Association between onchocerciasis and epilepsy in the Itwara hyperendemic focus, West Uganda: controlling for time and intensity of exposure.

In 38 pairs of epilepsy patients and controls matched for time and intensity of exposure to transmission of onchocerciasis, the presence of microfilariae in the skin of epilepsy patients was found insignificantly elevated compared with controls (odds ratio = 1.68; 95% confidence interval [CI] = 0.60-4.57; P = 0.31). This difference was more pronounced when detection of subcutaneous nodules was used as indication of infection with Onchocerca volvulus (odds ratio = 2.77; 95% CI = 0.92-8.33; P = 0.065). These findings from a patient group of limited size suggest that intensity of infection may play a substantial role in the development of onchocerciasis-associated epilepsy. Our results are in contrast to the results of two other independent studies from the identical endemic area; one case concluded a significant positive correlation between onchocerciasis and epilepsy, and the other case concluded a clearly negative correlation. Studies with a greater sample size are needed to confirm this possible relationship.

Trends in HIV infection: prevention-related attitudes and behaviors among secondary school students in western Uganda.

OBJECTIVE: To monitor trends in the attitudes and behaviors of youth in western Uganda with respect to prevention of HIV/AIDS. DESIGN: Annual data collection in a group of sentinel secondary schools in 3 districts using a short, self-administered, and anonymous questionnaire. METHODS: Fifteen secondary schools were randomly selected, and a cross-sectional survey of students was carried out each year between 1995 and 2001. All students from S (senior level) 2 to S4 were invited to complete the questionnaire. For data analysis, all completed questionnaires of students between the ages of 12 and 20 years were considered. RESULTS: In total, 6 surveys were carried out yielding 6231 valid questionnaires. Ever use of condoms among sexually active youth increased significantly from 48.8% in 1995 to 1996 to 72.8% in 2000 to 2001. Male students were more likely to report increased sexual abstinence during the time period than female students. Conversely, female students over the same time period reported having fewer sexual partners than male students. The number of sexually active students reporting sexual intercourse in the past 3 months remained the same. CONCLUSIONS: These data show that significant positive changes in the sexual behavior of secondary school students in western Uganda have occurred. This could explain, in part, the decline of HIV prevalence rates among young people observed in this region.

Adolescent reproductive health in Uganda: issues related to access and quality of care.

UNLABELLED: Adolescent health in Kabarole district, Uganda, is seriously jeopardized by both high teenage pregnancy rates and high rates of sexually transmitted diseases, including HIV infection. OBJECTIVES: To elucidate views, perceptions and attitudes of key informants who are involved in the delivery of reproductive health services to adolescents. STUDY GROUP: Four managers of youth-related nongovernmental organizations, two government nurses, and four youth leaders. METHODS: Qualitative study with content analysis using in-depth interviews. RESULTS: Participants agreed that reproductive health services in Kabarole district are not adolescent friendly. Most often, lack of privacy and confidentiality for the adolescents attending a health unit was cited as one important reason. Other factors contributing to a less adolescent friendly service environment were inconvenience of services including the fragmentation of different service components and lack of specific traIning for health workers on how to relate appropriately to adolescents. Also noted was that several participants had a negative attitude toward the sexual activity of adolescents. Suggestions for service improvement were limited to training of health workers and increased support for the infrastructure. CONCLUSIONS: Reproductive health services for adolescents in Kabarole district could be strengthened by improving the privacy and confidentiality of services. Health workers must also be trained in counseling and in treating adolescents in a youth-appropriate and high quality fashion. Staff attitudes must also be addressed.

Knowledge of and perceptions about sexually transmitted diseases and pregnancy: a qualitative study among adolescent students in Uganda.

This article reports the findings of a qualitative research study carried out in Kabarole district, western Uganda. Knowledge of and perceptions about HIV/AIDS and pregnancy and how both relate to one another were elucidated from eight focus-group discussions with 38 female and 32 male secondary students from four different schools. Widespread misinformation and misconceptions about contraceptives still exist as previously found in this area. There was a serious gap in knowledge and understanding of 'dual protection' against sexually transmitted diseases, including HIV/AIDS, and against pregnancy. Fertility was very highly valued, and many girls stated that they would want a child even if they were HIV-positive. Responses of girls showed that they were quite assertive in making decisions to use contraceptives. The reasons for students not being able to understand the interconnectedness of sexually transmitted diseases and pregnancy may lie in the fragmented fashion in which relevant health education is delivered through two separate programmes.