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Reaching the last 10 percent out of school children: the role of AIDS
(African Journals Online (AJOL), 2016) Okumu, Ibrahim Mike; Mugisha, Frederick
This paper investigates the role of AIDS on children being out of school. Put differently, whether it is because of AIDS that children are out of school. The main data source was the Northern Uganda Survey of 2004 conducted by Uganda Bureau of Statistics (UBOS) between July and December 2004. The survey was meant to provide indicators to guide the monitoring and evaluation function of the NUSAF project period in 18 districts of Northern Uganda. We defined and identified ‘aids affected households’, used descriptive analysis as well as a multinomial specification. We further explored the role of poverty using changes in household asset value between 1992 and 2004. There is no conclusive evidence that children are out of school due to AIDS. AIDS has a marginal effect on children failing to continue in school but this is not statistically significant. However there is strong evidence that children are out of school because of a decline in household asset value. To reach children who have never attended school, rather than focusing on ‘AIDS affected households’, a much greater impact is expected from preventing major decline in ‘household asset value’.
Realized Access to Antenatal Care Utilization in Uganda: Household Welfare and Governance Implications
(African Journals Online (AJOL), 2016) Okumu, Ibrahim Mike; Bbaale, Edward
The rationale of this study is to explain the link between household welfare, the region in which an infant is situated, literacy level of a mother and malaria prevalence among infants in Uganda with a more recent nationally representative data set that is the 2006 Uganda Demographic and Health Survey in lieu of the findings by other researchers on this particular subject. This was done with the aid of logit model estimation. The findings indicate that the region where an infant situated is fundamental in explaining malaria prevalence among infants. Alongside region is the location of a child whether he or she is in the rural or urban setting, the findings indicate that malaria prevalence lower among urban infants as compared to their rural counterparts. In conclusion, it was observed that malaria prevalence is not a case of household socioeconomic conditions but rather it's a communal disease as exemplified by the significance of region and urban-rural location of an infant.
“I felt my rights were violated”: Challenges with the discontinuation of provider‑dependent contraceptive methods in Eastern Uganda
(Contraception and Reproductive Medicine, 2025-03-18) Nabulondera, Agnes; Nabirye, Rose Chalo; Akello, Sarah Racheal; Munanura, Turyasiima; Epuitai, Joshua
The right to autonomy in family planning is a cornerstone of reproductive health. Yet, many women face challenges when seeking to discontinue provider-dependent contraceptive methods, such as implants and intrauterine devices (IUDs). This study explored the experiences of women in Eastern Uganda regarding the discontinuation of implants/IUDs. Using a qualitative descriptive design, we conducted 15 in-depth interviews with women and six key informant interviews with healthcare providers. The study obtained ethical clearance and used a thematic analysis. Two themes were identified: (1) reasons for refusal and (2) women’s reactions to refusal to discontinue IUDs/implants. Women were denied to discontinue IUDs/implants because the due date had not been reached, insertion cards were missing, and there were healthcare constraints, especially inadequate equipment. Early removal or discontinuation before the due date was considered as a waste of resources, unjustifiable, and it was seen to increase risk of pregnancy among young girls. Healthcare workers preferred to first counsel for side effects instead of heeding women's requests to discontinue IUDs/implants. Women often felt betrayed and powerless when they were denied to discontinue using IUDs/implants. They felt that their reproductive rights were undermined which fostered mistrust towards future use of provider-dependent contraceptives. Women reported physical, social, and mental health struggles including strained marital relationships following denial to discontinue IUDs/implants. Most of the women incurred costs in discontinuing the use of IUDs/implants in private facilities. The findings underscore the need to uphold women’s autonomy by improving access to removal services, and addressing systemic and provider-level barriers to discontinuation of IUDs/implants. Insertion cards should not be a mandatory requirement during discontinuation of contraceptives, while enhancing record-keeping systems can address the need for insertion cards. Respecting women’s rights to discontinue contraceptives is essential for ensuring voluntary and sustained family planning use.
Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda: a qualitative study
(Contraception and Reproductive Medicine, 2024-10-10) Kamwesigye, Assen; Amanya, Daphine; Nahurira, Doreck; Oguttu, Faith; Mukunya, David; Willcox, Merlin
In Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda. We conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework. The use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples’ counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) . Low uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies.
“I have come to remove it because of heavy bleeding”: a mixed-methods study on early contraceptive implant removal and the underlying factors in eastern Uganda
(Contraception and reproductive medicine, 2024-04-16) Abiyo, Janet; Nambozo, Brendah; Mukunya, David; Musaba, Milton W.; Epuitai, Joshua
Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda. We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients’ serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis. In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding. A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants.
Enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda: a qualitative study
(Contraception and Reproductive Medicine, 2023-10-16) Tekakwo, Atkinson; Nabirye, Rose Chalo; Oguttu, Faith; Mukunya, David; Epuitai, Joshua
Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda. This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach. Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female’s issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement. Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods.
MinION Whole‑Genome Sequencing in Resource‑Limited Settings: Challenges and Opportunities
(Current Clinical Microbiology Reports, 2022-11-17) Wasswa, Fredrickson B.; Kassaza, Kennedy; Nielsen, Kirsten; Bazira, Joel
The introduction of MinION whole-genome sequencing technology greatly increased and simplified complete genome sequencing in various fields of science across the globe. Sequences have been generated from complex organisms to microorganisms and are stored in genome databases that are readily accessible by researchers. Various new software for genome analysis, along with upgrades to older software packages, are being generated. New protocols are also being validated that enable WGS technology to be rapidly and increasingly used for sequencing in field settings. MinION WGS technology has been implemented in developed countries due to its advantages: portability, real-time analysis, and lower cost compared to other sequencing technologies. While these same advantages are critical in developing countries, MinION WGS technology is still under-utilized in resource-limited settings. In this review, we look at the applications, advantages, challenges, and opportunities of using MinION WGS in resource-limited settings.
Gardnerella Vaginalis-binding IgA in the Urethra of Sexually Experienced Males
(Microbiome, 2025-01-29) Liu, Rachel; Galiwango, R. M.; Nnamutete, James; Isbirye, Yahaya; Wasswa, John Bosco; Kigozi, Godfrey; Kaul, Rupert
Genital inflammation increases HIV susceptibility and is associated with the density of pro-inflammatory anaerobes in the vagina and coronal sulcus. The penile urethra is a critical site of HIV acquisition, although correlates of urethral HIV acquisition are largely unknown. While Streptococcus mitis is a consistent component of the urethral flora, the presence of Gardnerella vaginalis has been linked with prior penile-vaginal sex and urethral inflammation. Here, we use a flow cytometry-based bacterial assay to quantify urethral IgA and IgG that bind G. vaginalis and S. mitis in a cross-sectional cohort of 45 uncircumcised Ugandan men and to evaluate their association with the urethral microbiome and local soluble immune factors. Urethral antibodies binding both bacterial species were readily detectable, with G. vaginalis predominantly bound by IgA, and S. mitis equivalently by IgA and IgG. Gardnerella vaginalis-binding IgA was elevated in participants with detectable urethral Gardnerella, with the latter only present in participants who reported prior penile-vaginal sex. In contrast, detectable urethral S. mitis was not associated with sexual history or levels of S. mitis-binding IgA/IgG. The time from the last penile-vaginal sex was inversely correlated with the urethral concentrations of total IgA, G. vaginalis-binding IgA, and chemokines IL-8 and MIP-1β; these inflammatory chemokines were independently associated with higher total IgA concentration, but not with G. vaginalis-binding IgA. This first description of microbe-binding antibodies in the penile urethra suggests that urethral colonization by Gardnerella after penile-vaginal sex specifically induces a G. vaginalis-binding IgA response. Prospective studies of the host-microbe relationship in the urethra may have implications for the development of vaccines against sexually-transmitted bacteria.
Challenges and support for quality of life of youths living with HIV/AIDS in schools and larger community in East Africa: a systematic review
(Systematic reviews, 2019-02-26) Kimera, Emmanuel; Reynaert, Didier; Nuwaha, Fred; Rubaihayo, John; Bilsen, Johan
Youths living with HIV/AIDS (YLWHA) experience innumerable challenges within schools and the larger community. Nonetheless, these environments are potential sources of support for such youths. This review provides a synthesis of evidence about these challenges and support available for YLWHA to inform the design and implementation of interventions that support the wellbeing of youths living with HIV/AIDS in an East African context. We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane central registry of systematic reviews and randomized control trials for studies conducted in East Africa and published in English in the last 10 years (March 2007 to March 2017). We also searched Google Scholar and reference lists of all included studies. We purposed to include both qualitative and quantitative data but no quantitative data merited inclusion. We analyzed qualitative data using a framework thematic analysis. We included 16 primary studies conducted in clinic and community settings that used qualitative or mixed methods. Three overarching themes—psychosocial wellbeing, treatment and health, and disclosure of HIV status together with a sub-theme of stigma that was important across the three overarching themes—were the basis for analysis. In each overarching theme, a duality of challenges versus support was reported. Psychosocial wellbeing included subthemes of challenges in schools and larger community, financial challenges, domestic violence, sexual and reproductive health challenges, and psychosocial support. YLWHA experience numerous challenges and support needs, some of which occur in schools and affect their QoL. The effects of these challenges are poor health and educational outcomes as well as school dropout. The schools in which youths spend most of their formative years have not provided adequate support for YLWHA. This review identified that although most of the challenges that studies identified arose from within schools and that a few supportive approaches were available, none of the studies explored how these supportive approaches would work in schools. It was additionally identified that stigma complicates challenges of living with HIV/AIDS necessitating interventions for the wellbeing of YLWHA to understand and address HIV-stigma and its ramifications. Such interventions ought to be sustainable in schools, culturally appropriate, and multidisciplinary in order to promote the general health of all students.
Examining the Relationship between Interpersonal support and Retention in HIV Care among HIV+ Nursing Mothers in Uganda
(BMC research notes, 2021-06-03) Nutor, Jerry John; Agbadi, Pascal; Anguyo, Geoffrey; Camlin, Carol S.
The global burden of HIV on women and pediatric populations are severe in sub-Saharan Africa. Global child HIV infection rates have declined, but this rate remains quite high in sub-Saharan Africa due to Mother-to-child transmission (MTCT). To prevent MTCT of HIV, postpartum women living with HIV (WLHIV) are required to return to a health facility for HIV care within 60 days after childbirth (Retention in HIV care). Studies suggest that interpersonal support was positively associated with retention in HIV care. However, information on this association is lacking among postpartum WLHIV in Uganda. Therefore, this study investigates the relationship between interpersonal support, measured with the Interpersonal Support Evaluation List (ISEL-12), and retention in HIV care. In a total of 155 postpartum WLHIV, 84% were retained in HIV care. ISEL-12 was negatively associated with retention in HIV care. Postpartum WLHIV retained in care (24.984 ± 4.549) have lower ISEL-12 scores compared to the non-retained group (27.520 ± 4.224), t(35.572) = − 2.714, p = 0.01. In the non-income earning sample, respondents retained in care (24.110 ± 4.974) have lower ISEL scores compared to the non-retained group (27.000 ± 4.855), t(20.504) = -2.019, p = 0.049. This was not significant among income earning WLHIV.
Ethnomedicinal plants used for malaria treatment in Rukungiri District, Western Uganda
(Tropical Medicine and Health, 2023) Gumisiriza, Hannington; Olet, Eunice A.; Mukasa, Paul; Lejju, Julius B.; Omara, Timothy
Malaria remains a major global health challenge and a serious cause of morbidity and mortality in sub-Saharan Africa. In Uganda, limited access to medical facilities has perpetuated the reliance of indigenous communities on herbal medicine for the prevention and management of malaria. This study was undertaken to document ethnobotanical knowledge on medicinal plants prescribed for managing malaria in Rukungiri District, a meso-endemic malaria region of Western Uganda. Methods An ethnobotanical survey was carried out between May 2022 and December 2022 in Bwambara Sub-County, Rukungiri District, Western Uganda using semi-structured questionnaire. A total of 125 respondents (81 females and 44 males) were randomly selected and seven (7) key informants were engaged in open interviews. In all cases, awareness of herbalists on malaria, treatment-seeking behaviour and herbal treatment practices were obtained. The ethnobotanical data were analyzed using descriptive statistics, informant consensus factor and preference ranking. Results The study identified 48 medicinal plants belonging to 47 genera and 23 families used in the treatment of malaria and its symptoms in the study area. The most frequently cited species were Vernoniaamygdalina, Aloevera and Azadirachtaindica. Leaves (74%) was the most used plant organ, mostly for preparation of decoctions (41.8%) and infusions (23.6%) which are administered orally (89.6%) or used for bathing (10.4%). Conclusions Indigenous knowledge of medicinal plants used as prophylaxis and for treatment of malaria still exist among the local communities of Bwambara Sub-County. However, there is a need to investigate the antimalarial efficacy, phytochemical composition and safety of species (such as Digitariaabyssinica and Berkheyabarbata) with high percentage use values to validate their use.
Research involvement among undergraduate health profession students in a resource‑limited setting: awareness, attitude, motivators and barriers
(BMC Medical Education, 2022) Kiyimba, Blaise; Atulinda, Linda; Nalunkuma, Racheal; Asasira, Ignatius; Kabunga, Jonathan; Banturaki, Davis; Nabyonga, Anastacia S.; Nakiganda, Rachel; Ndyabawe, Rachael; Nkalubo, Jonathan; Ssewante, Nelson; Bongomin, Felix; Bakeera‑Kitaka, Sabrina
Involvement of undergraduate health professions students (HPS) in research will facilitate evidencebased clinical practice among future healthcare practitioners. This study aimed to assess research involvement among undergraduate HPS students and associated factors in Uganda. Methods: A cross-sectional study was conducted using an online assessment tool sent through WhatsApp groups and E-mail addresses of HPS in 12 medical schools in Uganda between 20th September and 5th October 2021. Results: We enrolled 398 participants with a mean age of 23.9 ± 3.7 years. Of this, 267 (67.1%) were male. One hundred twenty (30.2%) participants previously participated in a research activity: 90 (58.4%) as research assistants, 39 (25.3%) published as first authors, and 25 (16.2%) as co-authors. Training on the conduct of research was received by 242 (65.8%) participants, and 326 (81.9%) had intentions of conducting research in the future. Factors influencing participation in research activities were, age ≥ 25 years (adjusted odds ratio (aOR): 1.9, 95% confidence interval (95% CI): 1.2–3.2, p = 0.012), being male (aOR: 2.1, 95%CI: 1.2–3.6, p = 0.008), and being in a clinical year i.e., year 3 (aOR: 3.2, 95% CI: 1.1–9.3, p = 0.033), year 4 (aOR: 3.3, 95% CI: 1.1–9.5, p = 0.028) and year 5(aOR: 11.6, 95% CI: 3.2–42.1, p < 0.001). Lack of funds (79.6%), and mentorship (63.3%) were reported as major barriers to research. Conclusions: Despite a high proportion of HPS showing interest in getting involved in research, less than one-third reported previous involvement. Addressing barriers such as funding could potentially improve research involvement and output among undergraduate HPS in resource-limited settings.
Knowledge on Infection Prevention and Control and associated factors among undergraduate health professional students at Makerere University College of Health Sciences, Uganda
(PLoS ONE, 2021) Nalunkuma, Racheal; Nkalubo, Jonathan; Abila, Derrick B.
To practice adequate Infection Prevention and Control (IPC) measures, health professional students need to have adequate knowledge of IPC. In this study, we assessed the knowledge of health professional students at Makerere University College of Health Sciences on Infection Prevention and Control. Methods We conducted a cross-sectional online survey among health professional students studying at Makerere University College of Health Sciences located in Kampala, Uganda. An adapted questionnaire was used to measure knowledge on Infection Prevention and Control among students. Results A total of 202 health professional students were included in the study. The mean age was 24.43 years. Majority were male 63.37% (n = 128), from the school of medicine 70.79% (n = 143) and used one source of information for IPC 49.50% (n = 100). Being in year three (Adjusted coefficient, 6.08; 95% CI, 2.04–10.13; p-value = 0.003), year four (Adjusted coefficient, 10.87; 95% CI, 6.91–14.84; p < 0.001) and year five (Adjusted coefficient, 8.61; 95% CI, 4.45–12.78; p < 0.001) were associated with a higher mean in total percentage score of knowledge on IPC compared to being in year one. Conclusion IPC knowledge was good among health professional students in Makerere University although more emphasis is needed to improve on their IPC knowledge in various sections
Widespread Pyrethroid and DDT Resistance in the Major Malaria Vector Anopheles funestus in East Africa Is Driven by Metabolic Resistance Mechanisms
(PloS one, 2014) Mulamba, Charles; Riveron, Jacob M.; Ibrahim, Sulaiman S.; Irving, Helen; Barnes, Kayla G.; Mukwaya, L. G.; Birungi, Josephine; Wondji, Charles S.
Establishing the extent, geographical distribution and mechanisms of insecticide resistance in malaria vectors is a prerequisite for resistance management. Here, we report a widespread distribution of insecticide resistance in the major malaria vector An. funestus across Uganda and western Kenya under the control of metabolic resistance mechanisms. Methodology/Principal Findings Female An. funestus collected throughout Uganda and western Kenya exhibited a Plasmodium infection rate between 4.2 to 10.4%. Widespread resistance against both type I (permethrin) and II (deltamethrin) pyrethroids and DDT was observed across Uganda and western Kenya. All populations remain highly susceptible to carbamate, organophosphate and dieldrin insecticides. Knockdown resistance plays no role in the pyrethroid and DDT resistance as no kdr mutation associated with resistance was detected despite the presence of a F1021C replacement. Additionally, no signature of selection was observed on the sodium channel gene. Synergist assays and qRT-PCR indicated that metabolic resistance plays a major role notably through elevated expression of cytochrome P450s. DDT resistance mechanisms differ from West Africa as the L119F-GSTe2 mutation only explains a small proportion of the genetic variance to DDT resistance. Conclusion The extensive distribution of pyrethroid and DDT resistance in East African An. funestus populations represents a challenge to the control of this vector. However, the observed carbamate and organophosphate susceptibility offers alternative solutions for resistance management.
Variation in morphological characters of adults of the Aedes (Stegomyia) simpsoni complex from Uganda, Kenya, and South Africa (Diptera: Culicidae)
(Mosquito Systematics, 1994) Lutwama, Julius J.; Mukwaya, L. G.
Examination of adult Aedes simpsoni (Theobald) s.Z. from locations in Uganda and Kenya showed more variation than reported previously. Four patterns of white banding on the midtarsomeres were identified, and they occurred in varying frequencies in samples from different locations. The length of the tarsal bands was distributed continuously within samples from different locations and was variable among progeny of single mothers. This character therefore is not diagnostic of species in the complex. Midtarsomeres 1 and 2 have longer white bands in the majority of males and females of anthropophilic populations in Kenya and Uganda, but there is considerable overlap between the anthropophilic and nonanthropophilic biotypes. A few females in some samples did not bear a tooth on all claws of the fore- or midlegs. Twelve patterns of scutal lines occurred in varying frequencies in samples from different locations. A scutal pattern with long inner lines and short outer lines was most common, with an average occurrence of 5 1.2% in females and 32.2% in males. An H-pattern of scutal lines was more frequent in males (42.1%) than in females (12.10/o), indicating a sex association. Three tergal banding patterns were defined. We conclude that the nominotypical Ae. simpsoni in southern Africa is a distinct species different from the more widespread Ae. Zilii (Theobald) in tropical Africa. Aedes bromeliae (Theobald) cannot be distinguished from the latter based on characters presently described as diagnostic.
The role of olfaction in host preference by Aedes (Stegomyia) simpsoni and Ae.aegypti
(Physiological Entomology, 1976) Mukwaya, L. G.
Host preference in females of the mosquitoes Aedes simpsoni (Theo.) and Aedes aegypti (L) appears to be based largely on responses to specific odours at short range, with the site of olfaction being the antennae. In blank Y‐olfactometer tests, 48 % of an anthropophilic (llobi) strain of Ae. aegypti responded to one arm and 52% to the other. However, presented with a man's hand in one arm of the olfacto‐meter and a whole rat, Arvicanthis niloticus, in the other, 65% responded to man and 35% to the rat. With the same strain in a blank Gouck's type of olfactometer, the response was very poor, only 1 % of the mosquitoes in the olfactometer responded at all, again with no preference for either side. On the introduction of the same hosts into the Gouck's olfactometer, the total response was c. 31 %, of which 72 % responded to man and 28 % to the rat. Elimination of some visual cues affected neither the total response nor the preference. Removing one antenna, reduced the preference for man from about 70 % in the normal mosquitoes to about 58%. The total response remained approximately the same as in the normal mosquitoes. Removing both antennae, in both Ae. aegypti and Ae. simpsoni, caused a sharp depression in the total response and in host discrimination.
The maraviroc expanded access program — safety and efficacy data from an open-label study
(HIV Clinical Trials, 2015) Lazzarin, Adriano; Reynes, Jacques; Molina, Jean-Michel; Valluri, Srinivas; Mukwaya, Geoffrey; Heera, Jayvant; Craig, Charles; van der Ryst, Elna; Sierra-Madero, Juan G.
The maraviroc (MVC) expanded access program (EAP) was initiated to increase MVC availability to patients with limited treatment options. Darunavir (DRV), raltegravir (RAL), and etravirine (ETV) were either recently approved or under regulatory review at study initiation and available for coadministration with MVC. Thus, the safety of MVC in combination with new antiretroviral therapies (ARVs) could be assessed. This open-label safety study of MVC was conducted at 262 sites worldwide in 1032 R5 HIV-positive treatment-experienced patients with limited/no therapeutic options. Methods: Study visits included screening, baseline, end of study or early discontinuation, and follow-up 30 days after last dose. Interim visits for HIV-1 RNA and CD4 cell counts occurred according to local HIV infection management guidelines. Safety data were analyzed overall and by subgroup based on ARV combination [MVC+optimized background therapy (OBT), MVC ± OBT+DRV/r, MVC ± OBT+RAL, MVC ± OBT+RAL+DRV/r, MVC ± OBT+RAL+ETV ± DRV/r]. Results: Most (90.3%) adverse events (AEs) were of mild or moderate severity with few grade 3/4 events, discontinuations, or temporary discontinuations/dose reductions due to AEs or serious AEs. Similar results were observed across subgroups. Of treated patients, 79.9% and 50% had HIV-1 RNA < 400 copies/ml and < 50 copies/ml respectively, at the end of the study, early termination visits, or at last known status. Tropism changes and selection of MVC-resistant R5 virus, including high-level MVC dependence, were mechanisms of viral escape. Conclusion: MVC was well tolerated with virologic suppression observed in most patients.
The epidemiology of yellow fever in Africa
(Microbes and infection, 2002) Mutebi, John-Paul; Barrett, Alan D. T.
Yellow fever (YF) is still a major public heath problem, particularly in Africa, despite the availability of a very efficacious vaccine. The World Health Organization estimates that there are 200,000 cases ofYF annually, including 30,000 deaths, of which over 90% occur in Africa. In the past 15 years, the number of YF cases has increased tremendously, with most of the YF activity in West Africa. This increase in YF activity is in part due to a breakdown inYF vaccination and mosquito control programs. Five genotypes ofYF virus have been found in Africa, and each genotype circulates in a distinct geographical region.West Africa genotype I, found in Nigeria and surrounding areas, is associated with frequent epidemics, whereas the three genotypes in East and Central Africa are in regions where YF outbreaks are rare. Other factors, including genetic and behavioral variation among vector species, are also thought to play a role in the epidemiology of YF in Africa.
Reduced‑representation sequencing identifies small effective population sizes of Anopheles gambiae in the north‑western Lake Victoria basin, Uganda
(Uganda. Malaria journal, 2018) Wiltshire, Rachel M.; Bergey, Christina M.; Kayondo, Jonathan K.; Birungi, Josephine; Mukwaya, Louis G.; Emrich, Scott J.; Besansky, Nora J.; Collins, Frank H.
Malaria is the leading cause of global paediatric mortality in children below 5 years of age. The number of fatalities has reduced significantly due to an expansion of control interventions but the development of new technologies remains necessary in order to achieve elimination. Recent attention has been focused on the release of genetically modified (GM) mosquitoes into natural vector populations as a mechanism of interrupting parasite transmission but despite successful in vivo laboratory studies, a detailed population genetic assessment, which must first precede any proposed field trial, has yet to be undertaken systematically. Here, the genetic structure of Anopheles gambiae populations in north-western Lake Victoria is explored to assess their suitability as candidates for a pilot field study release of GM mosquitoes. Methods 478 Anopheles gambiae mosquitoes were collected from six locations and a subset (N = 96) was selected for restriction site-associated DNA sequencing (RADseq). The resulting single nucleotide polymorphism (SNP) marker set was analysed for effective size (Ne), connectivity and population structure (PCA, FST). Results 5175 high-quality genome-wide SNPs were identified. A principal components analysis (PCA) of the collinear genomic regions illustrated that individuals clustered in concordance with geographic origin with some overlap between sites. Genetic differentiation between populations was varied with inter-island comparisons having the highest values (median FST 0.0480–0.0846). Ne estimates were generally small (124.2–1920.3). Conclusions A reduced-representation SNP marker set for genome-wide An. gambiae genetic analysis in the north-western Lake Victoria basin is reported. Island populations demonstrated low to moderate genetic differentiation and greater structure suggesting some limitation to migration. Smaller estimates of Ne indicate that an introduced effector transgene will be more susceptible to genetic drift but to ensure that it is driven to fixation a robust gene drive mechanism will likely be needed. These findings, together with their favourable location and suitability for frequent monitoring, indicate that the Ssese Islands contain several candidate field locations, which merit further evaluation as potential GM mosquito pilot release sites.
Population structure of the malaria vector Anopheles moucheti in the equatorial forest region of Africa
(Malaria Journal, 2008) Antonio-Nkondjio, Christophe; Ndo, Cyrille; Kengne, Pierre; Mukwaya, Louis; Awono-Ambene, Parfait; Fontenille, Didier; Simard, Frédéric
Anopheles moucheti is a major malaria vector in forested areas of Africa. However, despite its important epidemiological role, it remains poorly known and insufficiently studied. Here, levels of genetic differentiation were estimated between different A. moucheti populations sampled throughout its distribution range in Central Africa. Methods Polymorphism at ten microsatellite markers was compared in mosquitoes sampled in Cameroon, the Democratic Republic of Congo and an island on Lake Victoria in Uganda. Microsatellite data were used to estimate genetic diversity within populations, their relative long-term effective population size, and the level of genetic differentiation between them. Results All specimens collected in Tsakalakuku (Democratic Republic of Congo) were identified as A. m. bervoetsi while other samples consisted of A. m. moucheti. Successful amplification was obtained at all microsatellite loci within all A. m. moucheti samples while only six loci amplified in A. m. bervoetsi. Allelic richness and heterozygosity were high for all populations except the island population of Uganda and A. m. bervoetsi. High levels of genetic differentiation were recorded between A. m. bervoetsi and each A. m. moucheti sample as well as between the island population of A. m. moucheti and mainland populations. Significant isolation by distance was evidenced between mainland populations. Conclusion High levels of genetic differentiation supports complete speciation of A. m. bervoetsi which should henceforth be recognized as a full species and named A. bervoetsi. Isolation by distance is the main force driving differentiation between mainland populations of A. m. moucheti. Genetically and geographically isolated populations exist on Lake Victoria islands, which might serve as relevant field sites for evaluation of innovative vector control strategies.

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