Evaluation of Integrated Community Case Management in Eight Districts of Central Uganda

Objective

Evidence is limited on whether Integrated Community Case Management (iCCM) improves treatment coverage of the top causes of childhood mortality (acute respiratory illnesses (ARI), diarrhoea and malaria). The coverage impact of iCCM in Central Uganda was evaluated.

Methods

Between July 2010 and December 2012 a pre-post quasi-experimental study in eight districts with iCCM was conducted; 3 districts without iCCM served as controls. A two-stage household cluster survey at baseline (n = 1036 and 1042) and end line (n = 3890 and 3844) was done in the intervention and comparison groups respectively. Changes in treatment coverage and timeliness were assessed using difference in differences analysis (DID). Mortality impact was modelled using the Lives Saved Tool.

Findings

5,586 Village Health Team members delivered 1,907,746 treatments to children under age five. Use of oral rehydration solution (ORS) and zinc treatment of diarrhoea increased in the intervention area, while there was a decrease in the comparison area (DID = 22.9, p = 0.001). Due to national stock-outs of amoxicillin, there was a decrease in antibiotic treatment for ARI in both areas; however, the decrease was significantly greater in the comparison area (DID = 5.18; p<0.001). There was a greater increase in Artemisinin Combination Therapy treatment for fever in the intervention areas than in the comparison area but this was not significant (DID = 1.57, p = 0.105). In the intervention area, timeliness of treatments for fever and ARI increased significantly higher in the intervention area than in the comparison area (DID = 2.12, p = 0.029 and 7.95, p<0.001, respectively). An estimated 106 lives were saved in the intervention area while 611 lives were lost in the comparison area.

Conclusion

iCCM significantly increased treatment coverage for diarrhoea and fever, mitigated the effect of national stock outs of amoxicillin on ARI treatment, improved timeliness of treatments for fever and ARI and saved lives.     

Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis?

Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hypertonicity was hypothesized as a potential excessive polymorphic trait which could contribute to chronic biomechanical overloading and exaggerated stresses at entheseal sites. Such a mechanism may help to integrate many of the characteristic host, pathological, and structural features of ankylosing spondylitis and axial spondyloarthritis. Biomechanical stress and strain were recently documented to correlate with peripheral entheseal inflammation and new bone formation in a murine model of spondyloarthritis. Ankylosing spondylitis has traditionally been classified by the modified New York criteria, which require the presence of definite radiographic sacroiliac joint lesions. New classification criteria for axial spondyloarthritis now include patients who do not fulfill the modified New York criteria. The male-to-female sex ratios clearly differed between the two patient categories - 2:1 or 3:1 in ankylosing spondylitis and 1:1 in non-radiographic axial spondyloarthritis - and this suggests a spectral concept of disease and, among females, milder structural alterations. Magnetic resonance imaging of active and chronic lesions in ankylosing spondylitis and axial spondyloarthritis reveals complex patterns, usually interpreted as inflammatory reactions, but shows similarities to acute degenerative disc disease, which attributed to edema formation following mechanical stresses and micro-damage. A basic question is whether mechanically induced microinjury and immunologically mediated inflammatory mechanisms operate in both ankylosing spondylitis and degenerative disc disease but differ in relative degrees. The hypothesized biomechanical properties raised in this commentary require documentation of their association with the onset risk and course of ankylosing spondylitis and axial spondyloarthritis. If particular subsets of ankylosing spondylitis and axial spondyloarthritis patients are confirmed to have altered axial myofascial properties, their biological basis and underlying biomechanical mechanisms promise to become clarified. Understanding how biomechanical and physical properties can affect symptomatic and structural manifestations of these disorders could also improve their management.     

Inhibition of Abscisic Acid 8′-Hydroxylase Affects Dehydration Tolerance and Root Formation in Cuttings of Grapes (Vitis labrusca L. × Vitis vinifera L. cv. Kyoho) Under Drought Stress Conditions

The effects of an inhibitor (Abz-E3M) of abscisic acid (ABA) 8′-hydroxylase, which is a primary enzyme of ABA catabolism, on dehydration tolerance and root formation in grape cuttings under drought conditions were investigated. Cuttings of ‘Kyoho’ grape (Vitis labrusca L. × Vitis vinifera L.) were sprayed with 100 μM of Abz-E3M and subjected to water deficit conditions at the stage when their first leaves fully expanded. The physiological and morphological changes in the leaves and basal portions of the cuttings were determined. In Abz-E3M-treated leaves, lower ABA metabolite and higher ABA and indole-3-acetic acid (IAA) concentrations were observed. Compared to the untreated control leaves, higher water potential was significantly maintained in Abz-E3M-treated leaves. Abz-E3M applications resulted in lower proline accumulation and 2,2-diphenyl-2-picrylhydrazyl radical scavenging activity in the leaves and led to enhanced dehydration tolerance. In addition, the percentage of rooted cuttings was significantly increased by Abz-E3M application. In the basal portion of Abz-E3M-treated cuttings, endogenous IAA concentrations and the gene expressions of VvARF6 and VvARF8, which are positive regulators of adventitious root formation, were significantly increased. Moreover, the expression levels of the negative regulator, VvARF17, were significantly lower. These results suggested that the inhibition of ABA 8′-hydroxylase enhanced dehydration tolerance and adventitious rooting and may be an effective strategy for achieving drought stress tolerance in grape cuttings.

     

l-Isoleucine (Ile) Promotes Anthocyanin Accumulation in Apples

Journal of Plant Growth Regulation - The functions of l-isoleucine (Ile) in anthocyanin biosynthesis were investigated in apple fruit. Whole trees (Malus × domestica Bokh.) were...     

Medicinal plants of Erute county,Lira district,Uganda with particular reference to their conservation

A medicinal plant study was carried out in eighteen parishes and 54 villages of Erute county, Lira district, Uganda. Parishes and villages were selected using stratified random sampling techniques. Questionnaires, interviews and discussions with the local people were used to obtain information on the names of the plants, their medicinal uses and conservation methods. The number of the medicinal plants species used was 180 belonging to 144 genera and 57 families of flowering plants. The major families recorded for medicinal purpose included Fabaceae (37 species), Asteraceae (26 species), Euphorbiaceae (eleven species), Vitaceae (eight species), Verbenaceae (seven species), Poaceae (six species), Solanaceae (five species), and Rubiaceae (four species). There is a need for putting in place measures to conserve these plants. Unfortunately, most of the healers or users were not interested in cultivation of the plants. The situation could worsen with the social changes and demand for land for agriculture in the district.     

Uganda's New National Laboratory Sample Transport System: A Successful Model for Improving Access to Diagnostic Services for Early Infant HIV Diagnosis and Other Programs

Introduction

Uganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing.

Methods

A retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed.

Results

The HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers.

Conclusions

The HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.     

Electromyographic comparison of standard and modified closed-chain isometric knee extension exercises

The purpose of this study was to compare electromyographic (EMG) activity during open kinetic chain (OKC) and a modified closed kinetic chain (MCKC) knee extension exercises. Both OKC and closed kinetic chain (CKC) exercises provide benefits when devising conditioning programs; however, there are no exercises that combine the benefits of both exercises. Subjects performed maximum isometric knee extensions for both traditional OKC and MCKC knee extension exercises. Surface electrodes were placed on 8 lower-extremity muscles. One second of integrated EMG activity followed 95% maximal knee extension force. The following muscles demonstrated greater EMG activity during the MCKC vs. the OKC knee extension exercises: vastus medialis, medial hamstring, lateral hamstrings, and gluteus maximus. There was no difference between force output between the 2 conditions. This study demonstrates that modifications to traditional OKC exercises demonstrate some characteristics of CKC exercises, and therefore provide another avenue of rehabilitation or strengthening.     

HIV Infection in Fishing Communities of Lake Victoria Basin of Uganda – A Cross-Sectional Sero-Behavioral Survey

Background

Uganda''s first AIDS case was reported in a fishing village. Thereafter, due to varying risk factors, the epidemic spread heterogeneously to all regions, with some populations more affected. Given the recent rising trends in HIV infection in Uganda, it is crucial to know the risk factors in different populations. The aim of this study was to determine the prevalence and risk factors of HIV infection among fishing communities.

Methodology

A cross-sectional survey of 46 fishing communities was conducted in 2010. Following written consent, 911 randomly selected respondents age 15–59 years were interviewed and gave blood for HIV testing. HIV testing was conducted in the field and central laboratory according to national algorithm. Survey protocol was approved by the Science and Ethics Committee of Uganda Virus Research Institute, and cleared by Uganda National Council for Science and Technology. Data was captured by EPIINFO and statistical analysis done in SPSS.

Findings

Overall HIV prevalence was 22%; there was no difference by sex (x ² test, p>0.05). Association with HIV infection was determined by x ² test, p<0.5. Never married respondents had lower HIV prevalence (6.2%) than the ever married (24.1%). HIV prevalence was lower in younger respondents, age 15–24 years (10.8%) than in age group 25 years and above (26.1%). Muslims had lower HIV prevalence (14.4%) than Christians (25.2%). HIV prevalence was higher among respondents reporting 3 or more lifetime sexual partners (25.3%) than in those reporting less numbers (10.8%). HIV prevalence was higher among uncircumcised men (27%) than in circumcised men (11%). Multivariate analysis identified 4 risk factors for HIV infection; age, religion, ever condom use and number of lifetime sexual partners.

Conclusions

HIV prevalence in the surveyed communities was three times higher than of general population. This underscores the need for tailor made HIV combination prevention interventions targeting fishing communities.