Sweet potato viruses in Uganda: identification of a new virus, a mild strain of an old virus and reversion

In 2009, a sweet potato begomovirus (sweepovirus) was detected for the first time in Uganda. An isolate was sequenced, providing the first full sequence of a sweepovirus from mainland Africa which differed from other sweepoviruses by at least 13%, discriminating this isolate as a new species, ‘Sweet potato leaf curl Uganda virus’ (SPLCUV). SPLCUV was quite common in cultivars (cvs) Ejumula, New Kawogo and 318L having uneven distribution in infected plants and reversion to healthy occurred, especially in cv New Kawogo. SPLCUV was observed not to be synergised by Sweet potato chlorotic stunt virus (SPCSV), apparently making it the first report of a sweet potato virus not synergised by SPCSV. Besides SPLCUV, a ‘mild’ SPCSV strain that induced purpling symptoms and 50% yield reduction similar to wild type SPCSV when infecting alone was identified from Busia district, Uganda. ‘Mild’ SPCSV was never observed to be co-infected with Sweet potato feathery mottle virus (SPFMV) in farmers’ fields. Experimentally, ‘mild’ SPCSV induced mild symptoms in Ipomoea setosa and sweet potato plants and SPFMV titre was greater in co-infections of SPFMV and wild type SPCSV than in co-infections of SPFMV and ‘mild’ SPCSV. Both RNase3 (accession No. HE575406) and p22 (accession No. HE575409) genes on RNA1 of ‘mild’ SPCSV compared closely to those reported previously. Instead, RNA1 region appears to be expressed less in the ‘mild’ SPCSV infection than in the wild type SPCSV infection though RNA2 continues to be more expressed in the ‘mild’ SPCSV infection than in the wild type SPCSV infection. Recovery from SPVD symptoms and reversion from SPFMV were observed in cv Kampala White co-infected with ‘mild’ SPCSV and SPFMV. Reversion from SPFMV single infections occured in several landraces with higher rates observed in shoots of resistant than susceptible cultivars. Overall, cv NASPOT 11 was the fastest to revert while cv Beauregard was the slowest

A case of massive splenomegaly due to chronic myeloproliferative neoplasm

A 34-year-old female, HIV non-reactive, presented to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, complaining of 7 months abdominal pain. She endorsed shortness of breath and early satiety for the same duration, but denied fever, chills, night sweats, and weight loss. The remainder of her review of systems was negative. She had no significant past medical history. There were no identifiable risk factors for myeloproliferative disorders, including family history, known genetic syndromes, chemical exposure, or history of ionizing radiation. On physical exam, she was noted to have a visible spleen (figure 1) which crossed into the right upper quadrant as well as the pelvis, and was non-tender to palpation. There was no cervical or axillary lymphadenopathy. The remainder of her exam was unremarkable

Community vaccine perceptions and its role on vaccination uptake among children aged 12-23 months in the Ileje District, Tanzania: a cross section study

Introduction: Underutilization of vaccines still remains a challenge in many regions across the world. Ileje district is one of the districts in Tanzania with consistently low pentavalent vaccine uptake (69%) and with drop out of 15%. We determined the vaccination completion with regard to Oral Polio virus, Measles, Bacillus Calmette-Guérin, and pentavalent vaccines and its association with community perceptions on vaccines. Methods: We conducted a cross sectional study in Ileje district from October to December 2013. We sampled 380 mothers using a multistage random sampling technique. We analysed data using EPI INFO. We summarized descriptive variables using mean and standard deviation and categorical variables using proportions. We conducted bivariate and multivariate logistic regression to identify factors influencing vaccination uptake, statistical significance was assessed at 95% confidence interval. Results: Mean age of the mothers was 27 years (SD 6.5 years) while that of their children was 16 months (SD 3.6 months). Fully vaccinated children were 71.1% and partially vaccinated were 28.9%, 99.2% were vaccinated with BCG vaccine and 73.4% were vaccinated with all OPV vaccine. Predictors of vaccination completion included negative perception on the vaccine provider-client relationship (AOR 1.86, 95%CI1.03-3.35), Perceived satisfaction with vaccination services (AOR 2.63, 95%CI 1.1 - 6.3). Others include child being born in the health facility (AOR 13.8 95% CI 8.04-25.8) and younger age of a child (AOR 0.51, 95%CI 0.29-0.9). Conclusion: improving quality of vaccination services, promoting health education and sensitizing community on health facility delivery will improve child vaccination completion in the districtPan African Medical Journal 2016; 2

Response of cowpea germplasm to bacterial blight in Uganda

Cowpea (Vigna unguiculata (L.) walp) is a legume crop mainly grown on small scale in low–input farming systems in Uganda. Cowpea bacterial blight (CoBB) disease caused by Xanthomonas axonopodis pv. vignicola (Burkh.) Dye is increasingly becoming a major hindrance to cowpea productivity. Sixty-four cowpea genotypes were evaluated for their response to bacterial blight disease (CoBB). Field experiments were carried out during the first and second rainy seasons using alpha lattice design with three replications. Data on disease incidence and severity, grain yield, days to 50% flowering, number of seeds per pod, pod length, number of peduncles per plant, and number of branches per plant were collected. Disease severity and incidence data was used to determine relative Area Under Disease Progress Curve (rAUDPC). Results showed significant differences (P ≤ 0.001) among the genotypes for rAUDPC in each season. The rAUDPC across the seasons indicated that genotypes NE 32, WC 32A, WC 26 and NE 44 with rAUDPC values ranging from 0.22 to 0.26 were resistant to CoBB whereas genotypes NE 31 and NE 40 with rAUDPC values 0.44 and 0.46 respectively were susceptible. The rAUDPC did not show any significant correlation with days to 50% flowering, yield and its components. This study suggested that the genotypes NE 32, WC 32A, NE 44, and WC 26 be used as prospective parents in breeding initiatives to develop bacterial blight-resistant varieties due to their high yields and resistance to CoBB

Paradigm shift: contribution of field epidemiology training in advancing the “One Health” approach to strengthen disease surveillance and outbreak investigations in Africa

The occurrence of major zoonotic disease outbreaks in Sub-Saharan Africa has had a significant impact on the already constrained public health systems. This has, as a result, justified the need to identify creative strategies to address threats from emerging and re-emerging infectious diseases at the human-animal-environmental interface, and implement robust multi-disease public health surveillance systems that will enhance early detection and response. Additionally, enhanced reporting and timely investigation of all suspected notifiable infectious disease threats within the health system is vital. Field epidemiology and laboratory training programs (FELTPs) have made significant contributions to public health systems for more than 10 years by producing highly skilled field epidemiologists. These epidemiologists have not only improved disease surveillance and response to outbreaks, but also improved management of health systems. Furthermore, the FETPs/FELTPs have laid an excellent foundation that brings clinicians, veterinarians, and environmental health professionals drawn from different governmental sectors, to work with a common purpose of disease control and prevention. The emergence of the One Health approach in the last decade has coincided with the present, paradigm, shift that calls for multi-sectoral and cross-sectoral collaboration towards disease surveillance, detection, reporting and timely response. The positive impact from the integration of FETP/FELTP and the One Health approach by selected programs in Africa has demonstrated the importance of multi-sectoral collaboration in addressing threats from infectious and non- infectious causes to man, animals and the environment.Pan African Medical Journal 2011; 10(Supp1):1

Risk factors for non-communicable diseases in rural Uganda: a pilot surveillance project among diabetes patients at a referral hospital clinic

<0.0001) and (30.7 vs. 13%; p<0.0001) respectively. Overweight, obesity and hypertension were more prevalent in women (18.6% vs. 9.7%, 8.6% vs. 2.6%; p<0.0001, and 40.3% vs. 33%, p=0.018) respectively. CONCLUSION: This pilot project shows that use of hospital-based data is a valuable initial step in setting up surveillance systems for NCDs in Uganda. Risk factors for NCDs were both age and gender-specific and predominantly related to lifestyle. This suggests the need to design gender-sensitive prevention interventions that target lifestyle modification in this setting

The Ethiopian Field Epidemiology and Laboratory Training Program: strengthening public health systems and building human resource capacity

The Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) is a comprehensive two-year competency-based training and service program designed to build sustainable public health expertise and capacity. Established in 2009, the program is a partnership between the Ethiopian Federal Ministry of Health, the Ethiopian Health and Nutrition Research Institute, Addis Ababa University School of Public Health, the Ethiopian Public Health Association and the US Centers of Disease Control and Prevention. Residents of the program spend about 25% of their time undergoing didactic training and the 75% in the field working at program field bases established with the MOH and Regional Health Bureaus investigating disease outbreaks, improving disease surveillance, responding to public health emergencies, using health data to make recommendations and undertaking other field Epidemiology related activities on setting health policy. Residents from the first 2 cohorts of the program have conducted more than 42 outbreaks investigations, 27analyses of surveillance data, evaluations of 11 surveillance systems, had28oral and poster presentation abstracts accepted at 10 scientific conferences and submitted 8 manuscripts of which 2are already published. The EFELTP has provided valuable opportunities to improve epidemiology and laboratory capacity building in Ethiopia. While the program is relatively young, positive and significant impacts are assisting the country better detect and respond to epidemics and address diseases of major public health significance

Cervical Cancer at Mbarara Regional Referral Hospital: Magnitude, Trends, Stages at Presentation, Impact of Acetic Acid Screening and the Need for Radiotherapy Services

Background: Globally, cervical cancer the fourth most common cause of cancer death accountable for approximately 266,000 deaths of women, with sub-Saharan Africa and East Africa having the highest burden. In Uganda about 2,275 new cervical cancer deaths occur annually. The main objective of the study was to describe the magnitude, trends, clinical stage on presentation and show the importance of cervical cancer prevention and radiotherapy services at Mbarara Regional Referral Hospital. Methods: This was a descriptive cross-sectional study. In the first phase of the study, leading cancers at Mbarara Regional Referral Hospital were determined.  In the second phase of the study, the burden of cervical cancer on the gynecological ward was determined. In the third part of the study the trends of cervical cancer over a ten year period was determined. In the fourth phase of the study the effects of acetic acid screening on the trends of cervical cancer was determined. Results: With a proportion of 25.2%, cervical cancer is the single leading cancer in the hospital. Cervical cancer contributes 10.1% of all diseases on the gynecological ward and 73.9% of all gynecological cancers.  The frequency of cervical cancer more than doubled between 2006 and 2014) with 60.3% of presenting with late stage. The number of cases of early cervical cancer detected had shown a small but steady increase since 2009. There was a decline in clinic cervical cancer incidence rate from 3.2% in 2009, 0.9% in 2013. Conclusion: Cervical cancer is the leading cancer and also the leading gynecological cancer at Mbarara Regional Referral Hospital. Women with cervical cancer are diagnosed late. Screening increases the rate of early detection. Acetic acid screening is effective in reversing the trends of cervical cancer. Expanding cervical cancer preventive services is capable of reducing the burden of cervical. Recommendations: There is need for expansion of HPV vaccination. There is need for expansion of acetic acid cervical cancer screening in southwestern Uganda. There is need for making radiotherapy services more accessible in developing countries. Keywords: Cervical Cancer, Magnitude, Trends, Stages, Impact, Acetic Acid, Screening, Radiotherapy

The prevalence of histologic acute chorioamnionitis among HIV infected pregnant women in Uganda and its association with adverse birth outcomes.

BACKGROUND: Preterm birth (PTB) is a leading cause of neonatal mortality and longer-term morbidity. Acute chorioamnionitis (ACA) is a common cause of PTB, however, there are limited data on the prevalence of ACA and its association with PTB in resource limited settings. METHODS: Data and samples came from a clinical trial evaluating novel strategies for the prevention of malaria in HIV infected pregnant women in Uganda. Women were enrolled between 12-28 weeks of gestation and followed through delivery. For each placenta delivered, three placental tissue types (membrane roll, umbilical cord and chorionic plate/villous parenchyma) were collected. Slides were assessed for diagnosis of maternal and fetal ACA by microscopic evaluation of neutrophilic infiltration using a standardized grading scale. The primary outcomes were PTB (<37 weeks), low birth weight (LBW, <2500 grams), and small-for-gestational age (SGA, birth weight <10th percentile for age). Univariate and multivariate logistic regression were used to estimate associations between 1) maternal characteristics (age, education, wealth, gravidity, gestational age at enrollment, placental malaria, anti-malarial prophylaxis treatment regimen, HIV disease parameters) and ACA, and 2) associations between ACA and adverse birth outcomes. FINDINGS: A total of 193 placentas were included in the analysis. The prevalence of maternal and fetal ACA was 44.5% and 28.0%, respectively. HIV infected women between 28-43 years of age had a higher risk of maternal ACA compared to those between 17-21 years of age (50.9% vs. 19.1%; aOR = 4.00 (1.10-14.5), p = 0.04) and the diagnosis of severe maternal ACA was associated with a significantly higher risk of PTB (28.6% vs. 6.0%; aOR = 6.04 (1.87-19.5), p = 0.003), LBW (33.3% vs. 9.4%; aOR = 4.86 (1.65-14.3); p = 0.004), and SGA (28.6% vs. 10.1%; aOR = 3.70 (1.20-11.4), p = 0.02). No maternal characteristics were significantly associated with fetal ACA and the diagnosis of fetal ACA was not associated with adverse birth outcomes. CONCLUSIONS: Histological evidence of severe maternal ACA was associated with an increased risk of PTB, LBW, and SGA in HIV infected, pregnant Ugandan women