The challenge to restoring basic health care in Uganda

This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993

Social anthropological aspects of onchocercal skin disease in Nebbi District; Uganda

"In providing health care; the busy medical practitioner often lacks the ""I-You"" quality of the personal experience of illness. This paper reports the perceptions; beliefs and practices of persons living in a hyperendemic focus of onchocerciasis in nebbi District; north-western Uganda. The study involved the use of focus group discussion and semi-structured interviewes designed to explore the experiences; meanings; and illness-related coping strategies employed by the community. The results indicated that oncherciasis believed that the cause of the disease is the small black fly (Kamacur); dirty water or rivers. However; non-affected individuals believed that the condition is caused by poor personal and environmental hydiene; and personal contact with persons affected by onchocerciasis. Affected people recommended public health education to control the diases while non-affected people; recommended the avoidance of personal contact with affected people; ensuring personal hygiene; and the improvement of environmental sanitation and the nutritional status of community. The belief systems of the community are probably responsible for the discriminatory practices of the people against those affected by the condition. The results indicate that onchocerciasis is a serious public health problem which needs to be controlled."

Dermatological problems of onchocerciasis in Nebbi District; Uganda

A cross-sectional survey of 770 subjects in onchocerciasis hyperendemic villages and 223 subjects from a control community in Nebbi District in the West Nile Region of Uganda revealed a high prevalence of onchocercial skin disease of 48in endemic villages. The most chronic skin problem was troublesome itching (40); and the prevalent skin lesions were chronic popular onchodermatitis (16); depigmentation (4); lichenifield onchodermatitis (2) and acute popular onchodermatitis (1). Other typical varieties of onchocercal skin diseases such as; hanging groin; lymphoedema and marked lymphadenopathy were infrequent; and considered rare. Pityriasis vergicolor was the most common non-onchocercal skin lesion in both control and endemic communities; accounting for 37of all non-onchocercal skin lesions. These skin lesions were associated with a variety of psycho-social and economic impact; and there was a positive correlation between the prevalence of troublesome itching and the prevalence of modules (correlation coefficient r=0.62; p=0.00). Given the prospects of onchorcerciasis control based on mass ivermectin distribution in communities where blindness is less common; but skin disease known to be predominant

Resource utilization patterns in patients with acquired immunodeficiency syndrome (AIDS)

A survey in 1991 of resource use patterns and factors affecting the cost of care for acquired immunodeficiency syndrome (AIDS) in Mulago Hospital; Kampala; Uganda; revealed that drugs constitute 97of the mean cost of care of affected individuals in the outpatient and 37in hospitalised patients. The cost of drugs per treatment episode was Ug.Sh. 5785.00 in the outpatient and Ug.sh. 8.309.00 for inpatients. (The exchange rate for 1991 was US$ = Ug. 910.00). Analysis of an attempt to provide essential drugs for the growing number of AIDS subjects shows that drugs alone could consume the entire health budget of the Ministry of Health in Uganda. There is therefore need to critically consider options to control the high cost for drugs in AIDS care

Absence of bacteremia with Mycobacterium avium-intracellulare in Ugandan patients with AIDS

Disseminated infection with Mycobacterium avium-intracellulare is the most common systemic bacterial infection in American patients with the acquired immunodeficiency syndrome. Blood cultures for mycobacteria were obtained from 50 severely ill Ugandan patients fulfilling the World Health Organization criteria for AIDS and considered late in the course of their illness; 98pc had antibody to HIV by ELISA. All blood cultures were negative. These data suggest that disseminated infection with M. avium-intracellulare is infrequent in Ugandan patients with AIDS; if it occurs at all

Prevalence and risk factors for nasopharyngeal carriage of streptococcus pneumoniae in Lira Municipality

"Streptococcus pneumoniae causes more than half of episodes of pneumonia in developing countries. It is the most common cause of Otitis media in children; and of Meningitis in adults. Over the last decades; resistance of this organism to penicillin and other drugs has emerged and been reported world wide; including Uganda. High nasopharyngeal carriage rates of up to 60have been reproted; the peak being in children below two years of age. Invasive disease often results from colonization of this site in children; the elderly and debilitated persons. Risk factors for carriage have been shown to be good predictors for invasive disease. Studies done in europe and USA have identified some factors associated with increased risk of pneumococcal carriage and drug resistance. In developing countries; such as Uganda; the magnitude of carriage; risk factors for resistance to drugs and sensitivity patterns are not well documented. A study done in Kampala; Uganda; documented high carriage rates in children but risk factors were not adequately explored. A cross sectional study was done in Lira Municipality to determine the prevalence of nasopharyngeal carriage; define the potential risk factors for carriage and resistance to five selected antibiotics. Thirty local Council 1 villages were selected at random to form ""clusters"" of households. Seven households were then selected at random and children aged four years and below living in these households were eligible for recruitment. Data on socio -demographic and risk factors were collected by trained field assistants using close ended; and open handed questionnaires administered to each subject. Laboratory samples were obtained by swabbing the nasopharynx of study subject with sterile aluminum swabs and immediately inoculating these on 5human blood agar media. Identification of pneumococci was based on sensitivity to optchin. Tests for susceptibility were done on Mueller-Hinton medium; using the disk diffusion method and diameters of zone of growth inhibition compared to a standard (NCCLS) table of zone diameter breakpoints (in mm). Data was entered; cleaned and analysed using EPI Info package in the Institute of Public Health. One hundred and eighty seven children were sampled. Mean age was 17.2 months; range 7 weeks to 48 months; standard deviation of 11.47 months. There were 91(48.7) girls and 96 (51.3) girls. Pneumococci were recovered from 90 (48.1) of the girls; but this was not significant (X2"