Exploring the Pathways of Leprosy Patients from Their Communities to a Diagnosis in the Districts of Mayuge, Yumbe and Kasese-Uganda

Background: Leprosy is known to cause disability that leads to severe outcomes like stigma, discrimination, mental health problems and participation restriction. Furthermore, in cases of infectious leprosy, longer delays increase the risk for the spread of the disease. Despite being preventable and curable, a significant proportion of new leprosy patients (39%) in 2019 had grade 2 (Described as Visible disability) at the time of diagnosis signifying late presentation. The aim of this study was to describe patient journeys from first symptoms suggestive of leprosy to a diagnosis and individual and community level factors associated with health seeking behavior of leprosy patients. Methods: This was a cross-sectional explorative study implemented in Kasese, Mayuge and Yumbe districts .A structured questionnaire was used to collect quantitative data. Qualitative assessment included patients, family members, health workers, voluntary health teams and the district health team. Descriptive statistics were presented in terms of percentages, frequency tables, pie Charts and graphs for easy interpretation and discussion. Results: The results indicate that 53% of the respondents identified as female. The median age of the respondents being 34 years, with a range of 1 to 76 years (Mean: 44.7, Mode: 65, Standard-Deviation: 19.6, Kurtosis: 0.6). The most common first symptom noticed by respondents was skin lesions (65%) followed by deformities (18%) (P value = 0.05%) occurring mostly in the feet (P-value = 0.48). Majority (52%) of the patients had taken more than 24 months (SD 18.72 OR 2.75) for a diagnosis to be made with a maximum delay of over 60 months. The most common cause of delay in seeking health care was lack of knowledge on leprosy (P value=Conclusions: There was a delay of 2 years in seeking health care for the majority of the patients. Key barriers to early diagnosis were lack of knowledge and infrastructure. Community sensitization and strengthening capacity building are needed to achieve early diagnosis of leprosy and proper management.

Malaria Prevalence and Associated Risk Factors among Batwa Indigenous People of Kanungu District in Southwestern Uganda: Does “Place” Matter?

Introduction: Malaria is an important disease, causing high morbidity and mortality, especially in Sub-Saharan Africa. Measuring malaria prevalence using malaria rapid diagnostic tests (mRDTs), particularly among a vulnerable population sub-group, is a vital public health step in discovering effective methods of prevention and control. This study set out to examine the association between “place” and other risk factors with malaria prevalence among Batwa Indigenous People (IP). Methods: An analytical cross-sectional study design was implemented. Two surveys January 2014 (n = 572) and April 2014 (n = 541) involving interviews and testing for malaria using mRDTs were conducted in 10 Batwa settlements where a total of 1113 Batwa of all ages were surveyed and tested. The data were first compiled in MS Excel and then imported and analyzed using STATA ver.14. Descriptive statistics, were generated, followed by bivariable and multivariable regression model analysis to establish associations between the predictor and outcome variables with p ≤ 0.05 considered statistically significant. Results: Overall prevalence was 13.94% (n = 146). There is a significant relationship between settlement (place) and malaria prevalence AOR 11.7, 95% CI (1.38 - 98.93), p-value = 0.02. More males 16.97% (n = 84) tested positive compared to females 11.23% (n = 62) but there was no statistically significant association between gender and mRDT (p-value > 0.005). Children less than 5 years registered high prevalence and there was a significant relationship between age and mRDT (p-value ≤ 0.005). Wealth proxy indicators showed no association with prevalence p-value = 0.390. Season had no association with prevalence (p-value = 0.80). However, the proportion of the day spent in the forest/woodlands was significantly associated with malaria prevalence COR 12.83, 95% CI (1.14 - 143.73) p-value = 0.04. Low elevation was significantly associated with malaria prevalence COR 2.42, 95% CI (1.32 - 4.41), p = 0.004 but sleeping under a net and level of education did not show any association with malaria prevalence. Conclusion: This study highlights the importance of place in predicting malaria prevalence among Batwa Indigenous People a marginalized and remortely located sub-population. This study has shown that place matters in determining malaria prevalence. However, other factors like age, elevation and gender also contribute to malaria prevalence. Batwa have higher prevalence than the national and even non-indigenous populations in the same district. We recommend targeting hotspots intervention approach since it has proven reasonable impact on reducing malaria prevalence.

A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

Uganda has been implementing the Global Health Security Agenda(GHSA)since 2015 to build its capacity according to World Health Organization(WHO)Benchmarks on International Health Regulations Capacities.The country remains prone to outbreaks,with more than 20 disease outbreaks reported in the past five years,including Ebola virus disease,Crimean-Congo haemorrhagic fever,Marburg haemorrhagic fever,measles,yellow fever,coronavirus disease 2019(COVID-19),and cholera.Antimicrobial resistance(AMR)is an ongoing challenge.Uganda scored capacity level 3 on infection prevention and control(IPC)and antimicrobial stewardship(AMS)in the 2017 Joint External Evaluation(JEE)assessment.Identified gaps were being addressed after a self-assessment in 2021.This paper describes the technical assistance approaches provided to Uganda by the Medicines,Technologies,and Pharmaceutical Services Program,funded by the United States(U.S.)Agency for International Development,and implemented by Management Sciences for Health.The program,through a One Health approach,supported systematic capacity strengthening based on the JEE's capacity advancement framework for global health security,specifically relating to AMR.The program's interventions impacted 32 WHO benchmark actions(7 for AMR multisectoral coordination,16 for IPC,and 9 for AMS),contributing to Uganda's strengthened GHSA capacity.Leveraging success built on the AMR platform,the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams.The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions,covering 45 districts and reaching 5,452 health workers at 858 health facilities.