Building democracy from below : lessons from Western Uganda

How to achieve democratisation in the neopatrimonial and agrarian environments that predominate in sub-Saharan Africa continues to present a challenge for both development theory and practice. Drawing on intensive fieldwork in Western Uganda, this paper argues that Charles Tilly’s ‘democratisation as process’ provides us with the framework required to explain the ways in which particular kinds of association can advance democratisation from below. Moving beyond the current focus on how elite-bargaining and certain associational forms may contribute to liberal forms of democracy, this approach helps identify the intermediate mechanisms involved in building democracy from below, including the significance of challenging categorical inequalities, notably through the role of producer groups, and of building trust networks, cross-class alliances and synergistic relations between civil and political society. The evidence and mode of analysis deployed here help suggest alternative routes for supporting local efforts to build democracy from below in sub-Saharan Africa

High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>There is limited data on Methicillin resistant <it>Staphylococcus aureus </it>(MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA.</p> <p>Results</p> <p>One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of <it>Staphylococcus aureus</it>. Forty one <it>S. aureus </it>isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and <it>mecA/femA/nuc</it>-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and <it>ica </it>genes. One isolate positive for all determinants possessed the <it>bhp </it>homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCC<it>mec </it>type I was the most common at 54% prevalence (22/41), followed by <it>SCCmec </it>type V (15%, 6/41) and <it>SCCmec </it>type IV (7%, 3/41). <it>SCCmec </it>types II and III were not detected and 10 isolates (24%) were non-typeable.</p> <p>Conclusions</p> <p>Hyper-virulent methicillin resistant <it>Staphylococcus aureus </it>is prevalent in the burns unit of Mulago hospital.</p

Neonatal invasive candidiasis in low-and-middle-income countries: data from the NeoOBS study

Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole resistant Candida spp. isolates in low-and-middle-income -countries (LMICs) compared to high-income-countries (HIC). We describe the epidemiology, Candida spp. distribution, treatment and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalised infants < 60 days postnatal age with sepsis (August 2018-February 2021). 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34) and median birth weight was 1270 g (IQR: 990-1692). Only a minority had high risk criteria, such as being born < 28 weeks, 19% (24/127), or birth weight < 1000 g, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%) and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrolment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines

The impact of career ambition on psychologists' extrinsic and intrinsic career success The less they want, the more they get

Purpose - The purpose of this paper is to investigate the relationship between career ambition - defined as high achievement motivation and strong career orientation - and both extrinsic (salary, position) and intrinsic success (job satisfaction, goal attainment) of psychologists. Over and above this, the authors explore whether extrinsic success predicts intrinsic success or vice versa.Design/methodology/approach - In order to analyze the impact of career ambition on extrinsic and intrinsic success, the authors conducted two online studies with psychology graduates - a cross-sectional study (Study 1; n =119) and a longitudinal one (Study 2; n = 63; two-three years interval between assessment points). The authors applied regression and cross-lagged analyses to investigate the interplay of career ambition and career success.Findings - The results show that career ambition impacts on both extrinsic and intrinsic success. More specifically, extrinsic success was positively predicted by career orientation in Study 1. In contrast, achievement motivation was negatively related to intrinsic success (Study 1) and even diminished it over time (Study 2). Findings of the cross-lagged analysis further underlined that intrinsic success predicts extrinsic success.Originality/value - The study contributes by separately investigating two aspects of career ambition and showing their different effects on career success in the specific profession of psychologists. As cross-lagged findings revealed that psychologists' intrinsic success predicted their extrinsic success and not vice versa, the authors discuss whether psychologists might be worsening their career development in the long run by showing high achievement motivation

Improving Nurses Knowledge and Practices of Delirium Assessment at Mbarara Regional Referral Hospital: A Quasi Experimental Study

Eric Baluku Murungi,1 Vallence Niyonzima,1 Evas Atuhaire,1 Susan Nantume,2 Esther Beebwa1 1Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda; 2Masaka School of Comprehensive Nursing, Masaka City, UgandaCorrespondence: Vallence Niyonzima, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda, Tel +256777842830, Email [email protected]: Despite the recommendations for delirium assessment in clinical settings, it stills remain a serious clinical problem associated with prolonged mechanical ventilation, stress on the patient and family, and mortality. There is paucity of data regarding delirium assessment and prevention in developing world. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was developed to aid in the assessment of delirium. There is no documented assessment of delirium and prevention in Uganda. This study evaluated the effect of an educational intervention on nurses’ knowledge and practices of delirium assessment using the CAM–ICU tool.Methods: We used a quasi-experimental and recruited a convenience sample of 29 nurses from ICU and ER. The assessment before and after the interventions was conducted using a self-completed questionnaire from October 2020 to January 2021. The interventions were delivered through face-to-face presentations, demonstrations, watching videos, and hands on practice. Data were entered into excel, cleaned and exported to Stata version 14. Median and interquartile ranges were used for continuous variables, and frequencies and percentages for categorical variables. The mean knowledge score was calculated before and after the intervention. A paired t-test was used to compare Pre- and Post-test knowledge and practice scores at P < 0.05.Results: Majority (62%) were female, 48% were Diploma holders, median age was 30 (IQR = 28– 32) years and median years of experience 3.5 (IQR = 3– 4). The Mean knowledge scores was 10.7 (SD = 2.36) pretest and 19 (0.94) posttest. The mean practice score was 2 (SD = 0.83) pretest and 6 (0.35) posttest. There were significant differences in mean knowledge and practice scores before and after intervention mean of (t (28) =17.32, p < 0.001) and (t (28) = 25.04, p< 0.001), respectively.Conclusion: Educational intervention Improved nurses’ knowledge and practice of delirium assessment. Continuous nursing education could improve nurses’ knowledge of delirium assessment and thus quality of patient care.Keywords: nurse, delirium, assessment, knowledge, practice, CAM-IC

Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

<div><p>Introduction</p><p>Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control.</p><p>Materials and Methods</p><p>We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO.</p><p>Results</p><p>A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries.</p><p>Conclusions</p><p>Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the school going children were the most affected age groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics.</p></div

Evaluation of Schistosoma mansoni cercaricidal activity of Solamargine a steroid glycoalkaloid from Solanum syzybrilifolium

ABSTRACT- The cercaricidal activity of a mixed solamargine (1) and β-solamarine (2) solution were directly tested against Schistosoma mansoni cercariae and a time-concentration relationship was observed; the concentrations needed to kill all cercariae (LC100) within 10 min of exposure were 0.01 mg/mL. Mixed solamargine (1) and β-solamarine (2) solution have a high level of cercaricidal activity against free swimming cercariae and it seems to be ecologically safe, since it is known to have very low toxicity to fish. The possible use of such sublethal concentrations in schistosomiasis transmission sites as an oriented promising technique to control this parasite and to minimize or prevent water pollution with pesticides

Reported cross-border cholera cases in Malawi and Uganda in 2015.

<p>Reported cross-border cholera cases in Malawi and Uganda in 2015.</p

Laboratory results of the cross-border cholera cases seen in Uganda and Malawi in 2015.

<p>Laboratory results of the cross-border cholera cases seen in Uganda and Malawi in 2015.</p