School of Medicine (KABSOM)

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Open Access
Effect of Educational Intervention Program on Self-Efficacy of Individuals with Type 2 Diabetes Mellitus in South-East, Nigeria.
(Kabale University, 2024) Okafor, Christiana Nkiru; Onyenekwe, Chinedu Charles; Okonkwo, Uchenna Prosper; Umunnah, Joseph Onuuwa; Okoro, Chukwuemeka Chukwubuikem; Mbanuzuru, Ahaoma Victor; Agunwah, Ukamaka Elizabeth; Odira, Chika Chioma; Makata, Eucharia Ngozi; Nwankwo, Chinenye Mercy
Objectives: Diabetes Mellitus is a chronic disease, which requires a level of confidence among the sufferers in its management. This study investigated the effect of an educational intervention program on self-efficacy (SE) in diabetic individuals with type 2 diabetes mellitus in South-East, Nigeria. Methods: The study was a quasi-experimental controlled study, comprising 382 individuals with type 2 DM selected, and assigned to intervention (IG) and control groups (CG). The instrument for data collection was the Stanford Chronic Disease Self-Efficacy Scale (SCDS). Pretest data were collected, and thereafter education on diabetes management was given to the IG group. The IG was followed up for 6 months. At the end of 6 months, post-test data were collected using the same instrument. Data were analyzed using Pearson Chi-square test statistics. A P-value less than .05 alpha level was considered significant. Results: There was no statistically significant difference between the two groups before intervention. However, after 6 months of intervention, a significant proportion of participants’ scores in IG moved from low to either moderate or high SE in almost all the SE domains (P < .05. Conclusions: There was an improvement in most domains of self-efficacy in the intervention group after 6 months of educational intervention.
Open Access
Factors associated with knowledge on the spread of HIV/AIDS among Secondary School Students of Groupe Scolaire De Rugando in Kigali City, Rwanda.
(Kabale University, 2024) Nwankwo, Chinenye Mercy; Uwizeye, Denyse Sibomana
Human Immunodeficiency Virus has continued to spread in most countries, including Rwanda. Youths are particularly vulnerable to HIV/AIDS because they are not sufficiently prepared to address problems related to their sexuality and also because they do not have enough real knowledge about HIV and AIDS. The study assessed factors associated with knowledge of the spread of the Human Immunodeficiency virus (HIV) among students of Groupe Scolaire de Rugando in Kigali City, Rwanda. The study adopted a descriptive cross-sectional approach among the target population of 950 students in the secondary school of Groupe Scolaire de Rugando. About 108 students were randomly selected using the systematic sampling method. Self-administered structured questionnaires were used for data collection for one month with the help of a trained research assistant. The study instrument was pilot-tested in a mission secondary school outside the study population and further validation was carried out before it was administered based on consent. The most common predisposing factors in the study to adolescents to HIV/AIDS were curiosity and the need to experiment. The study findings showed that 78% accepted that HIV is transmitted by engaging in unprotected sexual intercourse with an infected person, 65% accepted that the presence of other sex partners increases the risk of contracting HIV, 69% accepted that regular use of condoms helps to reduce the risk of contracting HIV and 55% accepted that by reducing the number of sexual partners, chances of HIV infection are reduced. Additionally, 44 (43.14%, C. I.: 33.37-53.32) of the students indicated that they had previously engaged in sex, while 58 (56.86%, C. I: 46.68-66.63) showed that they did not engage in sexual practice. The majority of the students who had engaged in sex had never used a condom (59.09%). The usage of condoms was perceived by respondents that it does not allow their partner to enjoy sex. This study recommends the need to design interventions that aim to raise awareness of the negative consequences of risky sexual behaviors; increase the availability and accessibility of condoms; fight against the entry of drugs into the country as well as their circulation and accessibility to the youth and finally, guidance and counseling services should be introduced in schools.
Open Access
Effect of Vigorous-Intensity Physical Activity on Incident Cognitive Impairment in High-Risk Hypertension.
(Kabale University, 2024) Kazibwe, Richard; Schaich, Christopher L.; Muhammad, Ahmad Imtiaz; Epiu, Isabella; Namutebi, Juliana H.; Chevli, Parag A.; Kazibwe, Joseph; Hughes, Timothy; Rikhi, Rishi R.; Shapiro, Michael D.; Yeboah, Joseph
Introduction: We investigated the effect of vigorous physical activity (VPA) on the risk of incident mild cognitive impairment (MCI) and probable dementia among individuals with high-risk hypertension. Methods: Baseline self-reported frequency of VPA was categorized into low VPA (<1 session/week), and high VPA (≥1 session/week). We used multivariate Cox regression analysis to examine the association of VPA categories with incident MCI and probable dementia events. Results: Participants in the high VPA category, compared with low VPA, experienced lower events rates (per 1000 person-years) of MCI (13.9 vs 19.7), probable dementia (6.3 vs 9.0), and MCI/probable dementia (18.5 vs 25.8). In the multivariate Cox regression model, high VPA, compared with low VPA, was associated with lower risk of MCI, probable dementia, and MCI/probable dementia (HR [95% CI]: 0.81 [0.68–0.97], 0.80 [0.63–1.03], and 0.82 [0.70–0.96]), respectively. DISCUSSION: This study provides evidence that VPA may preserve cognitive function in high-risk patients with hypertension.
Open Access
Optimization of Soursop (Annona Muricata L.) Leaf Extract in Nanoemulgel And Antiacnes Activity Test Against Propionibacterium Acnes, Staphylococcus Aureus, Staphylococcus Epidermidis Bacteria.
(Kabale University, 2023) Asyhari, Hanif Fibiana; Cabral, Kibedi B.; Wikantyasning, Erindyah R.
Soursop leaf extract (Annona muricata L.) has antibacterial activity with active components of alkaloids, flavonoids, steroids, and saponins. This research aims to optimize the use of VCO, Tween 80, and PEG 400 in the nanoemulsion system, which will be added Carbopol 940 as a gelling agent to form a nanoemulgel and to determine antibacterial activity. By utilizing the simplex lattice design method in Design Expert 13.0, the nanoemulsion formula has been successfully optimized involving a mixture of VCO, Tween 80, and PEG 400. A total of 14 different nanoemulsion formulas were produced through this process. The process of making nanoemulsion is carried out by mixing extracts, oils, surfactants and cosurfactants, homogenized using a vortex, then sonicated. Evaluation of % transmittance, emulsification time, and pH were carried out to determine nanoemulsion physical properties. The nanoemulsion optimal formula was evaluated for particle size, polydispersity index, and zeta potential and made into nanoemulgel with the addition of Carbopol 940. The optimal formula has a composition of 10.86% VCO, 67.33% Tween 80, 21.81% PEG 400 form homogeneous and clear nanoemulsion with % transmittance of 91.97±1.11%, emulsification time of 56.42±0.72 seconds, and pH of 5.67±0.24. Particle size, polydispersity index, and zeta potential of the optimal formula were 229.47±38.79 nm, 0.41±0.10, and -39.13±0.19 mV, respectively. Evaluation of nanoemulgel physical properties showed homogeneous, pH value of 5.83±0.24, spreadability of 5.57±0.25cm, the adhesive force of 3.80±0.25 seconds, viscosity of 11479.33±167.49 cP, antibacterial activity against P.acnes, Staphylococcus aureus, and Staphylococcus epidermidis with inhibition zone diameters of 9.67±0.47 mm, 7.33±0.47 mm, and 5.67±0.47 mm. respectively. Nanoemulgel soursop leaf extract has suitable physical properties, and antibacterial activity is in the medium category.
Open Access
Pain Assessment Following Open Hemorrhoidectomy Under Local Anesthesia Versus Saddle Block: A Multicenter Randomized Controlled Trial.
(Kabale University, 2024) Sikakulya, Franck Katembo; Ssebuufu, Robinson; Okedi, Xaviour Francis; Baluku, Moris; Lule, Herman; Kiyaka, Sonye Magugu; Kyamanywa, Patrick
Background There is a disparity in evidence on pain assessment post open hemorrhoidectomy (OH) using local anes- Thesia and its use in developing countries are different from those in developed countries. Therefore, we conducted this study to assess the occurrence of postoperative pain following open hemorrhoidectomy under local anesthesia versus saddle block for uncomplicated 3rd or 4th-degree hemorrhoids. Methods This was a prospective equivalence randomized, double-blind controlled trial conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th-degree hemorrhoids. Pain severity was assessed at 2, 4 and 6 h post open hemorrhoidectomy using visual analogue scale (VAS). Data was analyzed using SPSS version 26 at a p<0.05 as statically significant using the visual analog scale (VAS). Results We recruited 58 participants in this study who underwent open hemorrhoidectomy under local anesthesia or saddle block (29 participants per group). The sex ratio was of 1.15 of female to male and a mean age of 39±13. VAS was found to be different at 2 h post-OH compared to other times of pain assessment but not statically significantly by area under the cover (AUC) (95% CI=486–0.773: AUC=0.63; p=0.09) with a significance by Kruskal–Wallis’s test (p:0.925). Conclusion Local anesthesia was found to have a similar pain severity occurrence in the post-operative period among patients undergoing open hemorrhoidectomy for primary uncomplicated 3rd or 4th-degree hemorrhoids. Close monitoring of pain in the postoperative period is mandatory especially at 2 h to assess the need of analgesia. Trial registration Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 8th October, 2021.
Open Access
Local Anesthesia Versus Saddle Block for Open Hemorrhoidectomy: Cost-Analysis From a Randomized, Double Blind Controlled Trial.
(Kabale University, 2024) Sikakulya, Franck Katembo; Ssebuufu, Robinson; Okedi, Xaviour Francis; Baluku, Moris; Lule, Herman; Kiyaka, Sonye Magugu; Muhumuza, Joshua; Selamo, Fabrice Molen; Bassara, Godefroy Nyenke; Waziri, Musa Abbas; Kithinji, Stephen Mbae; Mugisho, Munyerenkana Leocadie; Byamungu, Pahari Kagenderezo; Munihire, Jeannot Baanitse; Vahwere, Bienfait Mumbere; Kiswezi, Ahmed; Kyamanywa, Patrick
Background Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first-line technique in low-income countries such as Uganda; therefore, we aimed to compare the cost of OH under LA versus Saddle block among patients with 3rd or 4th-degree hemorrhoids. Methods This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time and direct costs in (US$) including medical and non-medical were recorded. We analyzed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0. Results Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p<0.05). The mean operating time was 15.52±5.34(SD) minutes versus 33.72±11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42±8.90 US$ compared to 63.38±12.77US$ in the SB group. Conclusion The use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia providers. Policymakers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals. Trial registration Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.
Open Access
Distribution and Antifungal Susceptibility Profile of Oropharyngeal Candida Species Isolated from People Living with HIV in the Era of Universal Test and Treat Policy in Uganda.
(Kabale University, 2024) Musinguzi, Benson; Turyamuhika, Laban; Mwesigwa, Alex; Nalumaga, Pauline Petra; Kabajulizi, Immaculate; Njovu, Israel Kiiza; Mwebesa, Edson; Luggya, Tonny; Ocheng, Francis; Kateete, David Patrick; Itabangi, Herbert; Mboowa, Gerald; Obondo, James Sande; Achan, Beatrice
Background: Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and the emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. Methods: A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species identified using the matrix-assisted laser desorption ionization-time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using the VITEK® (Marcy-l’Étoile, France) compact system. Data on viral load were retrieved from records, and a CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. Results: The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised 20 (57.1%) while C. tropicalis and Cglabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytosine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific species isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. Conclusion: The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.
Open Access
Education of nurses in Rural Primary Health Cares to Improve Vital Care of Newborns: A Community-Based Research in Nigeria.
(Kabale University, 2023) Eze, Nkiru Clementina; Elusoji, Christiana I.; Okafor, Christiana Nkiru; Emeh, Augusta Nkechi; Nwafor, Amuchechukwu Veronica; Obi, Ihuoma A.; Onyeabor, Juliana Odinakachukwu; Ohanme, Eugene Ohams
This study was designed to ascertain the level of knowledge and the degree of practice of the components of Essential New-born care (ENC), and the effects of a training program on the knowledge and practice of ENC among nurses in rural Primary Health Care (PHCs) in South East Nigeria. This study was a one-group pre-test and post-test intervention design. The components of ENC considered were: New-Born Initiation of Breastfeeding, Thermoregulation, New-Born Cord Care, Newborn Eye Care, Initiation of Breathing, and Administration of Vitamin K. A Neonatal care Knowledge and Practice Assessment (NCKPA) Questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (96) available nurses (All-female). There was a significant improvement in the level of knowledge and extent of practice of the components of ENC following the training program. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of Eye care 40(41.6%) - pre-intervention, and least knowledge of cord care 70 (72.9%) and eye care 90(93.8%) - post-intervention. The increase in knowledge corresponded with an increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, updated courses, and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rates.
Open Access
Impact of Essential Newborn Care education on Knowledge and Practice of New-Born Care among Nurses in Rural Primary Health Centres in Ebonyi State of Nigeria.
(Kabale University, 2023) Eze, Clementina N.; Elusoji, Christiana I.; Okafor, Christiana N.; Emeh, Augusta N.; Obi, Ihuoma A.; Odira, Chika C. H.; Onyeabor, Juliana O.; Nwafor, Amuchechukwu V.; Ohanme, Eugene O.
Background: This study was designed to determine the level of knowledge and the extent of the practice of the components of essential new-born care (ENC), and the effects of a training program on the knowledge and practice of ENC among nurses in rural primary health care (PHCs) in Ebonyi state Nigeria. Methods: This study was a one-group pre-test and post-test intervention design. The components of ENC considered were: New-born initiation of breastfeeding, thermoregulation, new-born cord care, newborn eye care, initiation of breathing, and administration of vitamin K. A neonatal care knowledge and practice assessment (NCKPA) questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (48) available nurses (All-female). Results: There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training program. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of eye care 20 (41.6%) pre-intervention, and the least knowledge of cord care 35 (72.9%) and eye care 45 (93.8%)-post-intervention. Conclusions: An increase in knowledge corresponded with an increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, updated courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.
Open Access
A 5-year Retrospective Review of the Presentation Pattern and Management outcomes of Uterine Fibroids in a Nigerian Tertiary Hospital.
(Kabale University, 2024) Madunatu, Chimezie Michael; Okoro, Chukwuemeka Chukwubuikem; Onyejiaka, Chukwudubem Chinagorom; Enechukwu, Chukwunonso Isaiah; Ofojebe, Chukwuemeka Jude; Ani, Vincent Chinedu; Eleje, George Uchenna; Mbachu, Ikechukwu Innocent; Okafor, Chigozie Geoffrey; Okoro, Amarachukwu Doris; Okafor, Christiana Nkiru; Oguejiofor, Charlotte Blanche; Eze, Stephen Chijioke
Background: Uterine fibroids are a common gynecological condition affecting reproductive-age women. Although fibroids are considered benign, they are a cause of major quality-of-life issues for women in their reproductive age. Objectives: To determine the prevalence, pattern of presentations and management outcomes of uterine fibroids over 5 years. Materials and Methods: This is a retrospective review of the prevalence, clinical presentations, and outcome of the management of uterine fibroid over 5 years (between January 1st, 2017, and 31st December 2021) at Nnamdi Azikiwe University Teaching Hospital (NAUTH). The case files of women who were managed for uterine fibroid during this period were obtained from the hospital’s Health Records department to extract relevant information. The social, demographic, and clinical data of the subjects were extracted using a designed proforma. The outcome measures included the prevalence, clinical presentations, and management outcomes of uterine fibroids. Data was analyzed using the SPSS 26.0 IBM Corporation. Results: The prevalence of uterine fibroids was 10.7% of all gynecological cases that were presented to the clinic. Participants, mean age was 39.11±7.01 years, most (75.4%) being nulliparous. Abdominal swelling was the commonest (62.3%) pattern of presentation and most of the subjects presented late with a mean duration of symptoms of 38.2±9.82 months. Surgery was the commonest method of treatment with myomectomy being the modality used in 86.5% of subjects. The common postoperative complication was anemia which was reported in 15.2% of the subjects. Conclusion: Uterine fibroid prevalence in this review of 10.66% is high and so also are the associated complications. The symptoms correlate with delayed presentations common in our locality. Surgical management comprising predominantly myomectomy and hysterectomy remained the commonest treatment option in our environment.
Open Access
Self-Care Practices and the Associated Socio-Demographic Variables of Persons with Type 2 Diabetes Mellitus (T2dm) in Southeast, Nigeria.
(Kabale University, 2024) Okafor, Christiana Nkiru; Okonkwo, Uchenna Prosper; Ani, Kenneth Umezulike; Onuora, Ethel Ogoemeka; Nwokike, Mathew; Byabagambi, Jane Turyasingura; Tamu, JohnBosco Munezero; Mfitumukiza, Valence; Nwankwo, Mercy Chinenye; Tumusiime, Alex
Objective: The study was aimed at assessing the self-care practices and the associated socio-demographic variables of persons with T2DM in South East, Nigeria. Methodology: A cross-sectional study involving 382 persons with T2DM proportionately selected from 4 tertiary health institutions in South Eastern, Nigeria. Data was collected using the Summary of Diabetes Self-Care Activities (SDSCA) and a researcher-developed questionnaire. The questionnaire was administered to persons with T2DM who attended a diabetic outpatient clinic. Data collected was analyzed in frequency percentage. Responses on SDSCA were ranked and rated as poor, moderate, and good self-care behavior. The level of significance was placed at P < .05. Result: The majority of the participants were within the age groups of 40 to 59 (46.9%) and 60 and above (46.9%); the majority (74.6%) were married while a good proportion were traders (59.7%). Also, the majority of participants (81.2%) were on oral hypoglycemic agents. Findings further showed that a good proportion (51.3% and 89.8%) of study participants had good self-care behavior in diet and medication domains respectively. Whereas the proportion of participants with poor self-care behavior was very high in foot care (75.1%) and fairly high in both self-blood sugar testing (37.7%) and exercise (37.2%) domains. Only 7.9% practiced 3-monthly laboratory blood glucose testing while 16.5% went for eye checks every 6 months. Conclusion: Individuals with diabetes mellitus have poor self-management behavior in most domains of the self-management practice. Age, gender, marital status, educational level, and occupation significantly influenced self-management practices. Hence nurses and health educators should take diabetes self-management education very seriously to help diabetes sufferers improve their self-management
Open Access
Utilization of Educational School Facilities Among Students in a Selected Tertiary Institution in South East Nigeria.
(Kabale University, 2024) Okoro, Amarachukwu Doris; Okafor, Christiana Nkiru; Menkiti, Ifeoma Oluchukwu; Egbuna, Maryann Chioma; Munezero, Tamu John Bosco; Mandera, Immaculate; Okoro, Chukwuemeka Chukwubuikem
Background: Educational school facilities are indispensable in the teaching and learning process because they enhance understanding, application, and retention of knowledge. Despite the importance of these educational facilities in increasing the performance of students, studies assessing their utilization are scarce. Objectives: The objective of the study was to assess the utilization of educational school facilities among students of a Nursing training institution in South East Nigeria. Methods: The study was a cross-sectional, descriptive, non-experimental, questionnaire-based study. A stratified sampling technique was used to select 130 students from the first, second, and third years who participated in the study. Results: There was poor utilization of the demonstration room partly due to the poor equipment of the laboratory and the school policy of insisting that the student replace any damaged item. There was poor utilization of the computer laboratory for learning mostly due to the non-availability of internet services. Conclusion: We recommend that government and non-governmental agencies join hands in re-equipping the educational facilities and provide the needed manpower to make the facilities suitable and conducive for students.
Open Access
Plasmodium falciparum genetic diversity and multiplicity of infection based on msp‑1, msp‑2, glurp and microsatellite genetic markers in sub-Saharan Africa: a systematic review and meta-analysis.
(Kabale University, 2024) Mwesigwa, Alex; Ocan, Moses; Musinguzi, Benson; Nante, Rachel Wangi; Nankabirwa, Joaniter I.; Kiwuwa, Steven M.; Kinengyere, Alison Annet; Castelnuovo, Barbara; Karamagi, Charles; Obuku, Ekwaro A.; Nsobya, Samuel L.; Mbulaiteye, Sam M.; Byakika‐Kibwika, Pauline
Background In sub-Saharan Africa (SSA), Plasmodium falciparum causes most of the malaria cases. Despite crucial roles in disease severity and drug resistance, comprehensive data on Plasmodium falciparum genetic diversity and multiplicity of infection (MOI) are sparse in SSA. This study summarizes available information on genetic diversity and MOI, focusing on key markers (msp-1, msp-2, glurp, and microsatellites). The systematic review aimed to evaluate their influence on malaria transmission dynamics and offer insights for enhancing malaria control measures in SSA. Methods: The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Two reviewers conducted article screening, assessed the risk of bias (RoB), and performed data abstraction. Meta-analysis was performed using the random-effects model in STATA version 17. Results: The review included 52 articles: 39 cross-sectional studies and 13 Randomized Controlled Trial (RCT)/cohort studies, involving 11,640 genotyped parasite isolates from 23 SSA countries. The overall pooled mean expected heterozygosity was 0.65 (95% CI: 0.51–0.78). Regionally, values varied: East (0.58), Central (0.84), Southern (0.74), and West Africa (0.69). Overall pooled allele frequencies of MSP-1 alleles K1, MAD20, and RO33 were 61%, 44%, and 40%, respectively, while msp-2 I/C 3D7 and FC27 alleles were 61% and 55%. Central Africa reported higher frequencies (K1: 74%,MAD20: 51%, RO33: 48%) than East Africa (K1: 46%, MAD20: 42%, RO33: 31%). For MSP-2, East Africa had 60% and 55% for I/C 3D7 and FC27 alleles, while West Africa had 62% and 50%, respectively. The pooled allele frequency for glurpwas 66%. The overall pooled mean MOI was 2.09 (95% CI: 1.88–2.30), with regional variations: East (2.05), Central (2.37), Southern (2.16), and West Africa (1.96). The overall prevalence of polyclonal Plasmodium falciparum infections was 63% (95% CI: 56–70), with regional prevalences as follows: East (62%), West (61%), Central (65%), and South Africa (71%). Conclusion: The study shows substantial regional variation in Plasmodium falciparum parasite genetic diversity and MOI in SSA. These findings suggest a need for malaria control strategies and surveillance efforts considering regional-specific factors underlying Plasmodium falciparum infection.
Open Access
Fluoxetine attenuates stress-induced depression-like behavior due to decrease in pro-inflammatory cytokines in male rats.
(2024) Nabirumbi, Ritah; Onohuean, Hope; Kato, Charles Drago; Alagbonsi, Abdullateef Isiaka; Adedeji1, Ahmed A.
Pro-inflammatory cytokines are implicated in depression caused by both environmental- and alcohol-induced stress. The purpose of the study was to investigate the cytokine levels in serum and hippocampus following induction of depression-like behaviors (DLB) by either force. swimming test (FST) or ethanol-induced DLB (EID). We also investigated the effect of prior administration of the antidepressant drug fluoxetine on cytokines in animals exposed to both models of DLB. Methods: Animals were pretreated with fluoxetine before inducing DLB, while DLB was induced in some animals using FST and ethanol in different groups of rats without fluoxetine pretreatment. The ELISA was used to detect changes in cytokine (IL-1β, IL-6, and TNF-α) levels in serum and hippocampus. Results: The mean levels of IL-1β and IL-6 measured in serum and hippocampus were significantly higher in FST and EID models when compared to the control group. The serum concentrations of IL-1β and IL-6 were significantly reduced in animals pre-treated with 5 mg/kg and 10 mg/kg of fluoxetine in both FST and EID models when compared to the untreated FST and EID groups respectively. Conclusions: In conclusion, both environment and alcohol can induce stress and DLB in rats with similar intensity, and their mechanisms of DLB induction involve activation of pro-inflammatory cytokines. Moreover, fluoxetine can prevent stress-induced inflammation in models of DLB.
Open Access
COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study
(www.elsevier.com/locate/jvacx, 2023-07-07) Ouni, Patrick Diox; Namulondo, Racheal; Wanume, Benon; Okia, David; Olupot, Peter; Nantale, Ritah; Matovu, Joseph K.B.; Napyo, Agnes; Lubaale, Yovani A. Moses; Nshakira , Nathan f; Mukunya, David
Background: 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 dis trict, northern Uganda. Methods: This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the associa tion between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0. Results: Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers’ lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers. Conclusion: A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers’ trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda
Open Access
African animal trypanocide resistance: A systematic review and meta-analysis
(2024-02) Keneth, Iceland Kasozi; Ewan, Thomas MacLeod; Susan, Christina Welburn
African animals resistance ( AATr) continues to undermine global efforts to eliminate the transmission of africa intrypanosomiasis in endemic communities. the continued lack of new trypanocides has participated drug misuse and over use, thus contributing to the devlopment of the AADr phenotype. in this study, we investigated the threate associated with AAtr by using the major globally available chemotherapeutic agents. Methods: A total of seven electronic databases were screened for an article on trypanocide resistance in AATr by using keywords on preclinical and clinical trials with the number of animals with treatment relapse, days taken to relapse, and resistant gene markers using the PRISMA checklist. Data were cleaned using the SR deduplicator and covidence and analyzed using Cochrane RevMan®. Dichotomous outputs were presented using risk ratio (RR), while continuous data were presented using the standardized mean difference (SMD) at a 95% confidence interval. Results: A total of eight publications in which diminazene aceturate (DA), isometamidium chloride (ISM), and homidium chloride/bromide (HB) were identified as the major trypanocides were used. In all preclinical studies, the development of resistance was in the order of HB > ISM > DA. DA vs. ISM (SMD = 0.15, 95% CI: −0.54, 0.83; I 2 = 46%, P = 0.05), DA vs. HB (SMD = 0.96, 95% CI: 0.47, 1.45; I 2 = 0%, P = 0.86), and HB vs. ISM (SMD = −0.41, 95% CI: −0.96, 0.14; I2 = 5%, P = 0.38) showed multiple cross-resistance. Clinical studies also showed evidence of multi-drug resistance on DA and ISM (RR = 1.01, 95% CI: 0.71–1.43; I2 = 46%, P = 0.16). To address resistance, most preclinical studies increased the dosage and the treatment time, and this failed to improve the patient’s prognosis. Major markers of resistance explored include TbAT1, P1/P2 transporters, folate transporters, such as F-I, F-II, F-III, and polyamine biosynthesis inhibitors. In addition, immunosuppressed hosts favor the development of AATr.
Open Access
Ugochukwu, Oliver Ukachi
(Oxford University Press, 2023-02-09) Maduabuchi , Patrick Aja; Chukwu, Chinecherem Adanna; Okechukwu, Ugwu Paul Chima; Anthony, Boniface Ale; Chinedu , Peter Agu; Deusdedi, Tusubira; Chukwu, Darlington C; Onyedika, Gabriel Ani; Ugbala, Ezebuilo Ekpono; Akobi , Hilary Ogwoni; Awoke , Joshua Nonso; Ogbu, Patience N; Aja, Lucy; Orji, Obasi Uche; Nweke, Chinoso Peter; Egwu, Chinedu; Ekpono, Ejike Ugbala; Ewa, Gift Onyinyechi; Igwenyi, Ikechuku Okorie; Esther, Alum Ugo; Uti, Daniel Ejim; Offor, Christian Emeka; Ifie, Josiah E.; Njoku, Amaobichukwu; Kenneth, Ekenechukwu; Ejike, Daniel Eze
OBJECTIVES: This study looked at how CMSO affected male Wistar albino rats' liver damage caused by bisphenol A. METHODS: The standard HPLC method was used to assess the CMSO's phenolic content. Then, six (n = 8) groups of forty-eight (48) male Wistar rats (150 20 g) each received either CMSO or olive oil before being exposed to BPA for 42 days. Groups: A (one milliliter of olive oil, regardless of weight), B (BPA 100 mg/kg body weight (BW)), C (CMSO 7.5 mg/kg BW), D (CMSO 7.5 mg/kg BW + BPA 100 mg/kg BW), E (CMSO 5.0 mg/kg BW + BPA 100 mg/kg BW), and F (CMSO 2.5 mg/kg BW + BPA 100 mg/kg BW). KEY FINDINGS: A surprising abundance of flavonoids, totaling 17.8006 10.95 g/100 g, were found in the HPLC data. Malondialdehyde, liver enzymes, reactive oxygen species, total bilirubin, and direct bilirubin levels were all significantly elevated by BPA (p 0.05). Additionally, nuclear factor-B, interleukin-6, interleukin-1, tumor necrosis factor, and histological alterations were all considerably (p 0.05) caused by BPA. The altered biochemical markers and histology were, however, noticeably recovered by CMSO to a level that was comparable to the control. CONCLUSION: Due to the abundance of flavonoid components in the oil, CMSO protects the liver from BPA-induced hepatotoxicity by lowering oxidative stress and inflammatory reactions
Open Access
Hepatoprotective potential of Tamarindus indica following prenatal aluminum exposure in Wistar rat pups
(Elsevier, 2023-03-04) Helen Ruth Yusuf a , Sunday Abraham Musa a , Abel Nosereme Agbon , Ejike Daniel Eze , Akeem Ayodeji Okesina , Ismail Onanuga , Theophilus Pius , Victor Archibong , Mario Edgar Fernandez Diaz , Juma John Ochieng , Nicholas Kusiima , Bot Yakubu Sunday , Ibe Michael Usman
Over time, the use of plant-derived agents in the management of various human health conditions has gained a lot of attention. The study assessed the hepatoprotective potential of ethyl acetate fraction Tamarindus indica leaves (EFTI) during prenatal aluminum chloride exposure. Pregnant rats were divided into 5 groups (n = 4); Group I rats were administered 2 ml kg− 1 of distilled water (negative control), Group II rats received only 200 mg kg− 1 aluminum chloride (positive control), Group III rats were administered 200 mg kg− 1 aluminum chloride and 400 mg kg− 1 EFTI, Group IV rats were administered 200 mg kg− 1 aluminum chloride and 800 mg kg− 1 EFTI, Group V rats were administered 200 mg kg− 1 aluminum chloride and 300 mg kg− 1 Vit E (comparative control). On postnatal day 1, the pups were euthanized, and liver tissues were harvested for the biochemical study (tissue levels of malondialdehyde, caspase-3, tumor necrosis factor-alpha, aspartate aminotransferase, alkaline phos - phatase, and alanine aminotransferases) and the liver histological examination. The administration of EFTI was marked with significant improvement in the tissue levels of malondialdehyde, caspase-3, tumor necrosis factor-alpha, aspartate aminotransferase, alkaline phosphatase, and alanine aminotransferases. There was a marked improvement in histopathological changes associated with prenatal aluminum chloride exposure. In conclusion, the administration of EFTI was protective during prenatal aluminum chloride exposure of the liver in Wistar rats, and is mediated by the anti-lipid peroxidative, antiapoptotic, and anti-inflammatory activity of EFTI.
Open Access
Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era
(BMC Surgery, 2023-02-08) Nyanzi, Daniel J.; Daniel, Atwine; Kamoga, Ronald; Birungi, Caroline; Nansubuga, Caroline A.; Nyaiteera, Victoria; Nakku, Doreen
Background Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on dis parities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda. Methods In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indica tions, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a trache ostomy-related complication was suspected during the 7 days follow-up. Comparison of patients’ baseline charac teristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were ftted using binomial regression in STATA 13.0 software. Results All patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The common est tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent pre dictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR=1.8, 95%CI: 1.19 – 2.76), Bjork fap tracheal incision (RR=1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR=1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR=1.22, 95%CI: 1.00 – 1.47). Conclusion Pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork fap or vertical tracheal incisions and being a child were associated with increased risk of complications. Emphasis on multidisciplinary team care,standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.
Open Access
Environmental justice in South Africa: the dilemma of informal settlement residents
(GeoJournal. https://doi.org/10.1007/s10708-022-10808-z, 2023) Ruhiiga, T. M.; Kekana, H. N.,; Ndou ·, N. N.
The concept of environmental justice is well established in the literature; however, schol- ars still battle to agree on what it really means. This concept has become more relevant to the studies of informal settlements amongst others. The location and environmental variables in informal settlements suggests a variety of injustices that comes with loca- tion, limited access to water, poor or lack of sanita- tion, challenges with transport availability, accessibil- ity, affordability, and lack of other social amenities. These and many other socio-economic needs forms part of the value chain of environmental justice debates across the world. This paper deals with envi- ronmental justice in the informal settlements of Kos- mos, in the Madibeng Local Municipality, Bojanala Region in the North-West Province of South Africa.The paper highlights some of the environmental chal- lenges faced by the informal settlement residents such as pollution, waste management (landfill sites, waste collection) sanitation and water provision. The paper explores how the Kosmos informal settlement com- munity has been excluded from decision making pro- cesses regarding their own environment and consid- ers the levels of environmental injustices commonly associated with this kind of practice.