57 research outputs found
Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda.
No full textUganda has made progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the WHO target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in Bukedea district.The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of Anti-retroviral drugs in animal husbandry was common in Bukedea District
Bacterial Colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda.
No full textThis study aimed to determine colonisation, the bacterial species diversity and susceptibility patterns in indwelling urinary catheters of postpartum mothers attending Mbale Regional Referral Hospital
Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda.
No full textUganda has made progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the WHO target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in Bukedea district.The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of Anti-retroviral drugs in animal husbandry was common in Bukedea District
Molecular epidemiology of antimicrobial resistance at a human-animal interface in pastoralist community of Kasese District, Uganda
No full textA thesis submitted to the Directorate of Research and Graduate Training for the award of the Degree of Doctor of Philosophy of Makerere University.Background: Intensive usage of antimicrobials in the management of animal diseases may cause selection for resistance among microorganisms. Transmission of resistant bacteria from the wild and domestic food animals to humans may occur via the food chain, environment, or direct interaction with animals and this may lead to the emergence of infections that are challenging to manage. This study aimed to determine the molecular epidemiology of antimicrobial resistance at a human-animal interface in pastoralist communities of Kasese district. Methods: A mixed-methods cross-sectional study was carried out involving participants presenting with fever and/or diarrhea in the health facilities whose samples were taken for culture and sensitivity. Participants from whom multidrug-resistant bacteria were isolated were back-traced to the community and samples were taken from members of the household. Speciation and antibiotic susceptibility of the isolates was done using the Phoenix automated microbiology system (Phoenix 100 ID/DST system) from Becton and Dickson (Franklin Lakes, NJ, USA) and the results interpreted using the CLSI guidelines Whole-genome paired-end sequencing (WGS) was performed at the facilities of Kenya Medical Research Institute-Wellcome trust, Kilifi for the multidrug-resistant isolates from humans and cattle. In the community, questionnaires were administered to the participants and key informant interviews were conducted. Results: A total of 371 participants were recruited and 122 from whom multi-drug resistant bacteria were isolated were followed up to the community. Overall, high resistance patterns were detected among our isolates with many of the isolates being multi-drug resistant. The general trend of antimicrobial resistance among the Cholera isolates showed increased susceptibility to combination therapy as opposed to monotherapy Phenotypic resistance testing revealed similar resistance patterns among the human and the cattle isolates for the 15 antibiotics tested in this study, however, Phylogenetic analysis showed that the genomes of the human E. coli generally clustered together and away from those of cattle origin. The E. coli isolates were assigned to eight different phylogroups: A, B1, B2, Cladel, D, E, F, and G, with a majority being assigned to phylogroup A; while most of the animal isolates were assigned to phylogroup B1. The carriage of multiple AMR genes was higher from the E. coli population from humans than those from cattle. Among these were Beta-lactamase; blaOXA-1: Class D beta-lactamases; blaTEM-1, blaTEM-235: Beta-lactamase; catA1: chloramphenicol acetyltransferase; cmlA1: chloramphenicol efflux transporter; dfrA1, dfrA12, dfrA14, dfrA15, dfrA17, dfrA5, dfrA7, dfrA8: macrolide phosphotransferase; oqxB11: RND efflux pump conferring resistance to fluoroquinolone; qacL, qacEdelta1: quinolone efflux pump; qnrS1: quinolone resistance gene; sul1, sul2, sul3: sulfonamide resistant; tet(A), tet(B): tetracycline efflux pump. A high variation of virulence genes was registered among the E. coli genomes from humans than those of cattle origin. Carriage of multi-drug resistant bacteria among humans was 88 (93%) and 76(80%) among cattle. Consumption of lakeshore water and carriage of multi-drug resistant bacteria in cattle were associated with carriage of multi-drug resistant bacteria in the human population. The key informants reported that antibiotics were used as first aid both in humans and cattle and no surveillance measures for antimicrobial resistance were put in place. The key informants also associated the problem of antimicrobial resistance to poverty, illiteracy, lack of veterinary personnel, ignorance among the community, and the low-cadre of medical staff serving the community. Conclusion: We demonstrated high antimicrobial resistance in bacteria isolated in humans and animals in pastoralist communities of Kasese district. Consumption of lakeshore water and carriage of multi-drug resistant bacteria in cattle were associated with carriage of multi-drug resistant bacteria in the human population. From the analysis of the core genome and phenotypic resistance, this study has demonstrated that the E. coli of human origin and those of cattle origin may have a common ancestry. Limited sharing of virulence genes presents a challenge to the notion that AMR in humans is as a result of antibiotic use in the farm and distorts the picture of the directionality of transmission of AMR at a human-animal interface and presents a task of exploring alternative routes of transmission of AMR.This work was supported by the DELTAS Africa Initiative [grant# 107743/Z/15/Z]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant #107743/ Z/15/Z] and the UK government
Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study.
No full textSelf-medication with antibiotics remains one of the major drivers of antimicrobial resistance. Practices of self-medication among nursing and medical students have not been explored in our setting. This study sought to determine the prevalence and factors associated with self-medication with antibiotics among undergraduate university students pursuing health-related courses in Eastern Uganda. A descriptive cross-sectional study design was used. The study was done among undergraduate students who were doing undergraduate programs in Nursing, Anesthesia, and medicine at Busitema University. A self-administered questionnaire was used to collect data from 326 participants. Descriptive statistics were used in data analysis. The prevalence of self-medication with antibiotics was 93.8% (n = 300) of which 80% were either currently using self-medication or had self-medicated in the past six months. The common reasons for self-medication were the perception that it was a minor illness (55%), previous use of antibiotic (52%), a perception that they were health workers (50%), and the notion that they knew the right antibiotic for their condition (44%). Metronidazole (64%) and amoxicillin (65%) were the most commonly used antibiotics. Self-medication was most common for conditions such as peptic ulcer, diarrhea, and wound infections. Inappropriate drug use was common among participants on self-medication which occurred in the form of multiple use of antibiotics (64.4%, n = 194) and a tendency to switch to other antibiotics (58.5%) mostly because the former antibiotic was perceived not to be an effective treatment. The prevalence of self-medication with antibiotics was high among medical students. Prior use of the antibiotic and having a minor illness were the most common drivers of self-medication. Public health strategies should address the high misuse of antibiotics among medical students to negate the likely consequence of antimicrobial resistance
Whole genome sequences of multi-drug resistant Escherichia coli isolated in a Pastoralist Community of Western Uganda: phylogenomic changes, virulence and resistant genes
No full textBACKGROUND:The crisis of antimicrobial resistance is already here with us, affecting both humans and animals alike and very soon, small cuts and surgeries will become life threatening. This study aimed at determine the whole genome sequences of multi-drug resistant Escherichia coli isolated in a Pastoralist Community of Western Uganda: phylogenomic changes, virulence and resistant genes. METHODS:This was a laboratory based cross sectional study. Bacterial isolates analyzed in this study were 42 multidrug resistant E. coli isolated from stool samples from both humans (n = 30) and cattle (n = 12) in pastoralist communities collected between January 2018-March 2019. Most of the isolates (41/42) were resistant to three or more antibiotics (multi-drug resistant) and 21/42 isolates were ESBL producers; 13/30 from human and 8/12 from cattle. Whole Genome Sequencing (WGS) was carried out at the facilities of Kenya Medical Research Institute-Wellcome trust, Kilifi, to determine the phylogenomic changes, virulence and resistant genes. RESULTS:At household level, the genomes from both human and animals clustered away from one another except for one instance where two human isolates from the same household clustered together. However, 67% of the E. coli isolated from cattle were closely related to those found in humans. The E. coli isolates were assigned to eight different phylogroups: A, B1, B2, Cladel, D, E, F and G, with a majority being assigned to phylogroup A; while most of the animal isolates were assigned to phylogroup B1. The carriage of multiple AMR genes was higher from the E. coli population from humans than those from cattle. Among these were Beta-lactamase; blaOXA-1: Class D beta-lactamases; blaTEM-1, blaTEM-235: Beta-lactamase; catA1: chloramphenicol acetyl transferase; cmlA1: chloramphenicol efflux transporter; dfrA1, dfrA12, dfrA14, dfrA15, dfrA17, dfrA5, dfrA7, dfrA8: macrolide phosphotransferase; oqxB11: RND efflux pump conferring resistance to fluoroquinolone; qacL, qacEdelta1: quinolone efflux pump; qnrS1: quinolone resistance gene; sul1, sul2, sul3: sulfonamide resistant; tet(A), tet(B): tetracycline efflux pump. A high variation of virulence genes was registered among the E. coli genomes from humans than those of cattle origin. CONCLUSION:From the analysis of the core genome and phenotypic resistance, this study has demonstrated that the E. coli of human origin and those of cattle origin may have a common ancestry. Limited sharing of virulence genes presents a challenge to the notion that AMR in humans is as a result of antibiotic use in the farm and distorts the picture of the directionality of transmission of AMR at a human-animal interface and presents a task of exploring alternative routes of transmission of AMR
Attitudes and perceptions of undergraduate nursing students towards the nursing profession.
No full textBackgroundNursing students either possess positive or negative attitudes and perceptions about the nursing profession. Their attitudes towards the profession depict the quality of care they will offer to patients upon qualification. This study aimed to determine the attitudes and perceptions of undergraduate nursing students towards their profession.MethodsThis equal-status mixed methods study involved a census sample of 165 nursing students from year one to year four in two public universities in Uganda. Attitude Scale for Nursing Profession was used to collect quantitative data in the period between 20/11/2021 and 22/01/2022. Focus group discussions were held to collect qualitative data about the perceptions.ResultsMajority of the students (81.8%) had positive attitudes towards the nursing profession. There was a significant difference in attitudes based on year of study and entry scheme (R2 = 0.12, F = 2.21, p = 0.01). Nursing was perceived as a poorly remunerated, unpopular profession with bias towards recruitment of lower cadres.ConclusionThe results of this study showed that the attitudes of undergraduate nursing students towards the nursing profession were positive but their perceptions about the nursing profession were negative. An interventional study is recommended to facilitate a more positive change among nursing students
Prevalence and Factors Associated with Malnutrition: A Case among Hospitalized Adult Patients in a Tertiary Hospital, Eastern Uganda
No full textThis was a cross-sectional descriptive survey. Data were collected from adult inpatients admitted to the medical ward for at least 48 hours, aged ≥ 18 years and ≤ 65 years. The nutrition status was assessed using “Body Mass index (BMI), mid-upper arm circumference (MUAC) and subjective global assessment (SGA)”. Those variables in the bivariate analysis with p-value < 0.25 were considered candidates for inclusion in the univariate logistic regression. The level of significance was set at 95%
Malaria preventive practices and delivery outcomes: A cross-sectional study of parturient women in a tertiary hospital in Eastern Uganda.
No full textBackgroundUganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda.MethodsA cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics.ResultsOf the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24-1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04-2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant.ConclusionThe effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high
STROBE statement—checklist of items that should be included in reports of observational studies.
No full textSTROBE statement—checklist of items that should be included in reports of observational studies.</p
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