Gold Standard Cholera Diagnostics Are Tarnished by Lytic Bacteriophage and Antibiotics.

A fundamental, clinical, and scientific concern is how lytic bacteriophage, as well as antibiotics, impact diagnostic positivity. Cholera was chosen as a model disease to investigate this important question, because cholera outbreaks enable large enrollment, field methods are well established, and the predatory relationship between lytic bacteriophage and the etiologic agent Vibrio cholerae share commonalities across bacterial taxa. Patients with diarrheal disease were enrolled at two remote hospitals in Bangladesh. Diagnostic performance was assessed as a function of lytic bacteriophage detection and exposure to the first-line antibiotic azithromycin, detected in stool samples by mass spectrometry. Among diarrheal samples positive by nanoliter quantitative PCR (qPCR) for V. cholerae (n = 78/849), the odds that a rapid diagnostic test (RDT) or qPCR was positive was reduced by 89% (odds ratio [OR], 0.108; 95% confidence interval [CI], 0.002 to 0.872) and 87% (OR, 0.130; 95% CI, 0.022 to 0.649), respectively, when lytic bacteriophage were detected. The odds that an RDT or qPCR was positive was reduced by more than 99% (OR, 0.00; 95% CI, 0.00 to 0.28) and 89% (OR, 0.11; 95% CI, 0.03 to 0.44), respectively, when azithromycin was detected. Analysis of additional samples from South Sudan found similar phage effects on RDTs; antibiotics were not assayed. Cholera burden estimates may improve by accommodating for the negative effects of lytic bacteriophage and antibiotic exposure on diagnostic positivity. One accommodation is using bacteriophage detection as a proxy for pathogen detection. These findings have relevance for other diagnostic settings where bacterial pathogens are vulnerable to lytic bacteriophage predation.

Genomic analysis of filoviruses associated with four viral hemorrhagic fever outbreaks in Uganda and the Democratic Republic of the Congo in 2012.

In 2012, an unprecedented number of four distinct, partially overlapping filovirus-associated viral hemorrhagic fever outbreaks were detected in equatorial Africa. Analysis of complete virus genome sequences confirmed the reemergence of Sudan virus and Marburg virus in Uganda, and the first emergence of Bundibugyo virus in the Democratic Republic of the Congo.

A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions.

In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83-15·70], eating roadside food (aOR 2·91, 95% CI 1·24-6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54-161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63-9·14), female gender (aOR 2·43, 95% CI 1·09-5·43), and childhood age (10-17 years) (aOR 7·14, 95% CI 1·97-25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.

Prevalence factors associated with hypertension in Rukungiri district, Uganda--a community-based study.

BACKGROUND: Hypertension is a growing public health problem in Uganda and Africa as a whole. We conducted a study to determine the prevalence and identify factors associated withy hypertension among residents of the rural district of Rukungiri, Uganda. METHODS: A community-based cross-sectional study design was used to conduct this study. Between January and February 2006, a random sample of consenting district residents, aged 20 years or older were enrolled to participate in this study. Trained research assistants administered a standardized questionnaire and performed the physical measurements. The questionnaire collected data on demographics, social economic and exposure history to various potential risk factors for hypertension. Hypertension was defined as systolic blood pressure (BP) equal or greater than 140mmHg and/or diastolic BP equal or greater than 90mmHg, and/or being on regular anti-hypertensive therapy. Logistic regression analysis was used to identify factors associated with hypertension. RESULTS: Of the 842 study participants, 252 were hypertensive. The age-standardized prevalence of hypertension was 30.5%, with a 95% Confidence Interval (CI) of 26.6 - 34.3%. Factors found to be associated with hypertension included: past alcohol use, Odds Ratio (OR)=2.28, [1.42 - 3.64], present alcohol use OR=1.64 [1.12 - 2.43], being overweight OR=1.95 [1.37 - 2.79], obesity OR=5.07 [2.79 - 9.21], female sex OR=1.44 [1.03 - 2.06], having attained tertiary education OR=1.91 [1.03 - 3.56], and older age OR=1.42 [1.27 - 1.59]). CONCLUSION: The prevalence of hypertension in this rural Ugandan district is relatively high. The findings confirm the growing concern about hypertension as a public health problem in Uganda. More studies are however required to determine the distribution and determinants of hypertension in other parts of the country.