Publication by Staff

Farmers’ Knowledge, Control Methods, and Challenges of Managing Bean Leaf Beetles (Ootheca spp.) in Uganda

Julius Mugonza, James P. Egonyu, and Michael H. Otim

Bean leaf beetles (BLBs) (Ootheca spp.) are important field insect pests of the common bean (Phaseolus vulgaris L.) in agricultural communities in Sub-Saharan Africa. A survey of 128 farmers was conducted in Arua, Hoima, Lira, and Lwengo districts in Uganda, where the common bean is a major food and income crop. This paper evaluated farmers’ knowledge, control strategies, and challenges in managing BLBs. Over 87% of the farmers in Arua and Lira could identify BLBs by local names, compared to less than 45% in Hoima and Lwengo. Less than 8% of the farmers in all districts were aware that BLBs oviposit, diapause, and then emerge from the soil. Many farmers (75%) in Lwengo perceived BLBs infestation as mild, 65.6% in Hoima thought it was moderate, and 78% and 56% in Arua and Lira respectively thought it was severe. The use of chemicals was popular in all districts and also perceived to be the most effective method for controlling BLBs. The reported obstacles to controlling BLBs were a lack of understanding of proper control methods, and the existence of fake insecticides on the market. We recommend that the Ministry of Agriculture, Animal Industry and Fisheries customizes the agricultural extension information packages to include BLBs and cost-effective control strategies for them.
Keywords:common bean; farmers’ knowledge; insecticides; control strategies. Access full text

Variability in nutrient composition of the edible long-horned grasshopper (Ruspolia differens) in Uganda and its potential in alleviating food insecurity

Margaret Kababu,Collins K. Mweresa,Sevgan Subramanian, James P. Egonyu and Chrysantus M. Tanga


Ruspolia  differens Serville (Orthoptera: Tettigonidae) is a highly nutritious and luxu-rious insect delicacy that is consumed as a food source in many African countries. However, the nutrient profile of R. differens in different geographical regions have received limited research interest. Here, we provide comprehensive evidence of geo-graphical impact on the nutrient profile of R.  differens and its potential to meet the recommended dietary intake of the population. Our results demonstrated that prox-imate composition, fatty acids, amino acids, minerals, vitamins, and flavonoid contents of R.  differens collected from five districts in Uganda varied considerably. The crude protein (28–45%), crude fat (41–54%), and energy (582–644 Kj/100 g) contents of R. differences exceed that reported from animal origins. The highest crude protein, crude fat, and carbohydrate contents of R. differences were recorded in Kabale, Masaka, and Kampala, respectively. A total of 37 fatty acids were identified with linoleic acid (omega-6 fatty acid) being the most abundant polyunsaturated fatty acid in R. differ-ens from Kabale, Masaka, and Mbarara. All essential amino acids were recorded in R. different, particularly histidine with values exceeding the daily requirement for adults. Mineral and vitamin content differed significantly across the five districts. The highest quantity of flavonoids was recorded in R. different from Hoima (484 mg/100 g). Our findings revealed that R. different could be considered as functional food ingredients capable of supplying essential macro-  and micronutrients that are critical in curbing the rising food insecurity and malnutrition in the regions.KEYWORDSedible grasshoppers, food security, functional food ingredient, geographical location, Ruspolia different, vulnerable communities. Access full text

Socio‑cultural practices on the use of beetle grubs as food and feed in western Kenya

Martin N. Wanjala, Mary Orinda, John M. Nyongesah, Chrysantus M. Tanga,
Sevgan Subramanian, Menale Kassie & James P. Egonyu.

We examined the socio‑cultural practices on the use of beetle grubs as food and feed in western Kenya
by interviewing 211 randomly selected households and conducting seven focus group discussions in
Bungoma, Kakamega, Busia, and Trans Nzoia counties. The grubs were used as food and feed in ~ 39%
and 78% of the households, respectively. The perceived benefits of the grubs for human consumption
were nutritiousness and no linkage to allergies. The grubs were perceived to enhance animal weight
gain and increase poultry egg laying. They were also perceived to recycle nutrients from organic
waste, and clean the environment. Toasting and roasting were the dominant methods of preparing
the grubs. Lack of knowledge on the grub nutritional benefits and stigma were key deterrents to their
consumption. About 66% of the respondents expressed willingness to farm the grubs if the market
and rearing protocols are available. Almost 98% of the respondents lacked knowledge of the beetle
biology, indicating limited capacity to conserve them. The practices on the use of beetle grubs as food
and feed differed across counties and by gender, age, marital status and education level. Strategies
for sustainable use of the grubs as food and feed have been proposed and new research directions
highlighted.The use of edible insects as part of the global food security strategy is increasingly becoming popular. About
2000 species of insects are consumed globally, ~ 500 of them in Africa, and ~ 17 in Kenya 1, 2 . Members of the
order Coleoptera, commonly called beetles, account for 31% of insect species consumed worldwide 2 . These
insects are mainly consumed during their larval stage, commonly called grubs. Most edible beetle larvae thrive
on decomposing organic waste. Beetle grubs are rich in nutrients like protein (40.7%), fat (33.4%), energy
(490.3 kcal/100 g), minerals (notably, calcium, magnesium and iron), vitamins (A, C and B 1, 2, 3 and 5) and
essential amino and fatty acids 3, 4. There is less wastage in consuming grubs than other livestock because they are
consumed in their entirety once degutted, unlike 40–50% consumable portions of other livestock such as cattle,
pigs and checken 3 . Insects require significantly less land, water, and feed, and release insignificant amounts of
greenhouse gases compared to conventional livestock like cattle 3, 5, 6 . Adult beetles and their larvae are readily
available in farmyard compost among the resource-limited rural animal keepers7, 8. The availability of the beetles
in the community provides a wild source of start-up breeding stock for sustainable captive rearing as a source
of food and feed for the future. Captive rearing as an alternative to aggressive harvesting of natural populations
of the larvae could preserve them and sustain their ecological roles.
Ecologically, most beetle grubs contribute greatly to nutrient recycling through the decomposition of organic
matter, parasite suppression, secondary seed dispersal and increased air permeability of the soils 8–11 . The pres-
ence of diverse gut microbes like fungi and bacteria in coprophagous beetles enhances their metabolic activity
to reduce the complex components in the dung into simple organic components that are easily available for plant
uptake 12 . Many adult beetles on the other hand are important crop pollinators thereby contributing immensely
to increased crop productivity. For instance, scarabid beetles are important (and often obligate) pollinators of
decay-scented flowers in the families Araceae and Lowiacea 9 . On the flipside, some beetles are notorious crop
and animal pests, although their harvest for consumption is being advocated as a strategy for sustainably man-
aging them 13, 14 .According to Kusia et al. 15, beetle grubs are the fifth most consumed insects in Kenya after termites, grasshop-
pers, saturniids and crickets. However, the report by these authors indicates that consumption of beetle grubs is
restricted to communities in western Kenya, which may be a result of cultural differences across regions. A more. Access full text

Effect of desert locust control on non-target edible termites in eastern Uganda

M. Angole,G.M. Malinga,C.M. Tanga,S. Subramanian,X.Cheseto, and J.P. Egonyu.


Effects of widescale locust control with insecticides on non-target edible insects have been scarcely assessed. This study was carried out to investigate the effect of spraying desert locusts with cypermethrin and chlorpyrifos on (1) termite mound activity; (2) the safety of edible termites from contamination with pesticide residues; and (3) the nutritional composition of non-target edible termites. Incidences of inactive termitaria in the sprayed and unsprayed sites were enumerated. Edible soldiers of Macrotermes spp. from sprayed and unsprayed colonies whose alates swarm around dusk, midnight and dawn were analysed for cypermethrin and chlorpyrifos residues, and proximate, mineral and flavonoid compositions. The pesticide sprays did not influence the incidence of inactive termitaria. No cypermethrin and chlorpyrifos residues were detected in the termites. Chlorpyrifos spraying lowered crude fibre and protein contents in soldiers of dawn and midnight swarming colonies, respectively; whereas cypermethrin spraying lowered ash and crude fat contents in soldiers from dawn and dusk swarming colonies, respectively. Cypermethrin spraying increased moisture content in soldiers from midnight swarming colonies. The level of manganese in soldiers from dawn-swarming colonies was lowered by cypermethrin spraying, while contents of aluminium and cobalt from the same type of colony were lowered by chlorpyrifos spraying. However, levels of calcium, potassium, magnesium, phosphorus, zinc, aluminium, manganese and iron were enhanced in soldiers from different termite colonies sprayed with cypermethrin and/or chlorpyrifos. Similarly, soldier termite samples from both insecticide-sprayed sites contained higher flavonoid levels than the samples from unsprayed sites. Freedom of the edible soldier termites from pesticide residues renders them safe for consumption. The results provide insights into the likely effects of wide-scale pesticide sprays against locusts on the nutritional profiles of edible termites.
Keywords: termitaria activity, food safety, nutrient contents, pesticide residues. Access full text

Comparison of the Biological Basis for Non-HIV Transmission to HIV-Exposed Seronegative Individuals, Disease Non-Progression in HIV Long-Term Non-Progressors and Elite Controllers

Joseph Hokello,Priya Tyagi,Shelly Dimri,Adhikarimayum Lakhikumar Sharma,andMudit Tyagi

HIV-exposed seronegative individuals (HESIs) are a small fraction of persons who are multiply exposed to human immunodeficiency virus (HIV), but do not exhibit serological or clinical evidence of HIV infection. In other words, they are groups of people maintaining an uninfected status for a long time, even after being exposed to HIV several times. The long-term non-progressors (LTNPs), on the other hand, are a group of HIV-infected individuals (approx. 5%) who remain clinically and immunologically stable for an extended number of years without combination antiretroviral therapy (cART). Meanwhile, elite controllers are comprise a much lower number (0.5%) of HIV-infected persons who spontaneously and durably control viremia to below levels of detection for at least 12 months, even when using the most sensitive assays, such as polymerase chain reaction (PCR) in the absence of cART. Despite the fact that there is no universal agreement regarding the mechanisms by which these groups of individuals are able to control HIV infection and/or disease progression, there is a general consensus that the mechanisms of protection are multifaceted and include genetic, immunological as well as viral factors. In this review, we analyze and compare the biological factors responsible for the control of HIV in these unique groups of individuals.
Keywords: HIV; genetic; seronegative; long-term non-progressors; elite controllers. Access full text

Medicinal plants used for treatment of malaria by indigenous communities of Tororo District, Eastern Uganda

 R. S. Tabuti, Samuel Baker Obakiro, Alice Nabatanzi, Godwin Anywar, Cissy Nambejja,Michael R. Mutyaba,Timothy Omara and Paul Waako


Background Malaria remains the leading cause of death in sub-Saharan Africa. Although recent developments such as malaria vaccine trials inspire optimism, the search for novel antimalarial drugs is urgently needed to control the mounting resistance of Plasmodium species to the available therapies. The present study was conducted to document ethnobotanical knowledge on the plants used to treat symptoms of malaria in Tororo district, a malariaendemic region of Eastern Uganda. Methods An ethnobotanical study was carried out between February 2020 and September 2020 in 12 randomly selected villages of Tororo district. In total, 151 respondents (21 herbalists and 130 non-herbalists) were selected using multistage random sampling method. Their awareness of malaria, treatment-seeking behaviour and herbal treatment practices were obtained using semi-structured questionnaires and focus group discussions. Data were analysed using descriptive statistics, paired comparison, preference ranking and informant consensus factor. Results A total of 45 plant species belonging to 26 families and 44 genera were used in the preparation of herbal medicines for management of malaria and its symptoms. The most frequently mentioned plant species were Vernonia amygdalina, Chamaecrista nigricans, Aloe nobilis, Warburgia ugandensis, Abrus precatorius, Kedrostis foetidissima, Senna occidentalis, Azadirachta indica and Mangifera indica. Leaves (67.3%) were the most used plant part while maceration (56%) was the major method of herbal remedy preparation. Oral route was the predominant mode of administration with inconsistencies in the posology prescribed. Conclusion This study showed that the identified medicinal plants in Tororo district, Uganda, are potential sources of new antimalarial drugs. This provides a basis for investigating the antimalarial efficacy, phytochemistry and toxicity of the unstudied species with high percentage use values to validate their use in the management of malaria. Access full text

"It's just like a blood transfusion": perceptions on the use of donated breast milk in selected hospitals in central Uganda: a qualitative study

Mary Gorreth Namuddu, David Mukunya, Victoria Nakibuuka, Esther Amulen, Ritah Nantale and Juliet Kiguli


Background: Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda.

Methods: A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0.

Results: A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother's milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child.

Conclusion: In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.

Keywords: Donated breast milk; Human milk banking; Perceptions.

© 2023. The Author(s).

Factors associated with childhood overweight and obesity in Uganda: a national survey

Quraish Sserwanja, Linet M Mutis, Emmanuel Olal, Milton W Musaba and David Mukunya.


Background: Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016.

Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda.

Results: The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3-5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2-4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8-1.5). Mother's nutritional status, sex of the child, and child's age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49-59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North.

Conclusion: The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age.

Keywords: Children and Uganda; Obesity; Overweight; Prevalence.

© 2021. The Author(s). Access full text 

The Effect of COVID-19 Restrictions on General and HIV Positive Inpatient Admissions and Treatment Outcomes: An Uncontrolled Before-and-after Study at a Ugandan Tertiary Hospital

Andrew Kazibwe, Bonniface Oryokot, Andrew Peter Kyazz, Philip Ssekamatte, George Patrick Akabwai, Emmanuel Seremba, David Mukunya, Magid Kagimu, Irene Andia-Biraro and Robert Kalyesubula


Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan - Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31-40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85-2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.

Keywords: Africa; COVID19; HIV Care continuum; HIV epidemiology; Health systems; Treatment.

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. Access full text

Prevalence of and Factors Associated with Hypertension Among Adults on Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross Sectional Study

Ronald Kasoma Mutebi,Andrew Weil Semulimi,John Mukisa,Martha Namusobya,Joy Christine Namirembe,Esther Alice Nalugga,Charles Batte, David Mukunya, Bruce Kirenga, Robert Kalyesubula and Pauline Byakika-Kibwika.


Introduction: Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens.

Methods: We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents.

Results: The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2-31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m3 (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122-1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206-8.108, P < 0.001] and 35-44 years [aPR: 2.455, 95% CI: 1.216-4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m3 [aPR: 1.489, 95% CI: 1.072-2.067, P = 0.017] as compared with BMI < 25 kg/m3, duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001-1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064-1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205-2.484, P = 0.003] were associated with hypertension.

Conclusion: One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.

Keywords: HIV; dolutegravir; hypertension. Access full text

© 2023 Kasoma Mutebi et al.

Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda

Charles Batte, Andrew Weil Semulim,Ronald Kasoma Mutebi,Nelson Twinamasiko,Sarah Racheal Muyama,John Mukisa,Immaculate Atukund,David Mukunya,Robert Kalyesubula, Siddharthan Trishul & Bruce Kirenga


Measuring quality of life is a key component in the management of Chronic Obstructive Pulmonary Disease (COPD).
The COPD assessment test (CAT), an easy to administer and shorter instrument than the standard Saint George's respiratory questionnaire (SGRQ), could be an alternative tool for measuring the quality of life of COPD patients in rural Uganda. A cross-sectional study was conducted between June and August 2022, consecutively recruiting 113 COPD patients aged > 40 years from the Low-Dose Theophylline for the management of Biomass-associated COPD (LODOT-BCOPD) study. Upon obtaining consent, participants answered an interviewer administered social demographic, CAT and SGRQ questionnaire. Internal consistency for both SGRQ and CAT was determined using Cronbach's alpha coefficient and values > 0.7 were considered acceptable while correlations were determined using Spearman's rank correlation. Limits of Agreement were visualised using Bland Altman and pair plots. Of the 113 participants, 51 (45.1%) were female. The mean age was 64 ± 12 years, 19 (16.8%) had history of smoking while majority (112 (99.1%)) reported use of firewood for cooking.There was a strong correlation of 0.791 (p < 0.001) between the CAT and SGRQ total scores with a high internal consistency of CAT, Cronbach's alpha coefficient of 0.924 (0.901-0.946). The agreement between the absolute CAT scores and the SGRQ scores was good with a mean difference of -0.932 (95% Confidence Interval: -33.49-31.62). In summary, CAT has acceptable validity and can be used as an alternative to the SGRQ to assess the quality of life of COPD patients in rural Uganda.

Copyright: © 2023 Batte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Access full text

Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study

Background: Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda.
Methods: We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25).
Results: Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2-55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13-3.20), health insurance (AOR = 1.39, 95% CI: 1.12-1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04-1.52), exposure to television (AOR = 1.23, 95% CI: 1.05-1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07-1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49-0.87) and Northern (AOR = 0.75, 95% CI: 0.59-0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68-0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion.
Conclusions: To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.
Keywords: Adolescent girls; Comprehensive knowledge; HIV/AIDS; Rwanda. text

Multiple electrolyte derangements among perioperative women with obstructed labour in eastern Uganda: A cross-sectional study

Ritah Nantale, David Mukunya, Kenneth Mugabe, Julius N Wandabwa, John Stephen Obbo and Milton W Musaba. 

There is a dearth of information on the patterns of electrolyte derangements among perioperative women with obstructed labour. We measured the levels and patterns of electrolyte derangements among women with obstructed labour in eastern Uganda. This was a secondary analysis of data for 389 patients with obstructed labour, diagnosed by either an obstetrician or medical officer on duty between July 2018 and June 2019. Five milliliters of venous blood was drawn from the antecubital fossa under an aseptic procedure for electrolytes and complete blood analyses. The primary outcome was the prevalence of electrolyte derangements, defined as values outside the normal ranges: Potassium 3.3-5.1 mmol/L, Sodium 130-148 mmol/L, Chloride 97-109 mmol/L, Magnesium 0.55-1.10 mmol/L, Calcium (Total) 2.05-2.42 mmol/L, and Bicarbonate 20-24 mmol/L. The most prevalent electrolyte derangement was hypobicarbonatemia [85.8% (334/389)], followed by hypocalcaemia [29.1% (113/389)], then hyponatremia [18% (70/389)]. Hyperchloraemia [4.1% (16/389)], hyperbicarbonatemia [3.1% (12/389)], hypercalcaemia [2.8% (11/389)] and hypermagnesemia [2.8% (11/389)] were seen in a minority of the study participants. A total of 209/389 (53.7%) of the participants had multiple electrolyte derangements. Women who used herbal medicines had 1.6 times the odds of having multiple electrolyte derangements as those who did not use herbal medicines [Adjusted Odds Ratio (AOR): 1.6; 95% Confidence Interval (CI): (1.0-2.5)]. Having multiple electrolyte derangements was associated with perinatal death although this estimate was not precise [AOR 2.1; 95% CI: (0.9-4.7)]. Women with obstructed labour in the perioperative period have multiple electrolyte derangements. Use of herbal medicines in labour was associated with having multiple electrolyte derangements. We recommend routine assessment of electrolytes prior to surgery in patients with obstructed labour. text

Comparison of the Biological Basis for Non-HIV Transmission to HIV-Exposed Seronegative Individuals, Disease Non-Progression in HIV Long-Term Non-Progressors and Elite Controllers

Joseph Hokello, Priya Tyagi, Shelly Dimri, Adhikarimayum Lakihuhumar Sharma and Mudit Tyagi

HIV-exposed seronegative individuals (HESIs) are a small fraction of persons who are multiply exposed to human immunodeficiency virus (HIV), but do not exhibit serological or clinical evidence of HIV infection. In other words, they are groups of people maintaining an uninfected status for a long time, even after being exposed to HIV several times. The long-term non-progressors (LTNPs), on the other hand, are a group of HIV-infected individuals (approx. 5%) who remain clinically and immunologically stable for an extended number of years without combination antiretroviral therapy (cART). Meanwhile, elite controllers comprise a much lower number (0.5%) of HIV-infected persons who spontaneously and durably control viremia to below levels of detection for at least 12 months, even when using the most sensitive assays, such as polymerase chain reaction (PCR) in the absence of cART. Despite the fact that there is no universal agreement regarding the mechanisms by which these groups of individuals are able to control HIV infection and/or disease progression, there is a general consensus that the mechanisms of protection are multifaceted and include genetic, immunological as well as viral factors. In this review, we analyze and compare the biological factors responsible for the control of HIV in these unique groups of individuals. text

Using mobile audiometry (Wulira App) to assess noise induced hearing loss among industrial workers in Kampala, Uganda: A cross-sectional study

Batte, Charles; Atukunda, Immaculate; Semulimi, Andew Weil; Nakabuye, Mariam; Bwambale, Festo; Mumbere, Joab;  Twinamasiko, Nelson; Mukumya, David; Nyarubeli, Israel Paul, Mukisa, John

ccupational noise is a common cause of hearing loss in low-income countries. Unfortunately, screening for hearing loss is rarely done due to technical and logistical challenges associated with pure tone audiometry. Wulira app is a valid and potentially cost-effective alternative to pure tone audiometry in screening for occupational hearing loss. We aimed to determine the prevalence of occupational hearing loss among workers in a metal industry company in Kampala district

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High Burden of Neurodevelopmental Delay among Children Born to Women with Obstructed Labour in Eastern Uganda: A Cohort Study

Chebet, Martin; Musaba, Milton W.; Mukumya, David; Makoko, Brian; Napyo, Agnes; Nantale, Ritah; Auma, Proscovia; Atim, Ketty; Nahurira, Doreck; Lee, Seungwon; Okello, Dedan, Ssegawa, Lawrence; Bromley, Kieran; Burgoine, Kathy; Ndeezi, Grace; Tumwine, James K.; Wandabwa, Julius; Kiguli, Sarah

Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8–75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.

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COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study

Onuni, Diox Patrick; Namulondo, Racheal; Wamune, Benon; Okia, David; Olupot Olupot, Peter; Nantale, Ritah; Matovu, Joseph KB; Napyo, Agnes; Lubaale Yovani A. Moses; Nhakira,Nathan; Mukunya, David

COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo disttrict, northern Uganda

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Podlipnik, Crtomir

The book Ebola is a relevant resource of knowledge about various aspects of the Ebola virus (EBOV) and the related disease. Many experts from different fields of science and from different parts of the world contributed to the creation of this book. The book contains valuable information about firsthand experience of managing Ebola virus disease (EVD) in Third World countries and offers the best practices to handle possible pandemic outbreaks of Ebola. Detailed analysis of EBOV genome is also given, with the description of EBOV pathology supported with structural information, and in addition, the various tasks and strategies for the development of an effective anti-Ebola cure are proposed.

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Managing ebola in low-resource settings:

Okware, Samuel

Five outbreaks of Ebola virus disease of the Sudan Ebola virus and the Bundibugyo Ebola virus occurred in Uganda from 2000 to 2012. The attack rates and the case fatality rates were much higher for the former than the later. Fever and bleeding manifestations associated with the clustering of cases were typical clinical features. Close contact with infected person was probably the major route of spread. Apparent asymptomatic and atypical Ebola infection was demonstrated in some close contacts, suggesting past un recognized exposure or cross-reacting antibodies. A zoonotic connection was apparent in monkeys and asymptomatic villagers. The Ministry of Health together with its partners contained the outbreaks, sometimes with delays, but at least once prompt‐ ly. Early detection and communication yielded the best ideal outcomes. A community based response ensured timely case search and contact tracing for the isolation and management of patients. The syndrome-based EVD case definition and the laboratory screening tests for Ebola were used to detect cases. However, their unknown specificity and sensitivity and their low positive predictive values were a major weakness in the screening process. Validation of the criteria and the tests at the local level was essential. There were gaps in isolation procedures as 64% of the health care workers were infected after the isolation units were established. Palliative treatment was an important part of management as it improved survival and public confidence. 

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Ebola and health partnerships, action in a time of crisis.

Brown, Colin S; Elsherbiny, Mohamed; Johnson, Oliver; Kamboz, Amardeep; Lado, Marta; Leather, Andrew; Mounter, Natalie; Thomas, Suzanne; Youkee, Dan; Walker, Naomi; Awonuga, Waheed; Kamara, TB; Kamara, Cecilia; Kasette, Quannan; Ngauja, Ramatu

The chapter explores the role of health partnerships in delivering services throughout the West African Ebola Virus Disease epidemic, including the creation of the Ministry of Health & Sanitation Ebola Holding Unit models, command and control structures, research into diagnostics and care pathways, and general medical care. It will highlight how this provided resilience during the Ebola response, and how this will aid health systems strengthening going forward.

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A genomic landscape of haplotype diversity and signatures of phylogeographic distribution in Zaire ebolavirus during the 2014 EVD epidemic.

Teng, Yue; Yu, Yan; Jin, Yuan; An, Xiaoping; Feng, Dan

The Ebola virus (EBOV) disease epidemic from 2013 to 2015 is the largest in history, affecting multiple countries in West Africa. Genome sequencing of EBOV has revealed extensive genetic variation and mutation rate. The evolution and the variations among genotypes of EBOV observed remain low, which suggests that the viral haplotypes may be common in this transmission. To address this hypothesis, we investigated the genomic portrait of haplotype diversity in EBOV from 1976 to the 2014 outbreaks. We obtained 176 haplotypes in 305 gene-coding sequences of EBOV and found that the Hap8 in multiple viral haplotypes is the major epidemic lineage in the 2014 Sierra Leone outbreak. The phylogeographic analysis of EBOV transmission in Sierra Leone during 2014 outbreaks indicated that the genetic flow in EBOV was no more likely to occur within or without populations and the correlation between genetic and geographical distance is not significant. Our study first detected the diversity of viral haplotypes with systematic calculation of phylogeographic distribution in EBOV. This observation highlighted how Ebola virus is substantially different in virulence or transmissibility in comparison to the virus lineages associated with 2014 outbreaks in Sierra Leone, which provides a clue to understand the 2014 EBOV spreading. Keywords: Ebolavirus, Genome sequencing, Evolutionary, Haplotype diversity, Phylogeographic distribution.

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Prediction of ebolavirus genomes encoded microRNALike small RNAs using bioinformatics approaches.

Teng, Yue; Xu, Zhe; Yuan, Jin; An, Xiaoping; Song, Jiangman; Feng, Dan

Recent findings revealed that certain viruses encoded microRNA-like small RNAs using the RNA interference machinery in the host cells. However, the function of these virusencoded microRNA-like small RNAs remained unclear, and whether these microRNAlike small RNAs were involved in the replication of the virus and viral infection was still disputable. In this chapter, the negative-sense RNA genome of Ebola virus (EBOV) was scanned using bioinformatics tools to predict the EBOV-encoded microRNA-like small RNAs. Then, the potential influence of viral microRNA-like small RNAs on the viral immune evasion, host cellular signaling pathway, and epigenetic regulation of antiviral defense mechanism were also detected by the reconstructed regulatory network of target genes associated with viral encoded microRNA-like small RNAs. In this analysis, EBOV-encoded microRNA-like small RNAs were proposed to inhibit the host immune response factors, probably facilitating the evasion of EBOV from the host defense mechanisms. 

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Roles of VP35, VP40 and VP24 proteins of Ebola virus in pathogenic and replication mechanisms.

Hammou, Rahma Ait; Kasmi, Yassine; Khataby, Khadija; Laasri, Fatima Ezzahra; Boughribil, Said; Ennaji, My Mustapha

Ebola epidemic is a fatal disease due to Ebola virus belonging to Filoviridae; currently the viral evolution caused more than 50% of death worldwide. Among the eight proteins of ZEBOV, there are four structural proteins VP35, VP40, VP24, and NP, which have important functions in the intercellular pathogenic mechanisms. The multi‐functionality of Ebola's viral proteins allows the virus to reduce its protein number to ensure its proper functioning and keeping the compact structure of the virus. Therefore, the aim of this chapter is to study the mechanism of replication and the roles of VP30, VP35, NP, and L in this process. We provide as well to highlight the influence of the virus on the immune system and on the VP24. Keywords: Ebola, VP35, VP40, VP24, pathogenic, replication, mechanisms, immune system.

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Strategies for the development of small molecule inhibitors of Ebola viral infection.

Pleško, Sebastian; Podlipnik, Črtomir

The recent outbreak of Ebola viral disease (EVD) in West Africa reminded us that an effective anti-viral treatment still does not exist, despite the significant progress that has recently been made in understanding biology and pathology of this lethal disease. Currently, there are no approved vaccine and/or prophylactic medication for the treatment of EVD in the market. However, the serious pandemic potential of EVD mobilized research teams in the academy and the pharmaceutical industry in the effort to find an Ebola cure as fast as possible. In this chapter, we are giving the condensed review of different approaches and strategies in search of a drug against Ebola. We have been focusing on the review of the targets that could be used for in silico, in vitro, and/or in vivo drug design of compounds that interact with the targets in different phases of the Ebola virus life cycle. Keywords: small molecule inhibitors, Ebola virus, drug design, protein targets, structure and action.

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Community contribution to the control of Ebola outbreaks in Uganda, 2000-2022.

Okware, Samuel

Samuel Okware describes the role that communities have played in the control of Ebola outbreaks in Uganda from 2000 to 2022. He basically talks about how to manage Ebola in the low developed countries pointing out the experiences from Uganda. This chapter discusses the different Ebola outbreaks in Uganda between 2000 and 2012.

Ebola preparedness and risk in Latin America.

Rodriguez‐Morales, Alfonso J.; Cardona‐Ospina, Jaime AndrésFernanda‐Urbano, Sivia; Nasner‐Posso, Katherinn Melissa; Cruz‐Calderón, Stefania; Calvache‐Benavides, Carlos E.; Delgado‐Pascuaza, Yudy Lorena; Castillo, Juan Camilo; Alvarez‐Ríos, Maria Yamile; Marín‐Rincón, Hamilton A.; Urrutia, Liceth; Paniz‐Mondolfi, Alberto

Until today, February 22, 2016, no confirmed Ebola cases have been diagnosed in Americas (except USA, four cases with one death). Confusion, lack of knowledge, and fear have led to quickly misclassify cases as suspected, when in fact most of them are false alarms. Nevertheless, European governments summoned to mobilize resources to attend the Ebola outbreak in West Africa. And also Latin American governments should contrib‐ ute to halt this humanitarian crisis and to be prepared for the potential arrival of this deadly virus in the Caribbean, Central, and South American mainland. In this chapter, we described the experience of preparedness as well as risk assessment done in Latin America regarding the threat of Ebola for the region. Keywords: Ebola, preparedness, risk assessment, travel medicine, Latin America

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Ebola virus’s glycoproteins and entry mechanism.

Khataby, Khadija; Kasmi, Yassine; Hammou, Rahma Ait; Laasri, Fatima Ezzahra; Boughribil, Said; Ennaji, My Mustapha

Ebola virus glycoprotein (GP) is the only protein that is expressed on the surface of the virus. The GP proteins play critical roles in the entry of virus into cell and in the evasion of the immune system. The GP gene transcript to membrane GP is constituted of two subunits GP1 and GP2,and the secretory GP (sGP). The main function of GP1/2 is to attach virus to target cell’s membrane, whereas sGP has multiple functions on Ebola pathogen‐ esis, such as inactivate neutrophils through CD16b causing lymphocyte apoptosis and vascular dysregulation. There are many studies that focused on better understanding the GP mechanism and aim at developing new antibodies and drugs such as VSV-EBOV, cAd3-EBO Z, rVSVN4CT1 VesiculoVax, ‘C-peptide’ based on the GP2 C-heptad repeat region (CHR) targeted to endosomes (Tat-Ebo) and MBX2270. In this chapter, we discuss the Ebola viral glycoproteins, genomic organization, synthesis, and their roles and functions. On the other hand, we treat the mechanisms of pathogenicity associated with Ebola GPs. Keywords: EBOLA, virus, glycoprotein (GP), entry, mechanism, pathogenesis, structure

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