Is sexual risk taking behaviour changing in rural south-west Uganda? Behaviour trends in a rural population cohort 1993–2006

OBJECTIVE: To describe sexual behaviour trends in a rural Ugandan cohort in the context of an evolving HIV epidemic, 1993-2006. METHODS: Sexual behaviour data were collected annually from a population cohort in which HIV serological surveys were also conducted. Behaviour trends were determined using survival analysis and logistic regression. Trends are reported based on the years in which the respective indicators were collected. RESULTS: Between 1993 and 2006, median age at first sex increased from 16.7 years to 18.2 years among 17-20-year-old girls and from 18.5 years to 19.9 years among boys. Both sexes reported a dip in age at sexual debut between 1998 and 2001. One or more casual partners in the past 12 months among men rose from 11.6% in 1997 to 12.7% in 2004 and then declined to 10.2% in 2006. Among women it increased from 1.4% in 1997 to 3.7% in 2004 and then reduced to 1.4% in 2006. The rise in casual partners between 1997 and 2004 was driven mainly by older age groups. Trends in condom use with casual partners varied by age, increasing among those aged 35+ years, declining in the middle age groups and presenting a dip and then a rise in the youngest aged group (13-19 years). CONCLUSION: Among youth, risky behaviour declined but increased in the late 1990s/early 2000s. Among those aged 35+ years, condom use rose but casual partners also rose. Several indicators portrayed a temporary increase in risk taking behaviour from 1998 to 2002

Vδ2+ T cell response to malaria correlates with protection from infection but is attenuated with repeated exposure.

Vδ2+ γδ T cells are semi-innate T cells that expand markedly following P. falciparum (Pf) infection in naïve adults, but are lost and become dysfunctional among children repeatedly exposed to malaria. The role of these cells in mediating clinical immunity (i.e. protection against symptoms) to malaria remains unclear. We measured Vδ2+ T cell absolute counts at acute and convalescent malaria timepoints (n = 43), and Vδ2+ counts, cellular phenotype, and cytokine production following in vitro stimulation at asymptomatic visits (n = 377), among children aged 6 months to 10 years living in Uganda. Increasing age was associated with diminished in vivo expansion following malaria, and lower Vδ2 absolute counts overall, among children living in a high transmission setting. Microscopic parasitemia and expression of the immunoregulatory markers Tim-3 and CD57 were associated with diminished Vδ2+ T cell pro-inflammatory cytokine production. Higher Vδ2 pro-inflammatory cytokine production was associated with protection from subsequent Pf infection, but also with an increased odds of symptoms once infected. Vδ2+ T cells may play a role in preventing malaria infection in children living in endemic settings; progressive loss and dysfunction of these cells may represent a disease tolerance mechanism that contributes to the development of clinical immunity to malaria

Characterisation of tabanid flies (Diptera: Tabanidae) in South Africa and Zambia and detection of protozoan parasites they are harbouring

Tabanids are haematophagous flies feeding on livestock and wildlife. In the absence of information on the relationship of tabanid flies and protozoan parasites in South Africa and Zambia, the current study was aimed at characterizing tabanid flies collected in these two countries as well as detecting protozoan parasites they are harbouring. A total of 527 tabanid flies were collected whereby 70.2% were from South Africa and 29.8% were from Zambia. Morphological analysis revealed a total of 5 different genera collected from the sampled areas namely: Ancala, Atylotus, Haematopota, Philoliche and Tabanus. DNA extracted from South African Tabanus par and T. taeniola tested positive for the presence of Trypanosoma congolense and T. theileri whilst one member from T. par was positive for T. brucei-like parasite. DNA extracted from Zambian tabanid flies tested positive for the presence of Besnoitia besnoiti at 1.27% (2/157), Babesia bigemina 5.73% (9/157), Theileria parva-like species 30.11% (30/157) and 9.82% (14/157) for Trypanosoma evansi-like species. This study is the first to report on Babesia and Theileria parasites in tabanid flies. Further investigations are required to determine the role of tabanids in transmission of the detected protozoan parasites in livestock and wildlife in South Africa and Zambia

Laboratory Diagnosis of Candidiasis

The burden of Candidiasis continues to increase and so does the Candida species. Although Candida species are closely similar phenotypically, they differ from each other in terms of epidemiology, genetic characteristics, antifungal susceptibility and virulence profile. Therefore, reliable and accurate laboratory methods for identification of Candida species can determine the Candidiasis burden and enable the administration of the most appropriate antifungal drug therapy to reduce fungal mortality rates. Conventional and biochemical methods are often used in identification of Candida species. However, these techniques are specific and sensitive enough in detecting the non albicans candida (NAC) species. Molecular techniques have improved the laboratory diagnosis and management of Candidiasis due to improved sensitivity and specificity threshold. This chapter provides an overview of different laboratory methods for diagnosis of Candidiasis

Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

Background Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25–70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity which was masked on aggregate analysis. Patterns and clustering were observed for hypertension, physical inactivity, smoking, alcohol consumption and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas. Conclusion Modifiable cardiovascular risk factors are common in this low-income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored. In addition, the differences emphasize the value of small geographical area mapping and analysis to inform more targeted risk reduction interventions

A hidden crisis: strengthening the evidence base on the current failure of rural groundwater supplies

New ambitious international goals for universal access to safe drinking water depend critically on the ability of development partners to accelerate and sustain access to groundwater. However, available evidence (albeit fragmented and methodologically unclear) indicates >30% of new groundwater-based supplies are non-functional within a few years of construction. Critically, in the absence of a significant systematic evidence base or analysis on supply failures, there is little opportunity to learn from past mistakes, to ensure more sustainable services can be developed in the future. This work presents a new and robust methodology for investigating the causes of non-functionality, developed by an interdisciplinary team as part of a UK-funded development research project. The approach was successfully piloted within a test study in NE Uganda, and forms a basis for future research to develop a statistically significant systematic evidence base to unravel the underlying causes of failur

Improving nutrition with agricultural biodiversity

This guide describes the process and procedures for collecting important information required to assess local farming systems and agrobiodiversity, household food consumption norms and the nutritional status of vulnerable groups within a given population using specific indicators. Additionally, this guide provides a framework for practical implementation of a holistic program that focuses on creating a customized intervention based on community-specific data. The manual strives to combine perspectives from the following models and approaches: 1. Farming Systems Model (FAO/WB) 2. Agroecological Model (NAFRI, FAO) 3. Indigenous Food Culture Documentation (CINE/IDRC/FAO) 4. Measuring Nutritional Functional Diversity (Columbia EI) 5. Positive Deviance Model (The Positive Deviance Initiative) 6. FANTA Nutritional Assessment Guides (USAID) 7. Food Security and Livelihoods Model (ACF International) 8. Ethnobotanical Documentation: A User’s Model (ICH/UNESCO) The development of this manual also could not have been possible without the guidance of previously published manuals by the World Health Organization (WHO), the World Food Programme (WFP) and the Centre for Indigenous Peoples’ Nutrition and Environment CINE. This manual recommends a 7 phase process to approach communities of focus holistically and with a trajectory of long-term improvement

Beyond undetectable: modeling the clinical benefit of improved antiretroviral adherence in persons with human immunodeficiency virus with virologic suppression

BACKGROUND: Incomplete antiretroviral therapy (ART) adherence has been linked to deleterious immunologic, inflammatory, and clinical consequences, even among virally suppressed (<50 copies/mL) persons with human immunodeficiency virus (PWH). The impact of improving adherence in the risk of severe non-AIDS events (SNAEs) and death in this population is unknown. METHODS: We estimated the reduction in the risk of SNAEs or death resulting from an increase in ART adherence by (1) applying existing data on the association between adherence with high residual inflammation/coagulopathy in virally suppressed PWH, and (2) using a Cox proportional hazards model derived from changes in plasma interleukin 6 (IL-6) and D-dimer from 3 randomized clinical trials. Comparatively, assuming 100% ART adherence in a PWH who achieves viral suppression, we estimated the number of persons in whom a decrease in adherence to <100% would need to be observed for an additional SNAE or death event to occur during 3- and 5-year follow-up. RESULTS: Increasing ART adherence to 100% in PWH who are suppressed on ART despite imperfect adherence translated into a 6%-37% reduction in the risk of SNAEs or death. Comparatively, based on an anticipated 12% increase in IL-6, 254 and 165 PWH would need to decrease their adherence from 100% to <100% for an additional event to occur over 3- and 5-year follow-up, respectively. CONCLUSIONS: Modest gains in ART adherence could have clinical benefits beyond virologic suppression. Increasing ART adherence (eg, via an intervention or switch to long-acting ART) in PWH who remain virally suppressed despite incomplete adherence should be evaluated

Improving nutrition with agricultural biodiversity

This guide describes the process and procedures for collecting important information required to assess local farming systems and agrobiodiversity, household food consumption norms and the nutritional status of vulnerable groups within a given population using specific indicators. Additionally, this guide provides a framework for practical implementation of a holistic program that focuses on creating a customized intervention based on community-specific data. The manual strives to combine perspectives from the following models and approaches: 1. Farming Systems Model (FAO/WB) 2. Agroecological Model (NAFRI, FAO) 3. Indigenous Food Culture Documentation (CINE/IDRC/FAO) 4. Measuring Nutritional Functional Diversity (Columbia EI) 5. Positive Deviance Model (The Positive Deviance Initiative) 6. FANTA Nutritional Assessment Guides (USAID) 7. Food Security and Livelihoods Model (ACF International) 8. Ethnobotanical Documentation: A User’s Model (ICH/UNESCO) The development of this manual also could not have been possible without the guidance of previously published manuals by the World Health Organization (WHO), the World Food Programme (WFP) and the Centre for Indigenous Peoples’ Nutrition and Environment CINE. This manual recommends a 7 phase process to approach communities of focus holistically and with a trajectory of long-term improvement