Changing antimalarial drug resistance patterns identified by surveillance at three sites in Uganda.

: We assessed Plasmodium falciparum drug resistance markers in parasites collected in 2012, 2013, and 2015 at 3 sites in Uganda. The prevalence and frequency of parasites with mutations in putative transporters previously associated with resistance to aminoquinolines, but increased sensitivity to lumefantrine (pfcrt 76T; pfmdr1 86Y and 1246Y), decreased markedly at all sites. Antifolate resistance mutations were common, with apparent emergence of mutations (pfdhfr 164L; pfdhps 581G) associated with high-level resistance. K13 mutations linked to artemisinin resistance were uncommon and did not increase over time. Changing malaria treatment practices have been accompanied by profound changes in markers of resistance.<br/

SARS-CoV-2 Infection in Pregnant Women and Their Newborns.

There remain a number of uncertainties globally about the risks posed to women who are infected with SARS-CoV-2 during pregnancy. Furthermore, our understanding of the spread of COVID-19 in Sub-Saharan Africa is limited, owing to low testing rates in many parts of the continent. PeriCOVID Africa, in conjunction with the WHO/HRP Alliance, plans to address these knowledge gaps by harnessing research infrastructures in place in five sub-Saharan African countries in order to screen more than 50,000 pregnant women and their infants for SARS-CoV-2, while monitoring pregnancy and neonatal outcomes. We anticipate that the results of this study will provide much needed information about the risks that SARS-CoV-2 poses to pregnant women and their babies, as well as establishing potential routes of mother-to-child transmission

The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. A cluster-randomized trial was conducted from 2010-13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 95\% CI: 0.56, 1.17 p = 0.24). Most children (76.0\%) tested positive by reference mRDT, but many were not prescribed AL (22.5\% intervention versus 25.9\% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3\% invention vs 42.4\% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing seen elsewhere. Broader investment in health systems, including infrastructure and staffing, will be required to improve fever case management

Technical report on the environmental monitoring of the cage area at the Source of the Nile (SON) Fish Farm for Quarter 4: October – December 2017

The monitoring of water quality and biotic communities at Source of the Nile (SON) fish farm area, for quarter 4 (October – December) was undertaken in December 2017. The activity aimed at assessing possible changes in the water environment at SON cage area. The following parameters were assessed: water physico-chemicals and nutrients, algae, zooplankton, benthic macro invertebrates, and fish communities. Total depth was above 5.0 m (range: 5.63 – 9.74 m) at all sampled points and decreased towards the downstream of cages. Water transparency ranged from 1.26 – 1.48 in the cage area and 1.08 to 1.34 m away from the cages. Within the cage area, Dissolved Oxygen ranged from 5.7 – 6.4 mg/L at the surface, and 5.1 – 6.4 mg/L at the bottom, while in the non-cage areas, the range was 5.5 – 7.5 mg/L at the surface and 2.6 – 7.0 mg/L at the bottom. Temperature ranged from 27.0 – 28.0 o C at the surface and 25.5 – 27.5 o C at the bottom waters for all sites, and were within the optimal range (25 – 32 o C). pH in both surface and bottom waters was above 7.0 (range: 7.5 – 9.2) at all sites. Conductivity within cage area ranged from 100.5 – 102.6 μScm-1 in surface water and 101.8 – 112.1 μScm-1 in bottom water. In the non-cage areas conductivity ranged from 11.0 – 104.4 μScm-1 in surface water and 100.2 – 110.0 μScm-1 at the bottom. Ammonium nitrogen concentration during December was less than 0.02 mg/L at all sites (0.007 – 0.018 mg/L within the cage sites, and 0.012 – 0.019 mg/L in the non-cage sites). Nitrite nitrogen ranged from 0.002 – 0.169 mg/L in the cage area, and 0.003 – 0.057 mg/L in the non-cage areas. Similar to previous records of June and September 2017, nitrate nitrogen concentration generally increased towards the downstream site, being lowest at RPT (0.041 mg/L) and highest at DSC (0.204 mg/L). Soluble reactive phosphorus was less than 0.005 mg/L at all sites, and varied within narrow margin (range: 0.003 – 0.0048 mg/L in cage sites, and 0.0032 – 0.0047 mg/L in non-cage sites). The TP concentration ranged from 0.085 – 0.107 mg/L in the cages, and 0.090 – 0.118 mg/L in the non-cage sites and was higher than recorded in September (0.038 – 0.044 mg/L in the cages and 0.04 to 0.109 mg/L away from cages). Total nitrogen concentration was in the range of 0.138 – 0.553 mg/L within cage area and 0.421 – 0.513 mg/L in non-cage areas. The concentration of TSS ranged from 0.76 – 4.33 mg/L in the cage area and 0.57 – 2.76 mg/L in the non-cage areas. The phytoplankton community was composed of blue-green algae, green algae and diatoms, dominated by blue-green algae. The abundance of algae was higher in the non-cage areas (mean:7.20 ± 2.14 mm3L-1, Range: 5.15 – 10.20 mm3L-1) than recorded in the cage areas (mean: 6.0 ± 0.71 mm3L-1, Range: 5.30 – 6.98 mm3L-1), similar to observations of September 2017 (5.6 mm3L-1 in the non-cage sites). At all sampled points, blue-green algae contributed >70% of total abundance. Total zooplankton abundance ranged from 982,213 – 1,310,830 ind.m-2 in the non-cage sites, and 740,601 – 1,503,130 ind.m-2 in the cage areas. Similar to observations of September 2017, the upper cage site (WIC3 and WIC4) presented lower zooplankton abundance (mean: 788,954 ± 68,381 ind.m-2) when compared to the lower cage site with mean abundance of 1,128,232 ± 530,186 ind.m-2. Like in the previous sampling periods, copepods were the numerically dominant group (92.69 – 97.22 % of total zooplankton abundance) at all sampled points, with no major differences between cage and non-cage areas. The high abundance of copepods was attributed to the abundance of the juvenile stages (copepodites and Nauplius larvae) which contributed 83.72 – 92.78% of the total zooplankton abundance and this was mainly due to the Nauplius larvae (66.4 – 83.2 %). Cladocera relative abundance ranged from 0.32 – 3.98% while that of rotifers ranged from 1.55 – 3.74%. The macro-benthic community comprised molluscs, annelids and arthropods. Taxa richness ranged from 5 – 11 taxa in the cage area, and 7 – 9 taxa in the non-cage areas. The abundance of benthic invertebrates within the cage area ranged from 1,134 – 2,416 ind.m-2 and this was higher than previously recorded in September (294 – 1,415 ind.m-2). In the non-cage sites abundance was in the range of 420 – 3,992 ind.m-2. Oligochaete annelids which are reported to be very tolerant to pollution contributed 0 - 28 % of the abundance of benthos at cage sites and 3 - 20% at the non-cage sites. Diptera made the greatest contribution at almost all sites, with the percent abundance being higher in non-cage sites (40 – 86%) than what was recorded in the cage sites (37 – 82%). Chironomus spp. and Chaoborus sp. were the main contributors to the observed Diptera abundance at all sites. Six fish species, including haplochromines (Nkejje) as a single species group, were recorded in the vicinity of the cages during December 2017. Five fish species were recorded from upstream the cage site, four species from within cage area, and two species from downstream the cages. Overall mean catch rates were 1.8 fish/net/night and 148.6g/net/night compared to 1.7 fish/net/night and 175.4g/net/night recorded in September 2017. By weight, catch rates in December 2017 were highest upstream the cage site (312.1g/net/night) and also by numbers (3.1 fish/net/night). Four species of haplochromines were recorded in the vicinity of the cages during the survey of December 2017 compared to six species recorded in September 2017. The overall catch rate for the haplochromines, in December 2017 was 1.7fish/net/night and 27.5g/net/night compared to 3.4 fish/net/night and 62.3g/net/night recorded in the previous survey of September 2017. Among the fish species examined during December 2017 survey, most of the haplochromine cichlids (88.9%) were mature but only 50% breeding. Only one specimen of L. niloticus was mature and breeding. All S. afrofischeri and S. victoriae specimens examined were mature and in breeding condition while M. kannume was immature. The diet of fishes encountered comprised mostly of fish and insects, which are known natural foods of the fish species. Infection by fish parasites during the survey of December 2017 was not noticed in any fish recorded from the experimental gillnets. The overall observation on concentrations of nutrients, levels of physico-chemical variables, and biotic communities indicated minimal impact of cages on water quality. The farm should therefore continue adhering to the best environmentally sustainable aquaculture practices, especially continuing with fallowing or rotation of cages to allow resident organisms maintain their natural population densities, distribution and community structure in the area; reducing excess uneaten feed and other suspended materials which would impact on nutrient status and biota; as well as wise use of any chemicals in the area

Seroepidemiology of SARS-CoV-2 in a cohort of pregnant women and their infants in Uganda and Malawi.

BACKGROUND: Data on SARS-CoV-2 infection in pregnancy and infancy has accumulated throughout the course of the pandemic, though evidence regarding asymptomatic SARS-CoV-2 infection and adverse birth outcomes are scarce. Limited information is available from countries in sub-Saharan Africa (SSA). The pregnant woman and infant COVID in Africa study (PeriCOVID Africa) is a South-South-North partnership involving hospitals and health centres in five countries: Malawi, Uganda, Mozambique, The Gambia, and Kenya. The study leveraged data from three ongoing prospective cohort studies: Preparing for Group B Streptococcal Vaccines (GBS PREPARE), SARS-CoV-2 infection and COVID-19 in women and their infants in Kampala and Mukono (COMAC) and Pregnancy Care Integrating Translational Science Everywhere (PRECISE). In this paper we describe the seroepidemiology of SARS-CoV-2 infection in pregnant women enrolled in sites in Uganda and Malawi, and the impact of SARS-CoV-2 infection on pregnancy and infant outcomes. OUTCOME: Seroprevalence of SARS-CoV-2 antibodies in maternal blood, reported as the proportion of seropositive women by study site and wave of COVID-19 within each country. METHODS: The PeriCOVID study was a prospective mother-infant cohort study that recruited pregnant women at any gestation antenatally or on the day of delivery. Maternal and cord blood samples were tested for SARS-CoV-2 antibodies using Wantai and Euroimmune ELISA. In periCOVID Uganda and Malawi nose and throat swabs for SARS-Cov-2 RT-PCR were obtained. RESULTS: In total, 1379 women were enrolled, giving birth to 1387 infants. Overall, 63% of pregnant women had a SARS-CoV-2 positive serology. Over subsequent waves (delta and omicron), in the absence of vaccination, seropositivity rose from 20% to over 80%. The placental transfer GMR was 1.7, indicating active placental transfer of anti-spike IgG. There was no association between SARS-CoV-2 antibody positivity and adverse pregnancy or infancy outcomes

A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria

Background: Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs) in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy (ACT) in patients seeking treatment for fever in drug shops. Methods: A cluster-randomized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district, central Uganda. Ten clusters were randomly allocated to the intervention (diagnostic confirmation of malaria by mRDT followed by ACT) and ten clusters to the control arm (presumptive treatment of fevers with ACT). Treatment decisions by providers were validated by microscopy on a reference blood slide collected at the time of consultation. The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as: malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate, and patients with no malaria parasites not given ACT. Findings: A total of 15,517 eligible patients (8672 intervention and 6845 control) received treatment for fever between January-December 2011. The proportion of febrile patients who received appropriate ACT treatment was 72·9% versus 33·7% in the control arm; a difference of 36·1% (95% CI: 21·3 – 50·9), p<0·001. The majority of patients with fever in the intervention arm accepted to purchase an mRDT (97·8%), of whom 58·5% tested mRDT-positive. Drug shop vendors adhered to the mRDT results, reducing over-treatment of malaria by 72·6% (95% CI: 46·7– 98·4), p<0·001) compared to drug shop vendors using presumptive diagnosis (control arm). Conclusion: Diagnostic testing with mRDTs compared to presumptive treatment of fevers implemented in registered drug shops substantially improved appropriate treatment of malaria with ACT

More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>The proportion of Ugandan children who are fully vaccinated has varied over the years. Understanding vaccination behaviour is important for the success of the immunisation programme. This study examined influences on immunisation behaviour using the attitude-social influence-self efficacy model.</p> <p>Methods</p> <p>We conducted nine focus group discussions (FGDs) with mothers and fathers. Eight key informant interviews (KIIs) were held with those in charge of community mobilisation for immunisation, fathers and mothers. Data was analysed using content analysis.</p> <p>Results</p> <p>Influences on the mother's immunisation behaviour ranged from the non-supportive role of male partners sometimes resulting into intimate partner violence, lack of presentable clothing which made mothers vulnerable to bullying, inconvenient schedules and time constraints, to suspicion against immunisation such as vaccines cause physical disability and/or death.</p> <p>Conclusions</p> <p>Immunisation programmes should position themselves to address social contexts. A community programme that empowers women economically and helps men recognise the role of women in decision making for child health is needed. Increasing male involvement and knowledge of immunisation concepts among caretakers could improve immunisation.</p