Prevention and Control of African Swine Fever in the Smallholder Pig Value Chain in Northern Uganda: Thematic Analysis of Stakeholders' Perceptions

African swine fever (ASF) is endemic in Uganda and considered a major constraint to pig production. In the absence of a vaccine, biosecurity is key for ASF prevention and control. To improve prevention and control on farm and community level there is need for more knowledge on current application of biosecurity practises, and better understanding of how pig value chain actors perceive prevention and control. To achieve this, a qualitative interview study involving focus group discussions (FGD) was conducted with actors from the smallholder pig value chain in northern Uganda. Six villages were purposively selected based on previous outbreaks of ASF, preliminary perceived willingness to control ASF, and the representation of several different value chain actors in the village. Results indicated that biosecurity practises such as basic hygiene routines including safe carcass handling, minimising direct and indirect contacts between pigs or between pigs and people, trade restrictions and sharing of disease information were implemented in some of the villages. Thematic analysis based on grounded theory revealed six categories of data relating to ASF prevention and control. Together these categories form a logical framework including both enablers and hindrances for ASF prevention and control. In summary participants mostly had positive perceptions of ASF biosecurity, describing measures as effective. Participants further possessed knowledge of ASF and its transmission, some of which was in line with known scientific knowledge and some not. Nevertheless, participants were hindered from preventing and controlling ASF due to biosecurity costs and a need to prioritise family livelihood over disease transmission risks, incompatibility of current biosecurity practises with local culture, traditions and social contexts and finally lack of access to veterinarians or, occasionally, low-quality veterinary services. The constraints could be addressed by applying participatory processes in designing biosecurity measures to ensure better adaptation to local cultural and social contexts.

High Burden of Cryptococcal Meningitis Among ART-Experienced HIV-infected Patients in Northern Uganda in the era of “Test and Treat”: Implications for Cryptococcal Screening Programs

Background The impact of the "test-and-treat" program for HIV treatment in rural areas of Uganda on cryptococcal antigen (CrAg) screening or cryptococcal meningitis (CM) is poorly understood. Methods We retrospectively evaluated clinical factors in 212 HIV-infected patients diagnosed with CM from February of 2017 to November of 2019 at Lira Regional Referral Hospital (LRRH) in northern Uganda. Results Among 212 patients diagnosed with CM, 58.5% were male. Median age, CD4 count, and HIV viral load were 35 years, 86 cells/μL, and 9,463 copies/mL respectively. Only 10% of patients had a previous history of CM. We found that 190 of 209 (90.9%) patients were ART-experienced, and 19 (9.1%) were ART-naïve. Overall, 90 of 212 (42.5%) patients died while hospitalized with a median time to death of 14 days. Increased risk of death was associated with altered mental status (HR 6.6, 95% CI 2.411-18.219, p =<0.0001), and seizures (HR 5.23, 95% CI 1.245-21.991, p=0.024). Conclusion Current guidelines recommend CrAg screening based on low CD4 counts for ART-naïve patients and VL or clinical failure for ART-experienced patients. Using current guidelines for CrAg screening, some ART- experienced patients miss CrAg screening in resource limited settings, when CD4 or VL tests are unavailable. We found that the majority of HIV- infected patients with CM were ART- experienced (90.9%) at presentation. The high burden of CM in ART-experienced patients supports a need for improved CrAg screening of ART-exposed patients.

COVID-19 pandemic, challenges, and opportunities in Northern Uganda; Community overview and perspectives: A qualitative study using informant interviews.

Background Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), a virus that causes COVID-19, has overwhelmingly interrupted human activities worldwide, especially in the low-to-middle income countries. Not much is reported about exclusive challenges and opportunities presented by the COVID-19 pandemic in some remote communities in Africa. Objective The objective of this study was to assess the community’s views and perspectives on the challenges and opportunities of the COVID-19 pandemic in Northern Uganda. Methods We interviewed 36 participants (age range, 28-63 years), including health workers, civil servants, members of civil society, security forces, politicians, and staff of local government administration who were members of COVID-19 district task forces in Northern Uganda using qualitative study methods between August and September 2021. The initial selection of participants was purposeful, but the snowballing technique was later used to select others. The interview questions were pre-tested among health workers and laypersons who were not part of the main study. Participants described how the COVID-19 pandemic presented challenges and opportunities, and the experience could be used to strengthen community resolves to control the pandemic and any other in the future. A local IRB approved this study. Data were analyzed using thematic analysis. Results The current study findings revealed challenges but many opportunities during the COVID-19 pandemic in this community, including loss of lives and livelihoods, increased poverty, lack of personal protection equipment, uncertainties, stress, and anxiety among health workers in the community. However, it also offered opportunities for quality family time, increased engagement, sensitization, and mobilization of communities for health, improved general security of persons and property, increased budgets and logistics for government departments, reduced incidences of diarrheal diseases and road traffic accidents, increased incomes for task force members, and more interactions among members during task force meetings. Conclusion Although the COVID-19 pandemic presented enormous challenges to low-to-middle-income countries, there are opportunities in some communities that are worth mentioning. Information obtained in this study has practical lessons that disease control experts could use to develop strategies to organize communities better and conduct disease surveillance activities for the COVID-19 pandemic and others.

Factors associated with mortality among the COVID-19 patients treated at Gulu Regional Referral Hospital: A retrospective study

Background: The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There is a lack of data on the outcome of hospitalized African patients suffering from COVID-19.This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021.Methods: This was a single-center, retrospective study in patients hospitalized with confirmed COVID-19 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, comorbidities, duration of hospital stay, and treatment were analyzed, and factors associated with increased odds of mortality were determined.Results: Of the 664 patients treated, 661(99.5%) were unvaccinated, 632(95.2%) recovered and 32(4.8%) died. Mortality was highest in diabetics 11(34.4%), cardiovascular diseases 12(37.5%), hypertensive 10(31.3%), females 18(56.3%), > 50-year-olds 19(59.4%), no formal education 14(43.8%), peasant farmers 12(37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32(100.0%), Oxygen saturation (Sp02) <80 4(12.5%), general body aches and pains 31(96.9%), tiredness 30(93.8%) and loss of speech and movements 11(34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR=0.220,95%CI:0.059-0.827;p=0.030; Diabetes mellitus AOR=9.014, 95%CI:1.726-47.067;p=0.010; tiredness AOR=0.059,95%CI:0.009-0.371; p=0.0000; general body aches and pains AOR=0.066,95%CI:0.007-0.605; p=0.020; loss of speech and movement AOR=0.134,95%CI:0.270-0.660;p=0.010 and other comorbidities AOR=6.860, 95%CI:1.309-35.957;p=0.020.Conclusion: The overall hospital mortality was 4.8%. Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “Enhanced shielding” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.

Factors associated with differential community prevalence of hepatitis E in two sub-counties in Kitgum District in Northern Uganda: A comparative cross-sectional study

Background: Hepatitis E is one of the leading causes of acute viral hepatitis worldwide. During 2009, an epidemic of hepatitis E resulted in 10,437 infections and 167 deaths in Kitgum district.Objective: To investigate factors associated with the differential community prevalence of hepatitis E in two sub-counties in Kitgum District.Methods: We conducted a community survey during the 4th-31st of May 2012 in two Sub Counties in Kitgum District in Northern Uganda. A total of 474 heads of household were recruited using a probability proportional to size through multistage and random sampling methods. Two hundred thirty-four (49.26%) heads of household were from Mucwini, and 241 (50.74%) were from Kitgum Matidi Sub Counties. The questionnaire had an internal validity of Cronbach’s α=0.85. The study was approved by a local IRB. STATA version 10.0 was used for data analysis, and a p-value less than 0.05 was considered significant.Results: The prevalence of hepatitis E was significantly higher in Mucwini Subcountry 97 (41.99%) than in Kitgum Matidi 63 (26.47%); χ2=12.6; p=0.000. Factors associated with differential prevalence were hand washing after latrine use with Adjusted Odds Ratio (AoR)=0.23,95%CI:0.110-0.646; p=0.003; frequency of communal hand washing AoR=0.53,95%CI:0.330-0.860; p=0.01; patients’ handling by health workers AoR=1.91,95%CI:1.410-2.610; p<0.001; frequency of village health meetings held AoR=0.69,95%CI:0.56-0.85; p<0.001 and awareness of the cause of Hepatitis E AoR=1.42, 95%CI:0.710-1.880; p=0.015.Conclusions: Factors associated with the differential community prevalence of hepatitis E in the two communities were poor personal hygiene, poor community practices and a low level of community awareness about the virus. District and health authorities should put in place measures to improve personal and household hygiene and strengthen community health education on hepatitis E.

Yield and Disease Responses of Improved Groundnut Genotypes Under Natural Disease Infection in Northern Uganda: Implication for Groundnut Disease Management

Groundnut production in Uganda is constrained by groundnut rosette disease (GRD), the main cause of yield loss experienced by farmers. We conducted the current study to assess the responses of improved groundnuts to diseases (rosette and late leaf spot) and yield under local conditions. Four released groundnut genotypes (Serenut 5R, Serenut 8R, Serenut 9T and Serenut 14R) were evaluated in four locations in northern Uganda for two seasons in 2019. We established the experiment following randomised complete block design with three replications. GRD severity (harvest) and late leaf spot (LLS) severity (harvest) on the four genotypes were not significantly (P &gt; 0.05) different but positively correlated with the Area Under Disease Progress Curve (AUDPC). Genotype-by-location interaction for LLS AUDPC, GRD AUDPC and dry pod yield were significant (P &lt; .001). Season-by-genotype interaction was not significant (P = 0.367). Days to 50% flowering were also not significant (P &gt; 0.05). Highest and lowest yields were recorded for Serenut 9T in the Omoro district (1,291 kg/acre) and the Amuru district (609 kg/acre), respectively. Dry pod yield was significantly (P &lt; 0.001) negatively correlated with GRD severity and GRD AUDPC. Yield performance of the four genotypes was not significantly (P &lt; 0.05) different in the districts, except for Kitgum, where yields of Serenut 9T and Serenut 8R were significantly (P &lt; 0.05) higher. These genotypes could be used to manage GRD by smallholder farmers in Northern Uganda. Special consideration should therefore be given to these four groundnut genotypes for GRD management in the Acholi sub-region.