Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda. Methods In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 – Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables. Results In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19–1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34–5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26–223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108–1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36–23.1, p = .001) and being female (OR = .054, 95% CI: 0.30–1.00, p = .005). Conclusion Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children’s mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children
Indonesia is one of the highest producers of the automotive industry in Southeast Asia. However, rapid progress in this sector directly poses a threat to the increase in End-of-Life Vehicles in Indonesia. Several policies and instruments have been implemented to reduce the high number of ELVs, such as raising vehicle taxes and requiring periodic emissions testing systems to determine vehicle eligibility. These initiatives, however, do not reduce the use of ELV vehicles in Indonesia. Indonesia did not win the ELV because of high rejection from the users. To date, no research has been done to determine public acceptance of ELV policies. This study aims to examine the public acceptance of ELV management, particularly to gauge information about people’s knowledge, attitude, social influence, and institutional trust as mediation variables. A cross-sectional survey was conducted involving 243 respondents from JABODETABEK (Jakarta, Bandung, Depok, Tangerang, Bogor, and Bekasi). After passing satisfactory reliability and validity tests, the hypothesized research model was estimated using structural equation modelling. The study found that knowledge, attitude, social influence, and institutional trust all had a significant influence on public acceptance. The result also indicated that institutional trust variables serve as effective mediators. The proposed model is a good model (overall R2 = 0.703, F = 58.2, p = 0.00). The implication of this study suggested that policymakers should consider that implementing ELV-related policies is not only a solution to the automotive cycle and environmental health but also must address individual differences by taking into the factors forming one’s acceptance
Lake Bunyonyi is one of the major resources of social-economic potential in the districts of Rubanda and Kabale, South-Western Uganda. The lake’s sub-catchment faces environmental problems because of intensive agriculture, settlement, business and tourism activities, which consequently cause pollution of water in the lake’s system. This study, therefore, intended to determine the processes that govern nitrogen dynamism using a numerical model that takes into account various processes in the system using STELLA® 8.1.1 software. From the model simulation, it was found that mineralization, microbial uptake and nitrification were the major processes governing nitrogen transformation in the water phase, accounting for 47.8% (0.49 g/d m−2), 44.2% (0.45 g/d m−2), and 7.8% (0.05 g/d m−2), respectively. The developed model predicted reasonably well the behaviour of the lake evidenced by the validation results of observed and simulated data that showed good linear regression coefficients (R2) of organic nitrogen (0.48), ammonia–nitrogen (0.68), and nitrate–nitrogen (0.61). The model has proven suitable for application on lakes with characteristics similar to that of Lake Bunyonyi. The study recommended that a compressive investigation that puts into consideration all the possible sources of nutrient and water inflow into the lake system be done on Lake Bunyonyi.
The role of forests across the world has been recognized as key natural assets that offer several goods and services, especially to communities adjacent to them. Given this role, there have been minimal efforts to determine the factors characterizing this dependence of communities on non-timber forest products (NTFPs), especially in developing nations. This study surveyed and assessed different factors influencing household dependence on NTFPs in the Marrupa-Mecula Corridor, Niassa Special Reserve, Niassa Province of Mozambique. In total, 377 household members from eight villages attended the interview while employing proportional random sampling. Data analysis was done using descriptive statistics and binary logistic regression. The study revealed that 90.9% of the households participate in collecting, producing, and selling NTFPs. Three factors, namely, social, economic, and physical, with twenty sub-factors or characteristics were found to have a significant association with dependence on forest resources. They include the availability of NTFPs, taking a collection of NTFPs as a family job, strong cultural attachment to forests, seasonal engagement in collection, nearby forests being home for community leaders, distance to the nearby forest, the housing needs of forests, forests being a major source of medicine, forests being a resource for educational institutions, forests being a major source of household food security, forests being a ready income for households, forests being a tourist attraction in the area, and affordability of distance to markets. The binary logistic regression revealed that gender, age, education, family size, and time spent in the area are significantly associated with dependence on NTFPs. Additionally, strong cultural attachment to forests, seasonal engagement in collection, nearby forests being homes for community leaders, distance to the nearby forest, housing needs, a major source of medicine, Frontiers in Forests and Global Change | www.frontiersin.org 1 July 2022 | Volume 5 | Article 924959 Lubega et al. Non-timber Forest Products education, household food security, ready income, tourist attraction, and affordability of distance to markets were found to have a significant influence. On the contrary, scary dangerous wild animals, restriction of cultivation in non-gazetted forests, restriction of hunting in non-gazetted forests, and forest fires negatively affected the dependence on NTFPs/resources. As a way of achieving sustainable utilization of NTFPs, management plans and strategies need to incorporate these factors characterizing the dependence on NTFPs.
Background An in vitro assay on Sigmoidin A from Erythrina abyssinica stem bark revealed its potency to inhibit pancreatic lipase. However, studies indicate activity of extract bioactive compounds in combination far exceed the favorable effects of each individual compound due to synergy and additive effects. In this study, we provide information on the effect of E. abyssinica stem bark extract in Drosophila melanogaster. The objective of the study was to determine the safety and effects of E. abyssinica stem bark extract on fly survival, body weight, triglycerides, sterol, total protein, and catalase activity of obese male D. melanogaster. Methods Obesity was induced by exposing D. melanogaster white mutant w¹¹¹⁸ to coconut food for two weeks. Groups 1–3 were fed on coconut food + fenofibrate at 25 mM, 50 mM, and 75 mM. Groups 4–6 were fed on coconut food + E. abyssinica stem bark extract at concentrations of 2.5 g/ml, 5.0 g/ml, and 7.5 g/ml. The positive control was exposed to only coconut food while the negative control was on regular food. Fly survival observations were done for 15 days, while acute and chronic effects were done at 30 min and after 48 h respectively following treatment. Body mass, negative geotaxis, reducing power of the extract, triglycerides (TG/TP), sterol, total protein levels, and catalase activity were measured after 10 days of exposure to the experimental diets. Results Fly survival changes were observed after 10 days and E. abyssinica stem bark extract had the strongest reducing power at 7.5 g/ml extract concentration. E. abyssinica stem bark extract reduced body mass, triglyceride levels (TG/TP), sterol levels, and modulated catalase activity at 7.5 g/ml extract concentration. Though the standard drug fenofibrate had the highest fat accumulation reduction potential, the extract at 7.5 g/ml was much safer in reducing fat accumulation in obese male D. melanogaster than other concentration used. Conclusion Antioxidants in E. abyssinica stem bark extract are responsible for the observed anti-obesity activity.
Background: An in vitro assay on Sigmoidin A from Erythrina abyssinica stem bark revealed its potency to inhibit pancreatic lipase. However, studies indicate activity of extract bioactive compounds in combination far exceed the favorable effects of each individual compound due to synergy and additive effects. In this study, we provide information on the effect of E. abyssinica stem bark extract in Drosophila melanogaster. The objective of the study was to determine the safety and effects of E. abyssinica stem bark extract on fly survival, body weight, tri-glycerides, sterol, total protein, and catalase activity of obese male D. melanogaster. Methods: Obesity was induced by exposing D. melanogaster white mutant w 1118 to coconut food for two weeks. Groups 1-3 were fed on coconut food þ fenofibrate at 25 mM, 50 mM, and 75 mM. Groups 4-6 were fed on coconut food þ E. abyssinica stem bark extract at concentrations of 2.5 g/ml, 5.0 g/ml, and 7.5 g/ml. The positive control was exposed to only coconut food while the negative control was on regular food. Fly survival observations were done for 15 days, while acute and chronic effects were done at 30 min and after 48 h respectively following treatment. Body mass, negative geotaxis, reducing power of the extract, triglycerides (TG/TP), sterol, total protein levels, and catalase activity were measured after 10 days of exposure to the experimental diets. Results: Fly survival changes were observed after 10 days and E. abyssinica stem bark extract had the strongest reducing power at 7.5 g/ml extract concentration. E. abyssinica stem bark extract reduced body mass, triglyceride levels (TG/TP), sterol levels, and modulated catalase activity at 7.5 g/ml extract concentration. Though the standard drug fenofibrate had the highest fat accumulation reduction potential, the extract at 7.5 g/ml was much safer in reducing fat accumulation in obese male D. melanogaster than other concentration used. Conclusion: Antioxidants in E. abyssinica stem bark extract are responsible for the observed anti-obesity activity.
The systematic information based on concepts, interpretations, ideas, observations, and judgments is known as knowledge. The present study portrayed that the focus of scientific investigations is growing towards assessments based upon environmental knowledge system. The study aimed to understand the interactions between local knowledge systems and decision on land use allocation among rural households in South Africa. Decisions about land-use, resource access, determinants of land-use allocation and environmental knowledge were analysed using descriptive statistics. SPSS was employed to calculate a two-tailed Pearson correlation, multiple regression and ANOVA two-way of variance. Landform condition has a strong impact on the distribution of ecosystems through variation of the climate and controlled land-use. The allocations of land-use as related to landforms reveal both effortless and multifaceted results. A more multifaceted model of land-use allocation occurs on stripping slopes, hills, and foot slopes, which are difficult to access and are covered by forests and scrubland. The study detected a strong linkage between land-use patterns and environmental knowledge. The environmental knowledge acquired either from a formal or an informal resource has significant bearings on land-use patterns, thus being useful for sustainable land-use planning and management. Besides that, how the community allocates land for different purposes is dependent on a multitude of socioeconomic factors like land ownership (public or private), economic gains, education, access to credits and other resources.
Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic significance of BWF and AKI are not well understood. Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defined using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host markers of immune and endothelial activation were quantified on admission plasma samples. The relationships between BWF and AKI and clinical and biologic factors were evaluated using multivariable regression. Results: We evaluated BWF and AKI in 999 children with acute febrile illness (mean age 1.7 years (standard deviation 1.06), 55.7% male). At enrollment, 8.2% of children had a history of BWF, 49.5% had AKI, and 11.1% had severe AKI. A history of BWF was independently associated with 2.18-fold increased odds of AKI (95% CI 1.15 to 4.16). When examining host response, severe AKI was associated with increased immune and endothelial activation (increased CHI3L1, sTNFR1, sTREM-1, IL-8, Angpt-2, sFlt-1) while BWF was predominantly associated with endothelial activation (increased Angpt-2 and sFlt-1, decreased Angpt-1). The presence of severe AKI, not BWF, was associated with increased risk of in-hospital death (RR, 2.17 95% CI 1.01 to 4.64) adjusting for age, sex, and disease severity. Conclusions: BWF is associated with severe AKI in children hospitalized with a severe febrile illness. Increased awareness of AKI in the setting of BWF, and improved access to AKI diagnostics, is needed to reduce disease progression and in-hospital mortality in this high-risk group of children through early implementation of kidney-protective measures.
Background: Worldwide, more than 95 million children are sexually abused each year with children in sub-Saharan Africa experiencing sexual assault at higher rates than those in more developed areas. In Uganda, 20% of young people indicated that their sexual debut was non-consensual. The risk for transmission of HIV to children through Child Sexual Abuse is high because of greater mucosal tissue damage and the often repetitive nature of abuse. This contributes significantly to the burden of HIV in Uganda. Despite these risks, studies have shown gaps in active parental involvement in child sexual abuse prevention despite their being the primary protectors of children. Against this background we sought to explore parental understanding of childhood sexual abuse and prevention as a measure for HIV prevention in Rwampara District, South Western Uganda. Methods: A phenomenological study was carried out in four health centers that serve the communities of Rwampara district. A total of 25 (n = 25) parents or guardians of children aged 9-14 years were purposively selected to participate in the study. The participants were subjected to in-depth semi-structured interviews which were recorded, transcribed, and translated for thematic analysis. Results: Parents' understanding of child sexual abuse was limited to penetrative sex between a man and a child. Three of the parents interviewed reported to have had children who had been sexually abused while one of the parents had been abused when she was young. The children reported to have been abused were female and were between 3-14years. We also identified gaps in the sensitization of parents regarding home-based prevention of child sexual abuse and psychological support for the victims of abuse. Conclusion: Our study shows that child sexual abuse exists in rural western Uganda. There remains a significant gap in the awareness of parents regarding the extent of sexual abuse, signs of sexual abuse, case handling, and psychological support for victims of sexual abuse. This significantly affects the capacity of parents as the primary protectors of children to identify and protect the children against the multiple forms of child sexual abuse.
Background Uganda adapted Viral load (VL) testing for monitoring HIV treatment success and virologic failure. However, there is a paucity of data on how the VL testing guidelines are followed in practice in the HIV clinics. This study determined the adherence to national guidelines on VL testing, barriers, and associated factors in persons living with HIV (PLHIV) on ART in southwestern Uganda. Methods We conducted a cross-sectional mixed methods study from April to May 2021 at four HIV clinics in southwestern Uganda. Patient chart review using a checklist that captured age, gender, and level of a healthcare facility, dates of ART initiation, dates VL specimens were drawn, line of ART, patient adherence to ART was done. Continuous data were summarized using mean and median and Chi-square was used for categorical data. We performed regression analysis to determine factors associated with adherence to viral load testing guidelines at a 95% level of significance. Key informant interviews with managers of the health facility, ART clinic and laboratory were carried out, and thematic analysis was conducted to explore barriers to adherence to VL testing guidelines. Results The participants’ mean (SD) age was 39.9(± 13.1) years, 39.5% were male, 45.8% received care at a general hospital and median duration on ART was 5 years (IQR;3–7). Of the 395 patient charts reviewed, 317 had their VL testing (80.3%) per the guidelines (defined as up to one month post due date). Receiving care at a hospital (aOR = 2.20; 95%CI 1.30–3.70; p = 0.002) and increasing patient age (aOR = 1.02; 95%CI 1.02–1.06; p = 0.020) were the factors associated with adhering to VL testing guidelines. Long turnaround time of VL results and insufficient VL testing kits were cites by providers as barriers. Conclusion We found suboptimal adherence to VL testing guidelines in PLHIV on ART in southwestern Uganda. Increasing patient age and getting care at a higher-level health facility were associated with guideline-based viral VL testing. Long turnaround time of VL test results and inadequate test kits hindered compliance to VL monitoring guidelines. Strategies that target young PLHIV and lower-level health facilities, increase the stock of consumables and shorten VL results turnaround time are needed to improve adherence to VL testing guidelines.
Background Harmful alcohol use by 5–8-year-old children has been identified in Mbale District, Uganda. To further examine this finding, the present study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in this area. Methods We conducted eight focus group discussions with 48 parents of children aged < 10 years and 26 key informant interviews with teachers, health workers, child protection workers, police, local stakeholders, brewers, and others. Thematic content analysis was performed. Results Three main themes were identified: ‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to three main factors related to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights. ‘There is nowhere to take the child’: Schools, police, and remand homes were intuitively considered appropriate arenas for managing childhood substance use but were considered inaccessible, unresponsive, and inadequate due to insufficient resources, competence, and training. Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child. ‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act. Conclusions The participants were concerned about childhood alcohol and substance use, but the complexity and magnitude of the problem left them feeling incapacitated in responding. Relevant factors were identified on the community, institutional, and the government level, such as a lack of leadership in addressing it, a loss of mandate to interfere in child-rearing, inadequate services, weak legal structures, and missing government action. A strengthening of collective agency and public policy is necessary to prevent and address childhood alcohol and substance use.
The statistical performance of parametric control charts is questionable when the underlying process does not follow any specified probability distribution. Nonparametric control charts are the best substitute for this situation. On the other hand, the ranked set sampling technique is preferred over the simple random sampling technique because it reduces the variability of process parameters and improves the control chart’s performance. This study aims to offer a nonparametric double homogeneously weighted moving average control chart under Wilcoxon signed-rank test considering the ranked set sampling technique (regarded as NPDHWMA RSS ), to further enhance the process location monitoring. The proposed chart’s run-length performance is compared with competing control charts, such as DEWMA- X ¯ , NPDEWMA-SR, NPRDEWMA-SR, DHWMA, and NPHWMA RSS control charts. The comparison revealed that the proposed NPDHWMA RSS control chart outperformed the other competing control charts, particularly for small to moderate shifts in process location. Finally, a real-life application is also offered for quality practitioners to show the strength of the proposed control chart.
Background Stress among medical students is related to their academic lifespan; however, information on brain health among medical students from developing countries continues to be scarce. The objective of this study was to establish perceived academic stress levels, assess the ability to cope with stress, and investigate its effects on the visual reaction time (VRT), audio reaction time (ART), and tactile reaction time (TRT) in the somatosensory cortex among medical students of Uganda. Methods This was a cross-sectional study conducted among preclinical ( n = 88) and clinical ( n = 96) undergraduate medical students at Kampala International University Western Campus. A standard Perceived Stress Scale (PSS) was used to categorize stress into low, moderate, and severe while the ability to cope with stress was categorized into below average, average, above average, and superior stresscoper (SS). Data on reaction time were acquired through VRT, ART, and TRT using the catch-a-ruler experiment, and this was analyzed using SPSS version 20. Results This study shows that preclinical students are more stressed than clinical students (PSS prevalence for low stress = preclinical; clinical: 40, 60%). Moderate stress was 48.4 and 51.6% while high perceived stress was 75 and 25% among preclinical and clinical students. Among male and female students in preclinical years, higher TRT and VRT were found in clinical students showing that stress affects the tactile and visual cortical areas in the brain, although the VRT scores were only significantly ( P = 0.0123) poor in male students than female students in biomedical sciences. Also, highly stressed individuals had higher TRT and ART and low VRT. SS had high VRT and ART and low TRT in preclinical students, demonstrating the importance of the visual cortex in stress plasticity. Multiple regression showed a close relationship between PSS, ability to cope with stress, age, and educational level ( P < 0.05), demonstrating the importance of social and psychological support, especially in the biomedical sciences. Conclusion Preclinical students suffer more from stress and are poorer SS than clinical students. This strongly impairs their cortical regions in the brain, thus affecting their academic productivity.
Background: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda. Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files. Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%). Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.
Background: The Coronavirus pandemic has affected educational systems worldwide, leading to the widespread closure of schools in the affected countries with a phased reopening over time. The objective of this study was to determine the uptake, barriers, and determinants of e-learning among university students in Uganda and Nigeria following the COVID-19 disruption in 2020. Methodology: A total of 240 respondents comprising University students participated in this survey. A cross-sectional descriptive study used a self-administered structured online questionnaire using Google documents. Data were analyzed using IBM SPSS v.21 with statistical significance set at p<0.05. Results: The modal age group was 21–25 years at 128 (53.3%) participants, and uptake of e-learning was 159 (66.3%). The majority of respondents used a smartphone (98.8%) for the internet, with the WhatsApp platform (63.7%) as the most frequently used for e-learning. Barriers to e-learning, as self-reported by respondents, were the cost of internet services (82.1%), internet inaccessibility (68.8%), lack of institutional support (47.1%), and lack of training (40.8%). Determinants of e-learning were age (p<0.001) and sex (p=0.026). Conclusion: Two-thirds of university students had ever been taught online before the lockdown. Barriers to e-learning were mainly the cost of internet services and internet inaccessibility. Age and sex of respondents were determinants of e-learning use among University students. It is recommended that students be trained and facilitated by the Universities to adopt e-learning effectively. Governments in sub-Saharan Africa and the relevant sectors in the economy should improve the ICT infrastructure, and internet accessibility, and facilitate a reduction in the cost of services. Keywords: e-learning, university students, uptake, barriers, determinants, sub-Saharan Africa
Introduction In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations. Methods and analysis This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O’Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency. Ethics and dissemination The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people.
The hybrid exponentially weighted moving average (HEWMA) control chart is an enhanced version of the EWMA control chart that monitors the process parameters effectively. Similarly, the auxiliary information-based (AIB) EWMA control charts are very efficient for monitoring process parameters. The purpose of this paper is to propose two new control charts for the improved monitoring of process dispersion referred to as HEWMA AIB 1 and HEWMA AIB 2 control charts. A simulation study is carried out to assess the performance of the proposed HEWMA AIB 1 and HEWMA AIB 2 control charts. Average run length, extra quadratic loss, relative average run length, and performance comparison index are used to compare the performance of the proposed control charts against the existing counterparts. The comparisons reveal the superiority of the proposed control charts against other competing control charts, particularly for small to moderate shifts in the process dispersion. Finally, a real-life data set from the glass industry is used to demonstrate the practical implementation of the proposed control charts.
In Africa, Uganda is among the countries with a high number of babies (20,000 babies) born with sickle cell, contributing between 6.8% of the children born with sickle cell every year worldwide and approximately 4.5% of the children born with hemoglobinopathies worldwide. It is estimated that by 2050, sickle cell cases will increase by 30% if no intervention is put in place. To facilitate early detection of sickle cell anaemia, medical experts employ machine learning algorithms to detect sickle cell abnormality. Previous research revealed that algorithms for recognizing shape of a sickle cell from blood smear by fractional dimension, cannot detect sickle cells if applied on blood samples containing overlapping red blood cells. In this research, the authors developed an algorithm to detect overlapping red blood cells for sickle cell disease diagnosis. The algorithm uses canny edge and double threshold machine learning techniques and takes overlapping red blood cells images as inputs to detect if these cells are sickle cell anaemic. These images have a scale magnification of (200×, 400×, 650×) pixel taken using a microscope. The algorithm was tested on a total of 1000 digital images and the overall accuracy, sensitivity and specificity were 98.18%, 98.29% and 97.98% respectively.
Purpose: Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap, and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Participants and methods: We conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City. Results: The mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and child bearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples. Conclusion: Socially, psychologically and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported, and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related HIV serostatus disclosure.
Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.
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