Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study

Introduction: Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago.Methods: This was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio- demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done.Results: Two hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1n-patient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9). Conclusion: The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.Key words: Tuberculosis, health service delay, treatment delay, diagnostic delay, pulmonary tuberculosi

Principal Response Curve Analysis of Arthropod Community Abundance Data with Sparse Subsets

Principal response curve (PRC) analysis was applied to an assessment of the ecological impact of the genetically-modified (GM), insect-resistant, cotton MON 88702 on predatory Hemiptera communities in the field. The field community was represented by ten taxa collected ten times across the season at six sites, in which individual taxa were not observed in at least 25% of the time (unique site x collection combinations). These complete absences and those nearly so, called sparse subsets of the data in this investigation, were the result of geoclimatic and seasonal variations, which are both independent of the treatment effect for which the PRC analysis is intended. If the sparse subsets were included in the analysis, the treatment effect would be underestimated. Here, a modified analysis is proposed to remove those sparse subsets and to be performed on the incomplete data. In the application to MON 88702, four components (PRC1-4) were significant at the 5% level by the modified method, when more than 50% of the data were excluded due to no- or low responses, and five (PRC1-5) by the classical method. While PRC1-2 was highly consistent between two methods, PRC3-5 was largely different because of sparse subsets of the data. Differences in results between two methods demonstrate that excluding sparse subsets prevented the bias in the estimation of the treatment effect and the relationship with the community from confounding with the environmental variation that caused the sparse data. In this regard, the modification should be considered as a supplement of the classical PRC analysis and recommended when abundance data have sparse subsets

Surface run-off behaviour of bitumen emulsions used for the construction of seals

Paper presented at the 33rd Annual Southern African Transport Conference 7-10 July 2014 "Leading Transport into the Future", CSIR International Convention Centre, Pretoria, South Africa.The application of seals as surfacing on South African roads has increased due to its dual advantage in performance potential and sustainability. The field performance of spray seals depends on a number of factors, and its defects measured predominantly by bleeding and ravelling of the seals. During construction, viscosity is controlled such that the binder is sprayable, but not too low in viscosity as to run off the road surface. To avoid pavement distress resulting from loss of the binder or from inconsistent binder thickness after application, it is important to understand the run-off behaviour of seals. Run-off tests were conducted in the laboratory by constructing surfacing seals with varying texture depths. These seals were constructed on a surface that would allow the user to change the angle of application in order to simulate the spraying of the seals on different road gradients. A movable/mobile spraybar was used to simulate typical conditions as for a spray tanker during construction. Run-off was measured through a gutter system where the emulsions was collected and weighed. An analysis of the run-off results obtained from these experiments, revealed that the spray rate had the largest effect on run-off, followed by texture depth, and gradient.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by CE Projects cc. Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: [email protected]

Lay Perceptions about Tuberculosis among Non-UK-Born African in the United Kingdom

Background: Tuberculosis among non-UK-born Black Africans has been gradually recognized as a public health problem in the UK despite the various interventions implemented. Objectives: To explore the perceptions of non-UK-born Black Africans about TB health risk; to explore the health seeking behavior of the non-UK-born Black Africans in relation to TB and to explore lay views on TB health education and screening as opportunities for health promotion. Methodology and Study Design: A qualitative methodology was used on a purposively selected sample of 12 non-UK-born Black Africans living in Leeds. Face-to-face interviews were conducted to explore the lay perceptions about TB. Thematic analysis was used to derive important themes in accordance to the study objectives. Ethical approval was provided by Leeds Metropolitan University. Setting: Community setting of non-UK-born Black Africans in Leeds, UK. Results: This population holds mixed views and perceptions about tuberculosis, few facilitators and many barriers existed to current TB prevention efforts. The barriers included: language barriers, barriers related to services and systems, immigration status and stigma despite the benefits involved. The potential for black African communities to readily increase the likelihood of behavior change was found as an important finding for this study. Conclusions: Tuberculosis is a preventable public health problem. Involvement of the non-UK-born black Africans communities in the TB prevention may be beneficial for reducing and tackling TB rates in this population. Such an approach is potentially inexpensive and more readily implementable than other suggested strategies such as changes to immigration policies

Differences in symptom severity and quality of life among patients with cancer using conventional therapies with/without herbal medicines in Uganda: a cross-sectional study

Objective: Patients with cancer experience numerous symptoms related to cancer and treatment side effects that reduce their quality of life (QOL). Although herbal medicine (HM) is used to manage such symptoms by patients in sub-Saharan Africa, data on patients perceived clinical outcomes are limited. We compared differences in QOL and symptom severity between patients with cancer using HM plus conventional therapies (i.e., chemotherapy, hormonal therapy, radiotherapy, surgery) and those using conventional therapies alone. Methods: This cross-sectional study included patients with cancer aged \u3e18 years who were consecutively sampled and completed a researcher-administered questionnaire between December 2022 and January 2023. Specifically, data was collected using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the MD Anderson Symptom Inventory for Traditional Chinese Medicine (MDASI-TCM). Data were analyzed using descriptive statistics and chi-square and logistic regression analyses. Results: Of 400 participants (67.5% female), 49% (n=195) used HM plus conventional therapies and 51% (n=205) used conventional therapies alone. Most participants were aged \u3e38 years (73.3%; median age 47 years). A univariate analysis showed the HM plus conventional therapies group had better mean scores for most QOL and symptom severity measures than the conventional therapies alone group. However, only role functioning significantly differed (p=0.046) in the bivariate analysis. There were no statistically significant differences between the two groups after confounder adjustment for all others measures of symptom severity and QOL. Conclusion: HM plus conventional therapies may offer minimal benefits or differences for clinical outcomes among patients with cancer. However, our findings have clinical, research, and public health implications for Uganda and other sub-Saharan African settings

Determination of circulating Mycobacterium tuberculosis strains and transmission patterns among pulmonary TB patients in Kawempe municipality, Uganda, using MIRU-VNTR

<p>Abstract</p> <p>Background</p> <p>Mycobacterial interspersed repetitive units - variable number of tandem repeats (MIRU-VNTR) genotyping is a powerful tool for unraveling clonally complex <it>Mycobacterium tuberculosis </it>(MTB) strains and detection of transmission patterns. Using MIRU-VNTR, MTB genotypes and their transmission patterns among patients with new and active pulmonary tuberculosis (PTB) in Kawempe municipality in Kampala, Uganda was determined.</p> <p>Results</p> <p>MIRU-VNTR genotyping was performed by PCR-amplification of 15 MTB-MIRU loci from 113 cultured specimens from 113 PTB patients (one culture sample per patient). To determine lineages, the genotypes were entered into the MIRU-VNTR<it>plus </it>database [<url>http://www.miru-vntrplus.org/</url>] as numerical codes corresponding to the number of alleles at each locus. Ten different lineages were obtained: Uganda II (40% of specimens), Uganda I (14%), LAM (6%), Delhi/CAS (3%), Haarlem (3%), Beijing (3%), Cameroon (3%), EAI (2%), TUR (2%) and S (1%). Uganda I and Uganda II were the most predominant genotypes. Genotypes for 29 isolates (26%) did not match any strain in the database and were considered unique. There was high diversity of MIRU-VNTR genotypes, with a total of 94 distinct patterns. Thirty four isolates grouped into 15 distinct clusters each with two to four isolates. Eight households had similar MTB strains for both index and contact cases, indicating possible transmission.</p> <p>Conclusion</p> <p>MIRU-VNTR genotyping revealed high MTB strain diversity with low clustering in Kawempe municipality. The technique has a high discriminatory power for genotyping MTB strains in Uganda.</p

The meaning of caring for patients with cancer among traditional medicine practitioners in Uganda: A grounded theory approach

Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs’ caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling methods. Researcher-administered in-depth interviews were conducted, along with three focus group discussions. Data were analyzed using constant comparative analysis. The core category that represented TMPs’ meaning of caring for patients with cancer was “Restoring patients’ hope in life through individualizing care.” TMPs restored patients’ hope through five main processes: 1) ensuring continuity in the predecessors’ role; 2) having full knowledge of a patient’s cancer disease; 3) restoring hope in life; 4) customizing or individualizing care, and 5) improving the patient’s condition/health. Despite practice challenges, the substantive theory suggests that TMPs restore hope for patients with cancer in a culturally sensitive manner, which may partly explain why patients with cancer continue to seek their services. The findings of this study may guide research, education, and public health policy to advance traditional medicine in sub-Saharan Africa

Nutritional quality, fruit shape and relationships among exotic and local Capsicum pepper genotypes in Uganda.

Twenty-one hot pepper genotypes comprising of local (15) and exotic (6) types (C. annuum, C. frutescens and C. chinense) were characterized for selected fruit traits after propagation in a glasshouse at the Makerere University Agricultural Research Institute Kabanyolo in Central Uganda using a completely randomized design with three replicates. Ripe fruits were harvested and analyzed; traits evaluated were all significantly different at P<0.05 with variations in quality attributes. The genotype OHA-B305-10 had the highest ascorbic acid content (128.86 mg/100 g) and is recommended for improvement of both local and exotic genotypes targeting the fresh market. Genotypes CAP0408-12 and UG2 WE0511-22, with highest total soluble solids (16.17 ºBrix) and dry matter content (28.59%), respectively should be used in improvements for industrial use or processing to products such as chilli powder or flakes. BRS-M205-04 with highest titratable acidity (1.04%) can be used in enhancing shelf life of genotypes with low titratable acids as well as for the fresh market. In spite of the intraspecific relationships among genotypes, significant differences were observed in their quantitative traits. These genotypes will, therefore, be useful in improving the quality of hot pepper fruit in Ugand

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background: Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. )e purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods: Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta regression analyses were performed to explore source of heterogeneity. Results: In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). )e pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion: Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care