide range of species, few have focused on their use by mega- herbivores. In this study, we examined use of 41 wildlife crossing structures by African savanna elephants (Loxodonta africana) along a 133 km section of new railway in Tsavo, Kenya. We used a generalized linear mixed modeling approach to assess the relationship between elephant crossing rate over 28 months between July 2017 to April 2021 and explanatory factors including crossing structure attributes, livestock presence and proximity to highways, water points and human settlement. We found that structural attributes of crossing structures were most strongly associ- ated with the elephant crossing rate, particularly height and its interaction with type of crossing structure (bridges, wildlife underpasses and culverts). Higher crossing structures were associated with higher crossing rate, with the largest influence of height at culverts and wildlife underpasses. Although bridges comprised only 19.5 % of the 41 available crossing structures, they accounted for a disproportionately high number of elephants crossing events (56 %). The results demon- strated the importance of bridges over designated crossing structures for elephants, with pre- dicted seasonal counts of elephant crossings being 0.31 for average sized culverts, 2.88 for wildlife underpasses and 5.86 for bridges. The environmental and anthropogenic variables were not strongly associated with elephant crossing rate. Our findings have direct application for future siting and design of crossing structures across elephant rang

Investment Opportunities for Livestock in the North Eastern Province of Kenya: A Synthesis of Existing Knowledge

Pastoralism is the dominant livelihood activity in the North Eastern Province (NEP) of Kenya. It is supplemented only by a limited amount of agriculture along the rivers. The province faces various developmental challenges including chronic poverty and food insecurity, low human capital and poor health standards, high vulnerability to climate change, poor infrastructure, insecurity and low crop and livestock productivity. This study synthesises existing knowledge and provides recommendations on livestock investments to increase incomes, create employment and reduce food insecurity in the province. It examines investment opportunities in livestock and presents scenarios that meet the objectives of Kenya’s 2030 vision. Four scenarios are analysed. The first scenario consists of the business-as-usual case: a vision of the state of the livestock sector, and its contribution to NEP and national economy, if the current trajectory is maintained. The second scenario outlines a strategy that focuses on catering to domestic demand for livestock products. The third scenario focuses on feeding foreign demand for live animals, while the fourth scenario investigates the possibilities of a livestock sector driven by exports of processed livestock products. Also in these investment scenarios, the broad-based growth contribution to the economy is discussed. The analysis indicates that all three alternative scenarios have far better impacts on pastoralists’ income and employment than the ‘business-as-usual’ scenario. The second scenario is found to have the largest favourable impact. Besides creating jobs and income opportunities, it provides alternatives to meet the growing livestock product consumption spurred by population increase, rising incomes and urbanization in Kenya. However, there are several requirements for this scenario to work and yield the desired impact. The need for creating a favourable investment climate is discussed and specific roles of the public and private sectors are explained

Difference in HIV prevalence by testing venue:results from population level survey in Uganda

Growing demand for use of Health Facility (HF) HIV testing data, in addition to other testing data to obtain district level HIV prevalence requires understanding the comparability of these various sources. We analysed the 2011 Uganda AIDS indicator survey data to assess: the proportion of people tested for HIV across Uganda by venue of testing; HIV prevalence ratio for those tested in a HF compared to those tested in community setting; [Katz, D., Baptista, J., Azen, S. P., & Pike, M. C. (1978). Obtaining confidence intervals for the risk ratio in cohort studies. International Biometric Society, 34(3), 469-474. https://doi.org/10.2307/2530610] and factors associated with HIV positivity in each subgroup. Of the 11,685 individuals, 8978 (77.1%) had ever tested for HIV in a HF. Fifty nine per cent tested in a HF in the 12 months preceding the survey (female: 5507, 72.7% versus male: 1413, 34.9%). HIV prevalence ratio was 1.8 times among those tested in a HF compared to those tested at community setting (10.9% [95% CI: 10.0-11.7] versus 6.2% [95% CI: 5.4-7.0]). Among HF testers, older age group, previously married and having no sexual partner was associated with significantly higher HIV prevalence. Using facility testing data for planning and decisions should take into consideration the elevated and varying HIV prevalence among individuals accessing HIV testing services at HFs as well as differences in their social-demographic characteristics