The impact of advocacy and community mobilization on the utilization of health services at the Comprehensive Health Centre, Gindiri.

Primary Health Care facilities provide promotive, preventive, curative and rehabilitative services to a community. They may be well built and equipped with adequate resources but grossly underutilized due to several factors. Health records at the Comprehensive Health Centre Gindiri for 2005 were compared with those of 2007 after a wellcoordinated advocacy and mobilization programme in that community. The results show that the total out patient attendance in 2007 increased by 220.6% when compared to that of 2005. 293 patients were admitted into the wards in 2005 compared to 813 in 2007(277%). There was no surgery carried out in the whole of 2005, whereas in 2007 there were 98 surgeries. Advocacy and community mobilization could be important factors in the utilization of primary health service

Farmers’ knowledge on forage production in smallholder dairy systems of Uganda

The aim of the study was to assess dairy farmers’ knowledge on forage production and utilization in the Lake Victoria crescent and Eastern Highlands Agro Ecological Zones (AEZs) of Uganda. Semi-structured questionnaires were administered to a total of 208 small holder dairy farmers in Masaka (100) and Mbale (108) districts. Data was analyzed using Statistical Package for Social Scientists. While the main source of forage is on farm (67.2%), forage growing is not taken as a tradition among small holder dairy farmers. The most prominent forage species used for feeding livestock are Pennisetum purpureum, Calliandra calothyrsus, Musa paradisiacal (peelings and stems), and Leucaena leucocephala. Milk production increases during months of forage abundance (March to May and September to November) and the observed trends are generally comparable to the seasonal rainfall patterns in Uganda. Forage production among dairy farmers is significantly (P < 0.05) influenced by location, household size, land ownership, forage source and livestock feeding system. Apart from chopping before feeding the animals, minimal processing is done to forage. The study provides a basis for designing interventions for improving fodder production and utilization among Uganda’s smallholder dairy farmers.Buyinza Joel, Sekatuba Jude, Ongodia Gerald, Eryau Kenneth, Nansereko Susan, Opolot Ibwala Vincent, Kwaga Phiona, Akellem Richard, Mudondo Scovia and Agaba Hillar

Frequency of Cryptococcal Meningitis in HIV-1 Infected Patients in North Central Nigeria

Background: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality. There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile.Methods: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH), A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany).Results: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting (55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 &plusmn;22 days with a median of 17 days. The mean CD4 count was 89&plusmn;60 cells/mm3 with a median of 82 cells/mm3.Conclusion: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.Key words: Cryptococcal meningitis, HIV, North central Nigeri

Genetic variability and gain for storage root yield and yield components in yam beans

There is limited information on the genetic parameters and genetic gain of yam bean ( Pachyrhizus species) accessions introduced to Rwanda. No comprehensive literature exists on the inheritance of yield and yield components, on segregating populations. This study investigated variability, heritability and genetic advance in F2 yam bean genotypes. Seven F2 yam bean hybrids were evaluated at the Rubona Research Station located in Southern Province of Rwanda, during growing season 2014B. Results revealed significant (P&lt;0.01) genetic variability in plant vigour (PV), pod weight (WOP), plant height (PHT), 100 seed weight (100SW), total biomass yield (TBY), storage root yield (SRY), dry matter content (DMC), and starch content (STA). High genetic (\u3c32g) and phenotypic (\u3c32p) variances, and genotypic coefficients of variation (GCV&gt; 25%) were observed for WOP, PHT, 100SW, TBY, DMC and STA. Estimates of heritability (H2) were high (greater than 50%) for all traits, except for seed yield, number of roots and number of pods. The GA and genetic advance, as percentage of the mean (GAM%), were high for PV, WOP, PHT, 100SW, TBY and DMC. There were positive and significant (P&lt;0.05) associations between PV and PHT, protein content (PRO), 100SW, TBY, SRY, and DMC. Dry matter content also had positive and significant (P&lt;0.01) correlations with STA. These results indicate presence of high genetic variability, heritability and expected genetic gain suggesting potential for genetic improvement of plant vigour, weight of pods, plant height, 100 seed weight, total biomass yield, storage root fresh yield, dry matter content and starch content of yam beans in Rwanda.Il existe peu d\u2019informations sur les param\ue8tres g\ue9n\ue9tiques et le gain g\ue9n\ue9tique des accessions de haricot-igname (esp\ue8ce Pachyrhizus ) introduites au Rwanda. Il n\u2019existe pas de litt\ue9rature compl\ue8te sur l\u2019h\ue9r\ue9dit\ue9 du rendement et des composantes du rendement, sur la s\ue9gr\ue9gation des populations. Cette \ue9tude a \ue9tudi\ue9 la variabilit\ue9, l\u2019h\ue9ritabilit\ue9 et l\u2019avanc\ue9e g\ue9n\ue9tique des g\ue9notypes de haricot-igname F2. Sept hybrides de haricot-igname F2 ont \ue9t\ue9 \ue9valu\ue9s \ue0 la Station de Recherche de Rubona situ\ue9e dans la Province M\ue9ridionale du Rwanda, pendant la saison agricole 2014B. Les r\ue9sultats ont r\ue9v\ue9l\ue9 une variabilit\ue9 g\ue9n\ue9tique significative (P &lt;0,01) de la vigueur de la plante (PV), du poids de la gousse (WOP), de la hauteur de la plante (PHT), du poids de 100 graines (100SW), du rendement total en biomasse (TBY), du rendement des racines de stockage (SRY), teneur en mati\ue8re s\ue8che (DMC) et teneur en amidon (STA). Des variances g\ue9n\ue9tiques (\u3c32g) et ph\ue9notypiques (\u3c32p) \ue9lev\ue9es et des coefficients de variation g\ue9notypiques (GCV&gt; 25%) ont \ue9t\ue9 observ\ue9s pour WOP, PHT, 100SW, TBY, DMC et STA. Les estimations de l\u2019h\ue9ritabilit\ue9 (H2) \ue9taient \ue9lev\ue9es (sup\ue9rieures \ue0 50%) pour tous les caract\ue8res, \ue0 l\u2019exception du rendement en graines, du nombre de racines et du nombre de gousses. Le GA et l\u2019avance g\ue9n\ue9tique, en pourcentage de la moyenne (GAM%), \ue9taient \ue9lev\ue9s pour PV, WOP, PHT, 100SW, TBY et DMC. Il y avait des associations positives et significatives (P &lt;0,05) entre PV et PHT, la teneur en prot\ue9ines (PRO), 100SW, TBY, SRY et DMC. La teneur en mati\ue8re s\ue8che avait \ue9galement des corr\ue9lations positives et significatives (P &lt;0,01) avec le STA. Ces r\ue9sultats indiquent la pr\ue9sence d\u2019une variabilit\ue9 g\ue9n\ue9tique, d\u2019une h\ue9ritabilit\ue9 et d\u2019un gain g\ue9n\ue9tique attendus \ue9lev\ue9s sugg\ue9rant un potentiel d\u2019am\ue9lioration g\ue9n\ue9tique de la vigueur des plantes, du poids des gousses, de la hauteur des plantes, du poids de 100 graines, du rendement total en biomasse, du rendement en racines fra\ueeches de stockage, de la teneur en mati\ue8re s\ue8che et en amidon de haricot-ignames au Rwanda

HERITABILITY, COMBINING ABILITY AND INHERITANCE OF STORAGE ROOT DRY MATTER IN YAM BEANS

Storage root dry matter content (RDM) is central to the improvement of consumer and industrial attributes of root crops. Yam bean ( Pachyrhizus species) is a legume root crop newly introduced in Uganda, but its adoption may be constrained by low RDM. The objective of this study was to investigate the magnitude of variance for general combining ability (GCA) and specific combining ability (SCA) effects, heritability estimates and inheritance of RDM in yam beans. Progenies of sixteen crosses, generated using the North Carolina (NCII) mating scheme, were evaluated in F1 and F2 field experiments, with three replications at the National Crops Resources Research Institute (NaCRRI), Namulonge in Central Uganda, during the first cropping seasons of April, 2013 and 2014, respectively. Significant (p&lt;0.001) mean squares for general combining ability (GCA), and specific combining ability (SCA) were observed in F1 and F2 generations, demonstrating additive and non-additive genetic inheritance of RDM. High Baker\u2019s ratio in F1 (0.76) and F2 (0.78), and large \u3c32GCA/ \u3c32SCA (3.13) indicate predominance of additive gene effects. Narrow sense heritability was high in both F1 (0.74) and F2 (0.75), implying that RDM can be improved in yam beans through selection. The results provide a basis for selection of suitable parents for hybridisation and breeding programmes to develop high dry matter yam bean varieties in Uganda.La teneur en mati\ue8res \ue8che du stock racinaire (MSR) est essentiel en terme d\u2019am\ue9lioration des qualit\ue9s des cultures racinaires pour les consommateurs et d\u2019industriels. Le haricot-igname (esp\ue8ce Pachyrhizus ) est une culture racinaire l\ue9gumineuse nouvellement introduite en Ouganda, mais son adoption pourrait \ueatre handicap\ue9e par sateneur basse en mati\ue8res \ue8che racinaire. Cette \ue9tude avait pour objectif d\u2019\ue9tudier le niveau de la variance pour les effets de la capacit\ue9 de combinaison g\ue9n\ue9rale et la capacit\ue9 de combinaison sp\ue9cifique, estimations de l\u2019h\ue9ritabilit\ue9 et l\u2019h\ue9ritage de MSR dans les haricots ignames. Les prog\ue9nies de seize croisements g\ue9n\ue9r\ue9s \ue0 l\u2019aide du syst\ue8me de croisement de la Caroline du Nord (NCII), ont \ue9t\ue9 \ue9valu\ue9s dans des essais en champs de F1 et F2 avec trois r\ue9p\ue9titions \ue0 l\u2019Institut National de Recherche sur les Ressources V\ue9g\ue9tales (NaCRRI), Namulonge en Ouganda, pendant les premi\ue8res saisons culturalesd\u2019 Avril 2013 et 2014, respectivement. Les carr\ue9s moyens significatifs (P&lt;0,001) de capacit\ue9 g\ue9n\ue9ralede combinaison et capacit\ue9 sp\ue9cifique de combinaison \ue9taient observ\ue9s dans les g\ue9n\ue9rations F1 et F2 d\ue9montrant ainsi un heritage g\ue9n\ue9tique additif et non additive de MSR. Le rapport \ue9lev\ue9 de Baker en F1 (0,76) et F2 (0,78), et \u3c32GCA/ \u3c32SCA (3.13) large indiquent la pr\ue9dominance des effets de g\ue8nes additifs. Une \ue9troite h\ue9ritabilit\ue9 d\u2019ordre de F1 (0.74) et F2 (0.75) \ue9tait observ\ue9e, ce qui implique que MSR peut \ueatre am\ue9lior\ue9 dans le haricot-igname par voie de s\ue9lection. Les r\ue9sultats constituent une base pour la s\ue9lection des parents appropri\ue9s pour les programmes d\u2019hybridation et d\u2019am\ue9lioration g\ue9n\ue9tique pour d\ue9velopper des vari\ue9t\ue9s de haricot-ignames \ue0 haute teneur en mati\ue8res\ue8 che en Ouganda

Fluid balance concepts in medicine: Principles and practice.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance

Human immunodeficiency virus type-1 (HIV-1) genetic diversity and prevalence of antiretroviral drug resistance mutations in treatment-naïve adults in Jos, North Central Nigeria

The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine efficacy and drug resistance. It is important to know the circulating genetic variants and associated drug-resistance mutations in the context of scale up of antiretroviral therapy (ART) in Nigeria. The objective of this study was to determine the genetic diversity of HIV-1 and the prevalence of antiretroviral (ARV) drug resistance mutations among antiretroviral treatment-naïve HIV-1 infected patients in Jos, North Central Nigeria. Plasma samples were collected from 105 ARV drug-naïve patients enrolled for HIV care at the Jos University Teaching Hospital (JUTH) HIV Treatment Center between October 2010 and April 2011. One hundred (100) samples were successfully amplified. Viral subtyping was done using REGA subtyping tool and by phylogenetic analysis using PAUP software. The drug resistance mutations were determined using the Stanford University HIVdb sequence interpretation algorithm. HIV-1 subtypes identified were; CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). 8% of the patients’ isolates had at least one major resistance mutation in the RT gene: Nucleoside reverse transcriptase inhibitors: M41L (1%), K65KR (1%), M184IM (1%), M184V (2%) and T215ADNT (1%), non-nucleoside reverse transcriptase inhibitors: K103N (2%), K101E (1%), G190A (1%), P225HP (1%), Y181I (1%), Y188L (1%), and Y181C (1%). Among antiretroviral (ARV) naïve patients in Jos, North Central Nigeria, the common HIV-1 subtypes was CRF_02 and G. And the prevalence of drug resistance mutations was found to be high (8%). Further study and national surveillance will be critically important to understand the clinical impact of transmitted resistance mutations on ART naïve individuals in resource limited settings.Keywords: HIV-1 subtypes, antiretroviral (ARV), treatment-naïve, drug-resistance, mutation, accessory and polymorphisms, NigeriaAfrican Journal of Biotechnology Vol. 12(17), pp. 2279-228

The epidemiology of conjunctival squamous cell carcinoma in Uganda

As part of a larger investigation of cancer in Uganda, we conducted a case–control study of conjunctival squamous cell carcinoma in adults presenting at hospitals in Kampala. Participants were interviewed about social and lifestyle factors and had blood tested for antibodies to HIV, KSHV and HPV-16, -18 and -45. The odds of each factor among 60 people with conjunctival cancer was compared to that among 1214 controls with other cancer sites or types, using odds ratios, estimated with unconditional logistic regression. Conjunctival cancer was associated with HIV infection (OR 10.1, 95% confidence intervals [CI] 5.2–19.4; P<0.001), and was less common in those with a higher personal income (OR 0.4, 95% CI 0.3–1.2; P<0.001). The risk of conjunctival cancer increased with increasing time spent in cultivation and therefore in direct sunlight (χ2 trend=3.9, P=0.05), but decreased with decreasing age at leaving home (χ2 trend=3.9, P=0.05), perhaps reflecting less exposure to sunlight consequent to working in towns, although both results were of borderline statistical significance. To reduce confounding, sexual and reproductive variables were examined among HIV seropositive individuals only. Cases were more likely than controls to report that they had given or received gifts for sex (OR 3.5, 95% CI 1.2–10.4; P=0.03), but this may have been a chance finding as no other sexual or reproductive variable was associated with conjunctival cancer, including the number of self-reported lifetime sexual partners (P=0.4). The seroprevalence of antibodies against HPV-18 and -45 was too low to make reliable conclusions. The presence of anti-HPV-16 antibodies was not significantly associated with squamous cell carcinoma of the conjunctiva (OR 1.5, 95% CI 0.5–4.3; P=0.5) and nor were anti-KSHV antibodies (OR 0.9, 95% CI 0.4–2.1; P=0.8). The 10-fold increased risk of conjunctival cancer in HIV infected individuals is similar to results from other studies. The role of other oncogenic viral infections is unclear

New sources and stability of resistance to aphids in cowpea germplasm across locations in Uganda

Open Access ArticleThe cowpea aphid (Aphis craccivora Koch) is an economically important pest, whose feeding effects cause stunting, delayed flower initiation and yield reduction in cowpea (Vigna unguiculata L. Walp). Host plant resistance offers an alternative for controlling aphids; while simultaneously reducing reliance on chemical pesticides. The objective of this study was to evaluate a multi-parent advanced generation inter-cross (MAGIC) population of cowpea against aphids, across cowpea growing regions in Uganda. The study was arranged in alpha lattice design, with two replicates in three locations over two seasons (2018B and 2019A). Results revealed significant effects (P<0.001) for the main treatment effects, genotype x location and location x season interaction for both infestation and damage. The genotype x season interaction was significant (P<0.01) for both aphid infestation and damage; while the three-way interaction was only significant (P<0.001) for aphid infestation, but not for damage. The study identified five new resistant and stable genotypes from the MAGIC panel, including MAGIC131, MAGIC-132, MAGIC149, MAGIC170 and MAGIC280; and one resistant parent, SUVITA-2. The study further revealed MAGIC-125, MAGIC-171, MAGIC153, MAGIC-333, MAGIC177, MAGIC-292, MAGIC282, MAGIC249, MAGIC162, SEC 4W * SEC 5T, NAROCOWPEA 4, MAGIC-204, MAGIC-039, MAGIC060, MAGIC-097, NAROCOWPEA 3, MAGIC-233, MAGIC090 and MU 9 to be moderately resistant and high yielding genotypes. The above genotypes are recommended for use in the cowpea breeding programme, to develop improved resistant lines against aphids in Uganda

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

Background. Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.Objective. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs).Methods. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.Results. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64, 95% CI 0.57 - 0.71; p&lt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 - 1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 - 1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 - 1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 - 0.56; p&lt;0.00001.Conclusions. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent