Dairy agripreneurs' preference for production and animal health support services in Kenya-a choice experiment.

Utilization of production and animal health services among smallholder dairy agripreneurs is crucial in enhancing their productivity and income levels. However, studies have documented low uptake of these services among smallholder dairy agripreneurs in Kenya. This study utilizes a choice experiment (CE) to determine dairy agripreneurs' preferences and willingness to pay (WTP) for five attributes of production and animal health support services. Multistage sampling procedure was used to collect data from 682 dairy farmers in Murang'a County. Data were analysed using Random Parameter Logit (RPL)/Mixed Logit model. The results of CE reveal significant heterogeneity in preference among dairy agripreneurs. Dairy agripreneurs prefer to have group marketing services offered rather than selling on individual basis. They also prefer curative services rather than preventive services. In addition, dairy agripreneurs prefer use of artificial insemination in improving productivity of cows rather than using improved feeds such as hay and silage. The results further indicate that dairy agripreneurs have less preference for business plan training service. In relation to willingness to pay (WTP), dairy agripreneurs were more willing to pay for group marketing (KES 8797.91/month), artificial insemination (KES 2816.01/month) and curative services (KES 2577.62/month). Lastly, dairy agripreneurs were not willing to forgo KES 2411.29 per month for business plan training service. Service providers should consider the differences in preferences among dairy agripreneurs to increase the uptake of production and animal health services in dairy agrienterprises.

Prevention and Control of African Swine Fever in the Smallholder Pig Value Chain in Northern Uganda: Thematic Analysis of Stakeholders' Perceptions.

African swine fever (ASF) is endemic in Uganda and considered a major constraint to pig production. In the absence of a vaccine, biosecurity is key for ASF prevention and control. To improve prevention and control on farm and community level there is need for more knowledge on current application of biosecurity practises, and better understanding of how pig value chain actors perceive prevention and control. To achieve this, a qualitative interview study involving focus group discussions (FGD) was conducted with actors from the smallholder pig value chain in northern Uganda. Six villages were purposively selected based on previous outbreaks of ASF, preliminary perceived willingness to control ASF, and the representation of several different value chain actors in the village. Results indicated that biosecurity practises such as basic hygiene routines including safe carcass handling, minimising direct and indirect contacts between pigs or between pigs and people, trade restrictions and sharing of disease information were implemented in some of the villages. Thematic analysis based on grounded theory revealed six categories of data relating to ASF prevention and control. Together these categories form a logical framework including both enablers and hindrances for ASF prevention and control. In summary participants mostly had positive perceptions of ASF biosecurity, describing measures as effective. Participants further possessed knowledge of ASF and its transmission, some of which was in line with known scientific knowledge and some not. Nevertheless, participants were hindered from preventing and controlling ASF due to biosecurity costs and a need to prioritise family livelihood over disease transmission risks, incompatibility of current biosecurity practises with local culture, traditions and social contexts and finally lack of access to veterinarians or, occasionally, low-quality veterinary services. The constraints could be addressed by applying participatory processes in designing biosecurity measures to ensure better adaptation to local cultural and social contexts.

Health Research Profile to assess the capacity of low and middle income countries for equity-oriented research.

BACKGROUND: The Commission on Health Research for Development concluded that "for the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped." This project was designed to assess low and middle income country capacity and commitment for equity-oriented research. METHODS: A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe) developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP): 1) Research priorities; 2) Resources (amount spent on research); 3) Production of knowledge (capacity); 4) Packaging of knowledge and 5) Evidence of research impact on policy and equity. We surveyed three countries from each region. RESULTS: Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI) had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process. CONCLUSION: Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external agencies) should invest more in building a certain minimum level of national capacity for equity-oriented research.

Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda.

SETTING: Kiboga district, a rural area in Central Uganda. OBJECTIVE: To assess the cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients compared with conventional hospital-based care. METHODS: Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US dollars, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated. FINDINGS: The cost per patient treated for new smear-positive patients was dollars 510 with the conventional hospital-based approach to care (dollars 419 for the health system and dollars 91 for patients), and dollars 289 with community-based care (dollars 227 for health services, dollars 53 for patients and dollars 9 for volunteers). Important new costs associated with community-based care included programme supervision (dollars 18 and dollars 9 per patient at central and district levels, respectively) and training (dollars 18 per patient). The cost per patient successfully treated was dollars 911 with the hospital-based strategy and dollars 391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days. CONCLUSION: There is a strong economic case for the implementation of community-based care in Uganda.

Human endogenous retrovirus-R (ERV 3) env-like antigens expressed in baboon testes and epididymides.

BACKGROUND: A substantial component of the vertebrate genome comprise of retrovirus-related sequences named as endogenous retroviruses (ERVs). The role of these ERV-related sequences in the biological processes of the host species is still unknown. However, they have been associated with tumourigenesis, autoimmune diseases and placental morphogenesis in primates. OBJECTIVE: To determine the expression of ERVs in male baboon reproductive tissues. DESIGN: The testes and other reproductive tissues from sexually immature and mature male olive baboons (Papio anubis) were investigated for the expression of endogenous retrovirus-related particles. Immunohistochemical staining was performed using antibodies raised against human immunodeficiency virus (HIV)-1/2, simian immunodeficiency virus (SIV) and human ERVs. Biochemical properties were determined by western blot, and reverse transcriptase (RTase) activity in epididymal spermatozoa, ejaculate spermatozoa and seminal fluid was evaluated. SETTING: Institute of Primate Research, Nairobi, Kenya. RESULTS: ERV3 env-like antigens were detected on spermatogenic cells in mature baboon testes and on epididymal spermatozoa. Similarly, antigens cross-reactive with antibodies to HIV structural and envelope glycoproteins were expressed in mature and juvenile baboon testes. In addition, reverse transcriptase activity was detected in ejaculate spermatozoa, seminal fluid and epididymal spermatozoa. CONCLUSION: These results indicate that retroviral-related genes were expressed in normal male baboon testes and spermatozoa, similar to humans. The functions of these ERVs in vertebrates remains unclear.

Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa.

An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.

Lymphatic filariasis in Uganda: baseline investigations in Lira, Soroti and Katakwi districts.

Baseline epidemiological investigations on lymphatic filariasis were conducted for the first time in Uganda in 3 communities in the districts of Lira (Alebtong area), Soroti (Lwala area) and Katakwi (Obalanga area), located to the north of Lake Kyoga at an altitude of 1000-1100 m above sea level. Individuals from the communities were examined, in April-August 1998, for Wuchereria bancrofti specific circulating antigen (by ICT card test), microfilaraemia (by counting chamber and stained blood-smear techniques) and chronic clinical manifestations of lymphatic filariasis. Endophilic mosquitoes were sampled and dissected for filarial larvae. Prevalences of circulating filarial antigen positivity were 29%, 18% and 30% in the Alebtong, Lwala and Obalanga communities, respectively. Microfilaria (mf) prevalences were 18%, 9% and 21%, and geometric mean mf intensities among mf-positive individuals were 306, 171 and 402 mf/mL blood, in the same communities. Examination of stained blood smears revealed mf of both W. bancrofti and Mansonella perstans, but more than 80% of mf-positive individuals harboured the first of these parasites. Prevalences of hydrocoele in adult (> or = 20 years) males were 28%, 7% and 17%, and prevalences of limb elephantiasis in adults were 9%, 4% and 4%, in the Alebtong, Lwala and Obalanga communities, respectively. Anopheles gambiae s.l. (mainly An. gambiae s.s.) and An. funestus were common in all 3 communities, and showed W. bancrofti infectivity rates of 1.1-1.7% and 1.3-2.9%, respectively. It is concluded that lymphatic filariasis is highly endemic in these high-altitude areas of Uganda, with An. gambiae s.l. and An. funestus being the main vectors.

Natural human immunoglobulin G subclass responses to Plasmodium falciparum serine repeat antigen in Uganda.

Serum samples from Ugandan residents of a malaria-hyperendemic region were tested by enzyme-linked immunosorbent assay for reactivity against recombinant constructs of the 47 (SE47')- and 50 (SE50A)-kDa fragments of Plasmodium falciparum serine repeat antigen (SERA). Immunoglobulin (Ig) G3 and IgG1 were the predominant subclass responses to SE47' and SE50A, respectively. The geometric mean optical density (OD) for IgG3 anti-SE47' was significantly lower in children < 15 years compared with adults > or = 15 years (P < 0.0001). By contrast, the geometric mean IgG1 anti-SE50A was slightly higher in children compared with adults (P < 0.01). The proportion of high responders (ODs > 0.5) to SE47' was significantly lower in children compared with adults (P < 0.001), whereas the proportion of high responders to SE50A was comparable in children and adults (P = 0.07). This first detailed study of SERA in a malaria-hyperendemic region suggests that natural human IgG3 anti-SE47' might be associated with immunity to malaria.

Human IgG subclass antibodies to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)) and predominance of the MAD20 allelic type of MSP1 in Uganda.

OBJECTIVE: To determine the natural human humoral immune responses to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)), a malaria candidate vaccine antigen and to determine the prevalence of MAD20 and K1 alleles of P. falciparum MSP1. DESIGN: Community based cross-sectional study. SETTING: Atopi Parish, Apac District, Uganda, 1995. SUBJECTS: Three hundred and seventy four Ugandans between <1 and 70 years old provided serum samples. MAIN OUTCOME MEASURES: IgG subclass antibodies by ELISA; MAD20 and K1 allelic types of MSP1 by PCR. RESULTS: Both the prevalence and the mean concentration of serum IgG1, and to a lesser extent IgG3, antibodies increased with age. IgG2 or IgG4 antibodies were virtually nonexistent. The cross-reactivity between the 4 sequence variants (E-KNG, E-TSR, Q-KNG and Q-TSR) of MSP1(19) was confirmed; however, a minority of sera preferentially recognised the KNG but not the TSR variants. All 33 P. falciparum isolates from different parts of Uganda carried the E-TSR (Mad20) allelic type and 3 isolates were mixed infections with E-TSR (MAD20) and Q-KNG (K1) allelic types, confirming the rarity of the K1 allele in Uganda. CONCLUSION: There is a robust IgG1 antibody response to the malaria vaccine candidate antigen MSP1(19) which begins at an early age. Future cohort studies are necessary to estblish the impact of these antibodies on clinical immunity to malaria. The MAD20 allelic type of MSP1 id predominant in Ugandan P. falciparum isolates.

Plasmodium falciparum malariometric indices in Apac district, northern Uganda.

OBJECTIVE: To establish Plasmodium falciparum malariometric indices in a field study site in Apac district, northern Uganda. DESIGN: A community-based cross sectional survey. SETTINGS: Atopi Parish, Apac district, Uganda, 1995. SUBJECTS: One thousand two hundred and thirty four volunteers aged below one and ninety years. MAIN OUTCOME MEASURES: P. falciparum parasitaemia rates and parasite density, splenomegaly, bednet use and chloroquine consumption. INTERVENTIONS: All subjects with P. falciparum positive smears were treated with chloroquine. RESULTS: The population prevalence of parasitaemia was 62.1% with the predominant species being P. falciparum (100%) and P. malariae in the minority (3.5%); P. ovale was not seen. The prevalence of parasitaemia in subjects older than 20 years and in those under ten years was 36% and 85%, respectively. The geometric mean parasite density started to decline by the age of six years. The splenomegaly rate in subjects over the age of 12 years and in those under nine years was 19.8% and 63.1%, respectively. Bednet use and chloroquine consumption was low. Interestingly, the reported use of chloroquine in the week immediately preceding the study was more frequent in children under two years old than in the rest of the population. CONCLUSION: Malaria transmission in Atopi Parish in northern Uganda is hyperendemic and age-related acquired anti-parasite immunity seems to appear by seven years of age.

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. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilities, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial.

OBJECTIVE: To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching. METHOD: A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. RESULTS: While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. CONCLUSION: This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.

Quality of oral and parenteral chloroquine in Kampala.

Malaria remains an important public health problem in Uganda. The mainstay of treatment is still chloroquine. However, recently there have been several reports of poor response to chloroquine treatment. We do not know whether the reported poor response is due to true resistance or poor quality of the drug in the market. This study was done to assess the quality of chloroquine dosage forms in Kampala. The study was cross-sectional; end-point designed to assess the amount of the active ingredient in the tablet and injection dosage forms of the drug. The quality assay was based on the BP, 1988 standard, using both visual and potentiometric analysis technique. The study demonstrated that there is a problem with the quality of chloroquine in the market. Upto 30% of the tablet samples and 33% of injection samples contained less than the stated amount of the active ingredient. This may be one of the reasons for the reported poor response of malaria to chloroquine treatment in Uganda. Given that routine laboratory testing of active ingredients in pharmaceuticals is not practised in Uganda, this study has demonstrated the necessity for establishment of a drug quality control laboratory in the country.

Legislatory framework for private medical practice in Uganda.

BACKGROUND: In Uganda the private health sector has expanded dramatically in recent years with a striking proliferation of facilities for private medical practice which is particularly evident in urban areas. OBJECTIVES: The general objective of this study was to analyse the laws and regulations governing the private health sector in order to determine how they affect the operations and development of private medical practice in Uganda. METHODS: Between December 1995 and December 1996, we identified and reviewed all the laws, which affect private medical practice in Uganda. We discussed the contents of the laws with Ministry of Health officials and with representatives of private practitioners. We also made visits to a sample of clinics, which we inspected to ascertain compliance with the laws, and held interviews with managers of the clinics to get their views about the laws. RESULTS: Two categories of laws were identified. The first category includes two laws adopted in 1993, whose purpose is to ensure the availability at all times of efficacious and cost effective drugs in the country. The second category includes three laws, all adopted in 1996, which spell out the licensing procedures, supervision, disciplining and general control of different categories of professionals. The list of health professions, which are permitted to practice privately, was revised to include new categories, which were previously not allowed. We identified what we considered to be barriers to private health sector development, loopholes in the laws and also assessed the enforcement of the laws. The legal barriers include restrictions of drug imports, the requirement for the professionals to renew their practising licenses and to register the premises annually at one central place in the country, long periods of time mandated for acquiring experience before one can be permitted to practice privately and the finding that there are some capable professions which are still not allowed to practice privately. CONCLUSION: We made recommendations to the Ministry of Health to address all these barriers. We also recommended to the Ministry that non-professionals who have the ability to set up clinics should be allowed to register them provided they can engage professionals to operate them.

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

Research bioethics in the Ugandan context: a program summary.

PIP: A 5-day symposium on bioethical principles governing clinical trials was held in Jinja, Uganda in September 1994. The 13 attending male and female participants were ethicists, physicians, researchers, and pharmacists who had all conducted research themselves. The Ugandan Ministry of Health, Makerere University, the Uganda AIDS Commission, Uganda's National Council of Science and Technology, and the National Chemotherapeutic Laboratory were represented. The workshop was held as the first step toward examining Uganda's system of bioethical review; the applicability of the principles of autonomy, beneficence, nonmaleficence, and justice to biomedical research in Uganda; and strategies for the further development of a Ugandan code of research bioethics. The participants concluded that while the principles of autonomy, beneficence, nonmaleficence, and justice are relevant to research in Uganda, their adoption and implementation must reflect the circumstances and cultural context which are unique to Uganda. The issues considered during the workshop are discussed.^ieng