The Need for Law in the Control of HIV/AIDS in Uganda

Two decades have passed since the AIDS epidemic emerged. during this short period the disease has taken root particularly in sub-Saharan Africa where out of the total global estimate of 40 million by the end of 2001; 28.1 million are within sub-Saharan Africa as the epicentre of the disease. The disease is decimating the youth at a highly alarming rate and is putting considerable pressure on resources for the care of the AIDS victims and theor orphans. The disease has dawned on a region deeply colonised by poverty; wars and insurgency in the presence of inadequate health care infrastructures and economies. AIDS is making an already bad situation worse. HIV/AIDS has vehemently condemed sub-Saharan Africa to immense suffering. According to the end of 2001 global estimates for children and adults by the World Health Organisation; the new HIV infections during the year 2001 is 5 million. Such a figure is unacceptable; as it is a real threat to Africa where the problem is greatest

The Response of P.falciparum to 4-Amonioquinolines and Pyrimethamine sulfadoxine in 6 sites scattered throughout Uganda

Due to the absence of audience reprots from Uganda on the Chloroquine (CQ) treatment failure of P.falciparum and Pyrimethamine sulfadoxine (PSD) combination; the need for a study to demonstrate the response for P.falciparum to these drugs was obvious. We accordingly assessed the response of P.falciparum malaria in primary school children from six sites scattered throughout Uganda during the month of July and Agust 1988. The standardised WHO in vivo and in vitro micro test methods were employed. A total of 3999 primary school children were screened from the six sites and of these 780(20) had malaria. While Arua had the highest rate of CQ sensitivity of 97.2; Kampala had the lowest rate of 60.5. R3 cases were detected at only two of the six sites namely Kampala with 1 case (2.3) and Jinja with also one case (2.9). PSD were sensitive by day 7 but 3 of the 60 cases (5) become parasitaemic by day 7. In vitro P. falcuparum isolates were significantly more sensitive to amodiaquine (AQ) at all sites with a mean EC 99 of 6.443u mol/L compared to 347.7u mol/L for CQ (p0.001). There was correlation between the in vitro sensitivities. We; therefore; recommend that CQ should continue to be the first line drug for the treatment of malaria in Uganda but may use PSD or AQ for slide confirmed P. falciparum resistant to CQ as the second line drugs. Quinine should also be readily available for malaria unrespondive to CQ. Source: Uganda Med. J. Vol. 8 no. 2+4; Sept.-Dec. 1991

Some causes of malaria treatment failure in Uganda

Malaria as a cause of fever is a common disease in Uganda and accounts for a high morbidity and mortality especially among the children. Being a well known common cause of fever; any fever is assumed to be due to malaria; which belief has erroneously led to the rampant self medication or prescription by medical personnel often in wrong doses and for wrong indications. When some of these fevers fail to respond to the antimalarials; it is not unusual to blame the failure on the presence of drug resistant malaria; often without confirming the diagnosis of malaria. Consequently; secondline or even reserve drugs for malaria are taken either through self medication or prescription by the medical personnel. The causes of malaria treatment failure are many and include the following: misdiagnosis; multiple diagnoses; inadequate drug dosage; inactive drugs; undue change of medication; vomiting; fake symptoms; drugs not actually taken; reinfection and true drug resistance. From this presentation there are several reasons why malaria treatment failure is seen in Uganda; while the presence of malaria parasites resistant to drugs does occur in Uganda; it is by no means the commonest cause of the treatment failure. (This was a paper presented at the Uganda Medical Association Conference; Lake View Hotel; Mbarara)

Some causes of malaria treatment failure in Uganda

Malaria as a cause of fever is a common disease in Uganda and accounts for a high morbidity and mortality especially among the children. Being a well known common cause of fever; any fever is assumed to be due to malaria; which belief has erroneously led to the rampant self medication or prescription by medical personnel often in wrong doses and for wrong indications. When some of these fevers fail to respond to the antimalarials; it is not unusual to blame the failure on the presence of drug resistant malaria; often without confirming the diagnosis of malaria. Consequently; secondline or even reserve drugs for malaria are taken either through self medication or prescription by the medical personnel. The causes of malaria treatment failure are many and include the following: misdiagnosis; multiple diagnoses; inadequate drug dosage; inactive drugs; undue change of medication; vomiting; fake symptoms; drugs not actually taken; reinfection and true drug resistance. From this presentation there are several reasons why malaria treatment failure is seen in Uganda; while the presence of malaria parasites resistant to drugs does occur in Uganda; it is by no means the commonest cause of the treatment failure