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Zavaleta-Cortijo C, Ford JD, Galappaththi EK, Namanya DB, Nkwinti N, George B, Togarepi C, Akugre FA, Arotoma-Rojas I, Pickering K, Perera CD, Dharmasiri IP, Chicmana-Zapata V, Bezerra J, Nuwagira R, Nakwafila O, Amukugo H, Hangula M, Krishnakumar J, Marcelo K, Miranda JJ. Indigenous knowledge, community resilience, and health emergency preparedness. Lancet Planet Health 2023; 7:e641-e643. [PMID: 37558343 DOI: 10.1016/s2542-5196(23)00140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Carol Zavaleta-Cortijo
- Intercultural Citizenship and Indigenous Health Unit, School of Public Health and Administration, Cayetano Heredia University, Lima, 15102, Peru.
| | - James D Ford
- Priestley Centre for Climate Futures, University of Leeds, Leeds, UK
| | | | - Didacus B Namanya
- Ministry of Health, Uganda National Health Research Organisation, Entebbe, Uganda
| | - Nosipho Nkwinti
- Rhodes University Community Engagement, Makhanda, South Africa
| | | | - Cecil Togarepi
- Department of Animal Production, Agribusiness and Economics, University of Namibia, Windhoek, Namibia
| | - Francis A Akugre
- Institute for Environment and Sanitation Studies, University of Ghana, Accra, Ghana
| | | | - Kerrie Pickering
- Environmental Sustainability Research Centre, Brock University, St Catharines, ON, Canada
| | | | | | - Victoria Chicmana-Zapata
- Intercultural Citizenship and Indigenous Health Unit, School of Public Health and Administration, Cayetano Heredia University, Lima, 15102, Peru
| | - Joana Bezerra
- Rhodes University Community Engagement, Makhanda, South Africa
| | - Richard Nuwagira
- Ministry of Health, Uganda National Health Research Organisation, Entebbe, Uganda
| | - Olivia Nakwafila
- Department of Epidemiology and Biostatistics, University of Namibia, Windhoek, Namibia
| | - Hans Amukugo
- School of Nursing and Public Health, University of Namibia, Windhoek, Namibia
| | - Martha Hangula
- Department of Animal Production, Agribusiness and Economics, University of Namibia, Windhoek, Namibia
| | | | | | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bwire G, Sack DA, Lunkuse SM, Ongole F, Ngwa MC, Namanya DB, Nsungwa J, Aceng Ocero JR, Mwebesa HG, Muruta A, Nakinsige A, Kisakye A, Kalyebi P, Kemirembe J, Makumbi I, Kagirita A, Ampeire I, Mutegeki D, Matseketse D, Debes AK, Orach CG. Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda. Am J Trop Med Hyg 2023; 108:954-962. [PMID: 37037429 PMCID: PMC10160876 DOI: 10.4269/ajtmh.23-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023] Open
Abstract
In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then "relapsed." These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed "eliminated" from four of these 18 districts but then "relapsed." The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.
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Affiliation(s)
- Godfrey Bwire
- Department of Community Health, Ministry of Health Uganda, Kampala, Uganda
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stella M. Lunkuse
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Francis Ongole
- Department of National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Moise Chi Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jesca Nsungwa
- Department of Maternal and Child Health, Ministry of Health, Kampala, Uganda
| | | | - Henry G. Mwebesa
- Office of the Director General Health Service, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | - Anne Nakinsige
- Division of Public Health Emergency Preparedness and Response, Ministry of Health, Kampala, Uganda
| | | | - Peter Kalyebi
- Department of Environmental Health, Ministry of Health, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Atek Kagirita
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Immaculate Ampeire
- Uganda National Immunization Programme, Ministry of Health, Kampala, Uganda
| | - David Mutegeki
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | | | - Amanda Kay Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Pickering K, Galappaththi EK, Ford JD, Singh C, Zavaleta-Cortijo C, Hyams K, Miranda JJ, Arotoma-Rojas I, Togarepi C, Kaur H, Arvind J, Scanlon H, Namanya DB, Anza-Ramirez C. Indigenous peoples and the COVID-19 pandemic: a systematic scoping review. Environ Res Lett 2023; 18:033001. [PMID: 36798651 PMCID: PMC9923364 DOI: 10.1088/1748-9326/acb804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 02/01/2023] [Indexed: 05/06/2023]
Abstract
Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.
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Affiliation(s)
- Kerrie Pickering
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Eranga K Galappaththi
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States of America
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Chandni Singh
- School of Environment and Development, Indian Institute for Human Settlements, Bangalore, India
| | - Carol Zavaleta-Cortijo
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Keith Hyams
- Department of Politics and International Studies, University of Warwick, Coventry, United Kingdom
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ingrid Arotoma-Rojas
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Cecil Togarepi
- Department of Animal Production, Agribusiness and Economics, School of Agriculture and Fisheries Sciences, University of Namibia, Windhoek, Namibia
| | - Harpreet Kaur
- Indian Institute for Human Settlements, Bangalore, India
| | | | - Halena Scanlon
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Didacus B Namanya
- Ministry of Health, Uganda National Health Research Organisation, Entebbe, Uganda
| | - Cecilia Anza-Ramirez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Ost K, Berrang-Ford L, Bishop-Williams K, Charette M, Harper SL, Lwasa S, Namanya DB, Huang Y, Katz AB, Ebi K. Do socio-demographic factors modify the effect of weather on malaria in Kanungu District, Uganda? Malar J 2022; 21:98. [PMID: 35317835 PMCID: PMC8939205 DOI: 10.1186/s12936-022-04118-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is concern in the international community regarding the influence of climate change on weather variables and seasonality that, in part, determine the rates of malaria. This study examined the role of sociodemographic variables in modifying the association between temperature and malaria in Kanungu District (Southwest Uganda). Methods Hospital admissions data from Bwindi Community Hospital were combined with meteorological satellite data from 2011 to 2014. Descriptive statistics were used to describe the distribution of malaria admissions by age, sex, and ethnicity (i.e. Bakiga and Indigenous Batwa). To examine how sociodemographic variables modified the association between temperature and malaria admissions, this study used negative binomial regression stratified by age, sex, and ethnicity, and negative binomial regression models that examined interactions between temperature and age, sex, and ethnicity. Results Malaria admission incidence was 1.99 times greater among Batwa than Bakiga in hot temperature quartiles compared to cooler temperature quartiles, and that 6–12 year old children had a higher magnitude of association of malaria admissions with temperature compared to the reference category of 0–5 years old (IRR = 2.07 (1.40, 3.07)). Discussion Results indicate that socio-demographic variables may modify the association between temperature and malaria. In some cases, such as age, the weather-malaria association in sub-populations with the highest incidence of malaria in standard models differed from those most sensitive to temperature as found in these stratified models. Conclusion The effect modification approach used herein can be used to improve understanding of how changes in weather resulting from climate change might shift social gradients in health. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04118-5.
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Affiliation(s)
- Katarina Ost
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
| | | | - Margot Charette
- Department of Geography, McGill University, Montreal, Canada
| | | | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Didacus B Namanya
- Indigenous Health Adaptation To Climate Change, Research Team, Edmonton, Canada.,Uganda Martyrs University, Kampala, Uganda.,Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Yi Huang
- Department of Atmospheric and Ocean Sciences, McGill University, Montreal, Canada
| | - Aaron B Katz
- Department of Health Services, University of Washington, Seattle, USA
| | | | | | - Kristie Ebi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Priestley International Centre for Climate, University of Leeds, Leeds, UK.,School of Interdisciplinary Science, McMaster University, Hamilton, Canada.,Department of Geography, McGill University, Montreal, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,Department of Geography, Geo-Informatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda.,Indigenous Health Adaptation To Climate Change, Research Team, Edmonton, Canada.,Uganda Martyrs University, Kampala, Uganda.,Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda.,Department of Atmospheric and Ocean Sciences, McGill University, Montreal, Canada.,Department of Health Services, University of Washington, Seattle, USA.,Bwindi Community Hospital, Kanungu, Uganda.,Center for Health and the Global Environment, University of Washington, Seattle, USA
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Steele V, Patterson K, Berrang-Ford L, King N, Kulkarni M, Lwasa S, Namanya DB, Harper SL. Antenatal Care Research in East Africa During the Millennium Development Goals Initiative: A Scoping Review. Matern Child Health J 2022; 26:469-480. [PMID: 35028892 DOI: 10.1007/s10995-021-03355-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. METHODS Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. RESULTS Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. DISCUSSION These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient-provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa.
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Affiliation(s)
- Vivienne Steele
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Lea Berrang-Ford
- Priestley Centre for Climate Change, Leeds University, Leeds, LS2 9JT, York, UK
| | - Nia King
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3L4, Canada.
| | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, P.O. Box 7062, Kampala, Uganda
| | | | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada. .,School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 1C9, Canada.
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Scarpa G, Berrang-Ford L, Twesigomwe S, Kakwangire P, Galazoula M, Zavaleta-Cortijo C, Patterson K, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Cade JE. Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda. PLOS Glob Public Health 2022; 2:e0000144. [PMID: 36962281 PMCID: PMC10021580 DOI: 10.1371/journal.pgph.0000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
Abstract
Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, Leeds, United Kingdom
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, Leeds, United Kingdom
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Maria Galazoula
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Carol Zavaleta-Cortijo
- Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Ministry of Health, Kampala, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, Rotterdam, Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | | | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
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Scarpa G, Berrang-Ford L, Twesigomwe S, Kakwangire P, Peters R, Zavaleta-Cortijo C, Patterson K, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Harris-Fry H, Cade JE. A Community-Based Approach to Integrating Socio, Cultural and Environmental Contexts in the Development of a Food Database for Indigenous and Rural Populations: The Case of the Batwa and Bakiga in South-Western Uganda. Nutrients 2021; 13:nu13103503. [PMID: 34684504 PMCID: PMC8537349 DOI: 10.3390/nu13103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Comprehensive food lists and databases are a critical input for programs aiming to alleviate undernutrition. However, standard methods for developing them may produce databases that are irrelevant for marginalised groups where nutritional needs are highest. Our study provides a method for identifying critical contextual information required to build relevant food lists for Indigenous populations. For our study, we used mixed-methods study design with a community-based approach. Between July and October 2019, we interviewed 74 participants among Batwa and Bakiga communities in south-western Uganda. We conducted focus groups discussions (FGDs), individual dietary surveys and markets and shops assessment. Locally validated information on foods consumed among Indigenous populations can provide results that differ from foods listed in the national food composition tables; in fact, the construction of food lists is influenced by multiple factors such as food culture and meaning of food, environmental changes, dietary transition, and social context. Without using a community-based approach to understanding socio-environmental contexts, we would have missed 33 commonly consumed recipes and foods, and we would not have known the variety of ingredients’ quantity in each recipe, and traditional foraged foods. The food culture, food systems and nutrition of Indigenous and vulnerable communities are unique, and need to be considered when developing food lists.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, Leeds LS2 9JT, UK;
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
- Correspondence: ; +44-74-15966075
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, Leeds LS2 9JT, UK;
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Remco Peters
- School for Policy Studies, University of Bristol, Bristol BS8 1TH, UK;
| | - Carol Zavaleta-Cortijo
- Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, San Martín de Porres 15102, Peru;
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Didacus B. Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
- Ministry of Health, Lourdel Road, Nakasero P.O. Box 7272, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, 3072 Rotterdam, The Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda; (S.T.); (P.K.); (D.B.N.); (S.L.); (E.N.); (C.K.)
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK;
| | - Janet E. Cade
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
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Brubacher LJ, Berrang-Ford L, Clark S, Patterson K, Lwasa S, Namanya DB, Twesigomwe S, Harper SL. 'We don't use the same ways to treat the illness:' A qualitative study of heterogeneity in health-seeking behaviour for acute gastrointestinal illness among the Ugandan Batwa. Glob Public Health 2021; 17:1757-1772. [PMID: 34097579 DOI: 10.1080/17441692.2021.1937273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa.
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Affiliation(s)
| | | | - Sierra Clark
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, Kampala, Uganda
| | - Didacus B Namanya
- Ugandan Ministry of Health, Kampala, Uganda.,Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
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- School of Public Health, University of Alberta, Edmonton, Canada
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Scarpa G, Berrang-Ford L, Bawajeeh AO, Twesigomwe S, Kakwangire P, Peters R, Beer S, Williams G, Zavaleta-Cortijo C, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Rippin H, Cade JE. Developing an online food composition database for an Indigenous population in south-western Uganda. Public Health Nutr 2021; 24:2455-2464. [PMID: 33843552 PMCID: PMC8145457 DOI: 10.1017/s1368980021001397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda. DESIGN Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; and translation into relevant local languages. SETTING Kanungu District, south-western Uganda. PARTICIPANTS Seventy-four participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database. RESULTS We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56 % (n 82 items) of the items were already available in the myfood24 database, while 25 % (n 37 items) were found in existing Ugandan and Tanzanian food databases, 18 % (n 27 items) came from generated recipes and 1 % (n 2 items) from food packaging labels. CONCLUSION Locally relevant food databases are sparse for African Indigenous communities. Here, we created a tool that can be used for assessing food intake and for tracking undernutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, LS2 9JT, UK
- School of Food Science and Nutrition, University of Leeds, UK
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, LS2 9JT, UK
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Areej O Bawajeeh
- School of Food Science and Nutrition, University of Leeds, UK
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Remco Peters
- Leeds Institute of Health Sciences, University of Leeds, UK
| | | | | | | | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
- Ministry of Health, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, Rotterdam, Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Uganda
| | - Holly Rippin
- WHO European Office for Prevention and Control of Non-communicable Diseases (NCD Office), Moscow, Russian Federation
| | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, UK
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10
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Bryson JM, Patterson K, Berrang-Ford L, Lwasa S, Namanya DB, Twesigomwe S, Kesande C, Ford JD, Harper SL. Seasonality, climate change, and food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda: Implications for maternal-infant health. PLoS One 2021; 16:e0247198. [PMID: 33760848 PMCID: PMC7990176 DOI: 10.1371/journal.pone.0247198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/02/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women's perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. METHODS Using a community-based research approach, we conducted eight focus group discussions-four in Indigenous Batwa communities and four in non-Indigenous communities-in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. RESULTS Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. CONCLUSIONS Programs promoting women's adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate.
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Affiliation(s)
- Julia M. Bryson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B. Namanya
- Department of Community Health, Ugandan Ministry of Health, Kampala, Uganda
| | | | | | - James D. Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | | | - Sherilee L. Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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11
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Patterson K, Berrang-Ford L, Lwasa S, Namanya DB, Ford J, Research Team IHACC, Harper SL. Food security variation among Indigenous communities in South-western Uganda. Journal of Hunger & Environmental Nutrition 2021. [DOI: 10.1080/19320248.2020.1852146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Kaitlin Patterson
- Dept. Of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Dept. Of Geography Geoinformatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B. Namanya
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Ugandan Ministry of Health, Kampala, Uganda
| | - James Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - IHACC Research Team
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sherilee L. Harper
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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12
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Zavaleta-Cortijo C, Ford JD, Arotoma-Rojas I, Lwasa S, Lancha-Rucoba G, García PJ, Miranda JJ, Namanya DB, New M, Wright CJ, Berrang-Ford L, Harper SL. Climate change and COVID-19: reinforcing Indigenous food systems. Lancet Planet Health 2020; 4:e381-e382. [PMID: 32777205 PMCID: PMC7413660 DOI: 10.1016/s2542-5196(20)30173-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 05/18/2023]
Affiliation(s)
- Carol Zavaleta-Cortijo
- Universidad Peruana Cayetano Heredia, Urbanización Ingeniería, San Martín de Porres, Lima 31, Peru.
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
| | | | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | | | - Patricia J García
- Universidad Peruana Cayetano Heredia, Urbanización Ingeniería, San Martín de Porres, Lima 31, Peru
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Urbanización Ingeniería, San Martín de Porres, Lima 31, Peru
| | | | - Mark New
- African Climate Development Initiative, University of Cape Town, Rondebosch, South Africa; School of International Development, University of East Anglia, Norwich, UK
| | - Carlee J Wright
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
| | - Sherilee L Harper
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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13
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Bryson JM, Bishop-Williams KE, Berrang-Ford L, Nunez EC, Lwasa S, Namanya DB, Indigenous Health Adaptation To Climate Change Research Team, Harper SL. Neglected Tropical Diseases in the Context of Climate Change in East Africa: A Systematic Scoping Review. Am J Trop Med Hyg 2020; 102:1443-1454. [PMID: 32228798 DOI: 10.4269/ajtmh.19-0380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
East Africa is highly affected by neglected tropical diseases (NTDs), which are projected to be exacerbated by climate change. Consequently, understanding what research has been conducted and what knowledge gaps remain regarding NTDs and climate change is crucial to informing public health interventions and climate change adaptation. We conducted a systematic scoping review to describe the extent, range, and nature of publications examining relationships between NTDs and climatic factors in East Africa. We collated all relevant English and French publications indexed in PubMed®, Web of Science™ Core Collection, and CAB Direct© databases published prior to 2019. Ninety-six publications were included for review. Kenya, Tanzania, and Ethiopia had high rates of publication, whereas countries in the Western Indian Ocean region were underrepresented. Most publications focused on schistosomiasis (n = 28, 29.2%), soil-transmitted helminthiases (n = 16, 16.7%), or human African trypanosomiasis (n = 14, 14.6%). Precipitation (n = 91, 94.8%) and temperature (n = 54, 56.3%) were frequently investigated climatic factors, whereas consideration of droughts (n = 10, 10.4%) and floods (n = 4, 4.2%) was not prominent. Publications reporting on associations between NTDs and changing climate were increasing over time. There was a decrease in the reporting of Indigenous identity and age factors over time. Overall, there were substantial knowledge gaps for several countries and for many NTDs. To better understand NTDs in the context of a changing climate, it would be helpful to increase research on underrepresented diseases and regions, consider demographic and social factors in research, and characterize how these factors modify the effects of climatic variables on NTDs in East Africa.
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Affiliation(s)
- Julia M Bryson
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.,Department of Population Medicine, University of Guelph, Guelph, Canada
| | | | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Emily C Nunez
- Department of Epidemiology and Biostatistics, Western University, London, Canada.,Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B Namanya
- Department of Community Health, Ugandan Ministry of Health, Kampala, Uganda
| | | | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, Guelph, Canada.,School of Public Health, University of Alberta, Edmonton, Canada
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14
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Albutt K, Drevin G, Yorlets RR, Svensson E, Namanya DB, Shrime MG, Kayima P. 'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda. PLoS One 2019; 14:e0224215. [PMID: 31648234 PMCID: PMC6812829 DOI: 10.1371/journal.pone.0224215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. Methods A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. Results Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. Conclusion As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.
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Affiliation(s)
- Katherine Albutt
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, United States of America
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Gustaf Drevin
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Rachel R. Yorlets
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, United States of America
| | - Emma Svensson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Didacus B. Namanya
- Ministry of Health (MOH), Kampala, Uganda
- Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Mark G. Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- St. Mary's Lacor Hospital, Gulu, Uganda
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15
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Tompkins AM, Colón‐González FJ, Di Giuseppe F, Namanya DB. Dynamical Malaria Forecasts Are Skillful at Regional and Local Scales in Uganda up to 4 Months Ahead. Geohealth 2019; 3:58-66. [PMID: 32159031 PMCID: PMC7038892 DOI: 10.1029/2018gh000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/02/2018] [Accepted: 01/04/2019] [Indexed: 06/10/2023]
Abstract
Malaria forecasts from dynamical systems have never been attempted at the health district or local clinic catchment scale, and so their usefulness for public health preparedness and response at the local level is fundamentally unknown. A pilot preoperational forecasting system is introduced in which the European Centre for Medium Range Weather Forecasts ensemble prediction system and seasonal climate forecasts of temperature and rainfall are used to drive the uncalibrated dynamical malaria model VECTRI to predict anomalies in transmission intensity 4 months ahead. It is demonstrated that the system has statistically significant skill at a number of sentinel sites in Uganda with high-quality data. Skill is also found at approximately 50% of the Ugandan health districts despite inherent uncertainties of unconfirmed health reports. A cost-loss economic analysis at three example sentinel sites indicates that the forecast system can have a positive economic benefit across a broad range of intermediate cost-loss ratios and frequency of transmission anomalies. We argue that such an analysis is a necessary first step in the attempt to translate climate-driven malaria information to policy-relevant decisions.
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Affiliation(s)
- Adrian M. Tompkins
- Earth System PhysicsAbdus Salam International Centre for Theoretical PhysicsTriesteItaly
| | - Felipe J. Colón‐González
- School of Environmental SciencesUniversity of East AngliaNorwichUK
- Tyndall Centre for Climate Change ResearchUniversity of East AngliaNorwichUK
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Albutt K, Punchak M, Kayima P, Namanya DB, Shrime MG. Operative volume and surgical case distribution in Uganda's public sector: a stratified randomized evaluation of nationwide surgical capacity. BMC Health Serv Res 2019; 19:104. [PMID: 30728037 PMCID: PMC6366061 DOI: 10.1186/s12913-019-3920-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023] Open
Abstract
Background Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. Methods A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda’s population. Results A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics. Conclusion An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Peter Kayima
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health, Kampala, Uganda.,Uganda Martyrs University, Nkozi, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Albutt K, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators. World J Surg 2018; 42:2303-2313. [PMID: 29368021 DOI: 10.1007/s00268-018-4485-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda. METHODS A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS This study captured information for public hospitals serving 64.0% of Uganda's population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized. CONCLUSION The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health (MOH), Kampala, Uganda.,Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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18
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Albutt K, Yorlets RR, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda. PLoS One 2018; 13:e0195986. [PMID: 29664956 PMCID: PMC5903624 DOI: 10.1371/journal.pone.0195986] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis. RESULTS The Ugandan public health care sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Hospital staff reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public to provide surgical care to those most in need. CONCLUSION Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda's surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Rachel R. Yorlets
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B. Namanya
- Ministry of Health (MOH), Kampala, Uganda
- Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Mark G. Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Boston, Massachusetts, United States of America
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Smith ER, Vissoci JRN, Rocha TAH, Tran TM, Fuller AT, Butler EK, de Andrade L, Makumbi F, Luboga S, Muhumuza C, Namanya DB, Chipman JG, Galukande M, Haglund MM. Geospatial analysis of unmet pediatric surgical need in Uganda. J Pediatr Surg 2017; 52:1691-1698. [PMID: 28427854 DOI: 10.1016/j.jpedsurg.2017.03.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/21/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), an estimated 85% of children do not have access to surgical care. The objective of the current study was to determine the geographic distribution of surgical conditions among children throughout Uganda. METHODS Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 2176 children in 2315 households throughout Uganda. At the district level, we determined the spatial autocorrelation of surgical need with geographic access to surgical centers variable. FINDINGS The highest average distance to a surgical center was found in the northern region at 14.97km (95% CI: 11.29km-16.89km). Younger children less than five years old had a higher prevalence of unmet surgical need in all four regions than their older counterparts. The spatial regression model showed that distance to surgical center and care availability were the main spatial predictors of unmet surgical need. INTERPRETATION We found differences in unmet surgical need by region and age group of the children, which could serve as priority areas for focused interventions to alleviate the burden. Future studies could be conducted in the northern regions to develop targeted interventions aimed at increasing pediatric surgical care in the areas of most need. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emily R Smith
- Duke University Global Health Institute, Durham, NC, USA; Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA.
| | - Joao Ricardo Nickenig Vissoci
- Duke University Global Health Institute, Durham, NC, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Tu M Tran
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA
| | - Anthony T Fuller
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA
| | - Elissa K Butler
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Luciano de Andrade
- State University of West of Parana, Unioeste, Foz do Iguaçu, Brazil; Public Health Research Group, Unioeste, Toledo, Brazil
| | | | - Samuel Luboga
- Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda
| | | | | | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael M Haglund
- Duke University Global Health Institute, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University Division of Global Neurosurgery and Neurology, Durham, NC, USA
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Kulkarni MA, Garrod G, Berrang-Ford L, Ssewanyana I, Harper SL, Baraheberwa N, Donnelly B, Patterson K, Namanya DB, Lwasa S, Drakeley C. Examination of Antibody Responses as a Measure of Exposure to Malaria in the Indigenous Batwa and Their Non-Indigenous Neighbors in Southwestern Uganda. Am J Trop Med Hyg 2016; 96:330-334. [PMID: 27895271 DOI: 10.4269/ajtmh.16-0559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/20/2016] [Indexed: 01/27/2023] Open
Abstract
Understanding variations in malaria transmission and exposure is critical to identify populations at risk and enable better targeting of interventions. The indigenous Batwa of southwestern Uganda have a disproportionate burden of malaria infection compared with their non-indigenous neighbors. To better understand the individual- and community-level determinants of malaria exposure, a seroepidemiological study was conducted in 10 local council cells in Kanungu District, Uganda, in April 2014. The Batwa had twice the odds of being seropositive to two Plasmodium falciparum-specific antigens, apical membrane antigen-1 and merozoite surface protein-119, compared with the non-indigenous Bakiga (odds ratio = 2.08, 95% confidence interval = 1.51-2.88). This trend was found irrespective of altitude level and after controlling for cell location. Seroconversion rates in the Batwa were more than twice those observed in the Bakiga. For the Batwa, multiple factors may be associated with higher exposure to malaria and antibody levels relative to their non-indigenous neighbors.
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Affiliation(s)
- Manisha A Kulkarni
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
| | - Gala Garrod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lea Berrang-Ford
- Department of Geography, McGill University, Montreal, Canada.,Indigenous Health Adaptation to Climate Change (IHACC) Research Team
| | - Isaac Ssewanyana
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Sherilee L Harper
- Indigenous Health Adaptation to Climate Change (IHACC) Research Team.,Department of Population Medicine, University of Guelph, Guelph, Canada
| | | | | | - Kaitlin Patterson
- Department of Geography, McGill University, Montreal, Canada.,Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change (IHACC) Research Team.,Department of Population Medicine, University of Guelph, Guelph, Canada.,Infectious Diseases Research Collaboration, Kampala, Uganda.,Ministry of Health, Kampala, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change (IHACC) Research Team.,Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University, Kampala, Uganda
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Donnelly B, Berrang-Ford L, Labbé J, Twesigomwe S, Lwasa S, Namanya DB, Harper SL, Kulkarni M, Ross NA, Michel P. Plasmodium falciparum malaria parasitaemia among indigenous Batwa and non-indigenous communities of Kanungu district, Uganda. Malar J 2016; 15:254. [PMID: 27146298 PMCID: PMC4855715 DOI: 10.1186/s12936-016-1299-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The indigenous Batwa of southwestern Uganda are among the most highly impoverished populations in Uganda, yet there is negligible research on the prevalence of malaria in this population. Plasmodium falciparum malaria parasitaemia prevalence was estimated in an indigenous Batwa and a non-indigenous neighbouring population, and an exploration of modifiable risk factors was carried out to identify potential entry points for intervention. Additionally, evidence of zooprophylaxis was assessed, hypothesizing that livestock ownership may play a role in malaria risk. METHODS Two cross-sectional surveys of Batwa and non-Batwa communities were carried out in Kanungu District, Uganda in July 2013 and April 2014 based on a census of adult Batwa and a two-stage systematic random sample of adult non-Batwa in ten Local Councils where Batwa settlements are located. A community-based questionnaire and antigen rapid diagnostic test for P. falciparum were carried out in the cross-sectional health surveys. A multivariable logistic regression model was built to identify risk factors associated with positive malaria diagnostic test. A subset analysis of livestock owners tested for zooprophylaxis. RESULTS Batwa experienced higher prevalence of malaria parasitaemia than non-Batwa (9.35 versus 4.45 %, respectively) with over twice the odds of infection (OR 2.21, 95 % CI 1.23-3.98). Extreme poverty (OR 1.96, 95 % CI 0.98-3.94) and having an iron sheet roof (OR 2.54, 95 % CI 0.96-6.72) increased the odds of infection in both Batwa and non-Batwa. Controlling for ethnicity, wealth, and bed net ownership, keeping animals inside the home at night decreased the odds of parasitaemia among livestock owners (OR 0.29, 95 % CI 0.09-0.94). CONCLUSION A health disparity exists between indigenous Batwa and non-indigenous community members with Batwa having higher prevalence of malaria relative to non-Batwa. Poverty was associated with increased odds of malaria infection for both groups. Findings suggest that open eaves and gaps in housing materials associated with iron sheet roofing represent a modifiable risk factor for malaria, and may facilitate mosquito house entry; larger sample sizes will be required to confirm this finding. Evidence for possible zooprophylaxis was observed among livestock owners in this population for those who sheltered animals inside the home at night.
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Affiliation(s)
- Blánaid Donnelly
- />Department of Geography, McGill University, Burnside Hall Building, 805 Sherbrooke St West, Montreal, QC H3A 0B9 Canada
| | - Lea Berrang-Ford
- />Department of Geography, McGill University, Burnside Hall Building, 805 Sherbrooke St West, Montreal, QC H3A 0B9 Canada
| | - Jolène Labbé
- />Department of Geography, McGill University, Burnside Hall Building, 805 Sherbrooke St West, Montreal, QC H3A 0B9 Canada
| | | | - Shuaib Lwasa
- />Department of Geography, Geoinformatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, CAES, Makerere University, P.O Box 7062, Kampala, Uganda
| | | | - Sherilee L. Harper
- />Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1 Canada
| | - Manisha Kulkarni
- />School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 600 Peter Morand Cres., 301E, Ottawa, ON K1H 8M5 Canada
| | - Nancy A. Ross
- />Department of Geography, McGill University, Burnside Hall Building, 805 Sherbrooke St West, Montreal, QC H3A 0B9 Canada
| | - IHACC Research Team
- />Department of Geography, McGill University, Burnside Hall Building, 805 Sherbrooke St West, Montreal, QC H3A 0B9 Canada
- />Batwa Development Program, Buhoma, Kanungu District, Uganda
- />Department of Geography, Geoinformatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, CAES, Makerere University, P.O Box 7062, Kampala, Uganda
- />Ministry of Health, Plot 6 Lourdel Rd, P.O Box 7272, Kampala, Uganda
- />Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1 Canada
- />School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 600 Peter Morand Cres., 301E, Ottawa, ON K1H 8M5 Canada
- />Office of the Chief Science Officer, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON K1A 0K9 Canada
| | - Pascal Michel
- />Office of the Chief Science Officer, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON K1A 0K9 Canada
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