Background: Ebola virus disease (EVD) is a rare and deadly infectious hemorrhagic fever disease. Four of the 6 known Ebola virus species can cause human disease. Since 1976, EVD outbreaks have been recorded sporadically in East, Central, and West Africa. Uganda has experienced 6 documented outbreaks of EVD since 2000 that can be attributed to 3 species of Ebola viruses (Zaire, Sudan, and Bundibugyo). Despite substantial advances in clinical management, the case fatality ratio for EVD remains high, reaching more than 60% for the Zaire Ebola virus in 2018–2020. Methods. The study followed a descriptive qualitative study design. Data were collected using an interviewer-administered questionnaire with both closed and open-ended questions. Data were analyzed using ATLAS Pro. Results: Our results illustrate the lack of health education in the community among the different categories of people and this comes from an emic perspective (country). We identified 4 high-level themes and 19 subthemes, (1) Knowledge of Ebola Virus Disease, (2) Prevention of EVD in the community, (3) Preparedness for Ebola Virus Disease and (4) community response to Ebola Virus Disease and the final thematic area (4) which included giving first aid, using traditional medicines, and approaching a health facility among others. Conclusions: With all the available information in relation to the previous outbreaks in Uganda, it is surprising that less effort was made this time round to take local sensibilities and culture into account among other social factors contributing to the poor practices of masses toward the Ebola Virus Disease, preparedness, prevention and response.

Abstract Introduction Ebola virus disease (EVD) is a severe hemorrhagic disease caused by the Ebola Virus. The EVD is highly infectious with a high fatality rate. Uganda has experienced multiple Ebola outbreaks. To address the need for renewed engagement between the government and community, this study aimed to assess knowledge, attitudes, and preventive practices towards EVD in different regions of Uganda. Objectives To determine the level of knowledge, attitude and prevention practices towards the Ebola Virus in the different regions of Uganda. Methods A descriptive community-based cross-sectional design was conducted. The study implored a quantitative approach. Participants were randomly assessed of their knowledge, attitude and prevention of the EVD. Data was analyzed with Stata 15. Results The study enrolled 737 community members. The majority of the community members demonstrated good knowledge levels of EVD. Participants who obtained information from social media had higher knowledge levels across the respective study regions of the country; Mbale (OR = 9.8, CI: 2.2–43.5, p = 0.03) and Mbarara (OR = 8.6, CI: 4.0-18.45, P = 0.001) cities. However, in Lira city, the association between social media and knowledge levels was not statistically significant. The use of television as an information source significantly positively affected knowledge levels in Mbale city, Eastern region (OR = 4.0, CI: 1.6–10.1, P = 0.004). Health workers exhibited significantly higher knowledge compared to the others (OR = 8.9, CI: 1.1–69.6, P = 0.038) Knowing how to approach a suspected case, had a significant level in Mbale city, Eastern region (OR = 8.6, CI: 2.4–30.4, P = 0.001). Similarly, knowing how to use PPE was associated with higher levels in Lira city north Eastern region (OR = 2.0, CI: 1.1–3.3) P = 0.021. The majority both females (94.4%, 91.7% and males (88.9%, 90%) agreed to the isolation of the case and the family respectively avoid the risk of infection and death, which also led to a discriminatory attitude towards survivors and a distrust of EVD treatment. All participants 74.3% and 76.9% female and male perceived the Ebola treatment as very expensive. Conclusion Our results are in tandem with previous reports. we found that urban communities are more knowledgeable and have better attitudes towards pandemic outbreaks, though this varies from region to region. Public perceptions, community engagement and social media may be useful tools in mapping knowledge and awareness strategies for disease outbreaks.

OBJECTIVE:To explore the knowledge and attitude towards sickle cell disease (SCD) among care givers of paediatric sickle cell patients at Mbale regional referral hospital in Eastern Uganda.METHODS:A cross sectional study was conducted at Mbale regional referral hospital. We used simple random sampling technique to recruit participants from among the care givers of pediatric sickle cell patients admitted at the hospital, administered questionnaires and conducted multivariable logistic regression to establish the association between the different factors.RESULTS:372 respondents participated in the study, 82.26% of which were female. 57.80% of the respondents had ever heard of SCD/SCA. 36.02% were willing to stay in a relationship with their partner despite the risk of having a child with SCD/SCA. A multivariate analysis revealed that variables; "number of children", "children with sickle cell can cope with life" and "willing to stay in a relationship despite the risk of a having a child with sickle cell" were statistically significant.CONCLUSION:There was a high level of general awareness about SCD/SCA but comprehensive knowledge about its cause and prevention was low and the majority did not find a reason as to why it should influence their marital decisions. Inclusion of SCD/SCA in existing health education programs is highly recommended.

Aims: Soil Transmitted Helminths and Plasmodium infections are ubiquitous within the tropical and subtropical regions.  However, the extent and consequences of Helminthic and Plasmodium infections and co-infections - geographical distributions are not fully understood. This study aimed determining the geographical distribution of these parasites. Study Design: Cross Sectional Survey. Place and Duration of Study: The survey was conducted in Bugesera District, Eastern Rwanda, between May and December 2020. Methodology: The survey was conducted among children between ages 5 and 18 years, across 21 randomly selected primary schools. Stool samples were collected and screened for soil transmitted helminths using Kato-Katz, while finger-prick blood samples were examined under the microscope to determine Plasmodium infection. Results: P. falciparum was common throughout the study area, with highest prevalence in provinces of   Nyiragiseke (22.78%) and Shami (18.99%).  The geographical distribution of STH was variably dominated by A.  lumbricoides.  The co-infection exhibited geographical variation consistent with the A. lumbricoides prevalence. Conclusion: The un-proportional distribution of and higher prevalence of P. falciparum in the provinces of Nyiragiseke (22.78%) and Shami (18.99%) calls for the review of the control methods, strategies and mechanisms to address the unique conditions and activities in each province. The variably dominant A.  lumbricoides- Plasmodium co-infection calls for targeted control strategies and mechanisms for these parasites since this association has been attributed to severe malaria.

Soil Transmitted Helminths and Plasmodium infections are ubiquitous with morbidity and mortality within the tropical and subtropical regions. However, the extent and consequences of STH-Plasmodium co-infection at different spatial scales are poorly understood. This study aimed at determining the prevalence of Soil Transmitted Helminths and Plasmodium coinfection, and, the impact thereof among school children in Bugesera District of Eastern Rwanda. Study Design: Cross Sectional Survey Place and Duration of Study: The survey was conducted in Bugesera district, Eastern Rwanda, between May and December 2020. Methodology: The survey was conducted among children between ages 5 and 18 years, across 21 randomly selected primary schools. Stool samples were collected and screened for soil transmitted helminths using Kato-Katz, while finger-prick blood samples were examined under the microscope to determine Plasmodium infection. Results: Overall the prevalence of A. lumbricoides, T. trichiura, Hookworm and P. falciparum was 4.43%, 0.76%, 0.16% and 3.15% respectively. On the other hand, 36.15% were co-infected with A. lumbricoides and P. falciparum. Surprisingly, the coinfection was higher 41.79%, (P<0.001) in girls than the overall coinfection prevalence. Conclusion: Helminthiasis and malaria remain dominant, in spite of the continuing and tremendous national control programs. The strikingly surprising higher prevalence of A. lumbricoides-P. falciparum co-infection in girls calls for additional investigations.

Objective To determine the uptake, knowledge level and attitude towards sickle cell trait screening in students aged 18 to 35 years in a Ugandan university. Methods This was a university-based, cross-sectional study of students aged 18 to 35 years who were students at the Busitema University Faculty of Health Sciences. We used a simple random sampling technique to recruit participants. We conducted multivariable logistic regression to establish the association between factors such as age, year of study, marital status and uptake of sickle cell trait screening (SCTS) services. Results A total of 315 students participated in the study. The uptake rate of SCTS was 24.4%. The knowledge level regarding sickle cell disease/SCTS was 93.7%, and 73.3% of respondents had a positive attitude towards SCTS, with a mean score of 23.32 ± 5.84. A multivariate analysis showed that those aged 25 to 29 years were 7.8 times more likely to have SCTS, while married respondents were 1.3 times more likely to be screened. Conclusion The uptake of SCTS services was low relative to the total number of participants recruited in this study. Therefore, the uptake of SCTS needs to be encouraged in students at universities.

The Corona Virus Disease - 19 (COVID-19) pandemic is one of the most devastating events in the history of human health for the last several decades. Our analysis aimed at a cross-section of events, models and theories surrounding the pandemic. These included mathematical modeling, lockdown diaries, Standard Operating Procedures (SOPs), religious approaches, and the 5G network theory among others. The Global economies have been checked negatively by the pandemic. The COVID - 19 – pandemic challenge, primed many innovations and adaptations for survival. Use of phones and ICT as well as proper handling of asymptomatic victims was necessary as it resolves the anxiety issue of the infection spread. Leadership from the President to the lowers levels was critical for the management of COVID -19 challenge in Uganda.

Purpose of review Primary immunodeficiencies (PIDs) lately referred to as inborn errors of immunity, are consequences of mutations that affect the immune integrity and function. Globally, severe PIDs are more common in infants and are fatal if not timely – appropriately diagnosed and managed. PID programmes and policies vary from country to country. The purpose of this review is to highlight PIDs initiatives and activities in Uganda with a focus on challenges and ideas for diagnosis. Recent findings It is now established that appropriate PID diagnosis leads to best treatment options for quality of life for the patients. However, there are still global disparities with these great milestones. PID awareness remains a fundamental global challenge. Autoimmune cytopenia, haemogram and peripheral blood film may be critical PIDs diagnostic markers and tests, respectively, for low-income countries. Summary As awareness is a master key to appropriate PID diagnosis and management, there is a need to design multidisciplinary and sustainable strategies. Complete blood counts and immunoglobulin profile tests may be less expensive alternatives for early diagnosis of PIDs in Uganda and other low-income countries.

Aims: To determine the effect of the leaf extract of Bidens pilosa on the rate of haemostasis and validate its traditional use application to fresh wounds. Study Design: Experimental Place and Duration of Study: The study was conducted at the Biology Department, Faculty of Science and Education, Busitema University and Nagongera Health Center IV laboratory between April and May 2019. Methodology: Different concentrations of the extract were applied to blood samples. Whole venous blood was collected by vein puncture in heparin tubes. The rate of clotting in presence and absence of the extract was determined. The experiment was replicated. Results: Increase in the concentration of the extract decreased the rate of haemostasis. Statistical analysis with a two-way ANOVA was significant, P = 0.02 at a 95% CI. Conclusion: High concentration Bidens pilosa leaf extract decreases the rate of haemostasis but may have other healing activities attributed to its historical and traditional use and application to fresh wounds.

BackgroundThe prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia is a condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body.MethodsThis was a cross sectional study conducted among 476-refugee camp school children. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration.ResultsThe overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual co-infection with Plasmodium falciparum+Taenia sp. compared to single parasitic infection (Odds=14.13, P=0.019). Co-infection with Plasmodium falciparum+Taenia spp, was a strong predictor of Malaria and anaemia.ConclusionThis study shows that Plasmodium falciparum and Taenia spp. co-infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the co-infections in the study area and similar settlements.

Despite the public health significance of anaemia in African children, its broader and often preventable risk factors remain largely under described. This study investigated, for the first time, the prevalence of childhood anaemia and its risk factors in an urban setting in Uganda.

IL-10-producing T cells have been shown to inhibit Ag-specific CD8+ T cell responses, and may play a role in the immune dysregulation observed in HIV-1 infection. We characterized the Gag-specific IL-10 responses by CD8+ T cells in HIV-1-positive volunteers from Uganda. HIV-specific IL-10 responses were detected in 32 of 61 (52.4%) antiretroviral naive and 2 of 15 (13.3%) volunteers with a complete virologic response on antiretroviral therapy (< 400 copies/ml). The frequency of HIV-specific IL-10-positive cells was significantly higher in volunteers with advanced disease (CD4+ T cell count <200 cells/mm3; p = 0.0004), and correlated positively with plasma HIV RNA (r = 0.43, p = 0.0004). Interestingly, the frequency of Gag-specific CD107a/b-, but not IFN-gamma-, positive cells was significantly lower in individuals with detectable IL-10-positive CD8+ T cells (p = 0.004). Gag-specific IL-10-positive CD8+ T cells demonstrated a pattern of surface memory marker expression that is distinct compared with CD107a/b- and IFN-gamma-positive CD8+ T cell populations (p < 0.0001). Our study describes a distinct population of IL-10-positive CD8+ T cells that may play a role in HIV-associated immune dysfunction.

Host immunity plays an important role in response to antimalarial therapy but is poorly understood. To test whether T cell activation is a risk factor for antimalarial treatment failure, we studied CD4(+) and CD8(+) T cell activation in 31 human immunodeficiency virus-negative Ugandan patients 5-37 years of age who were treated for uncomplicated Plasmodium falciparum malaria. Increased CD4(+) T cell activation, as indicated by co-expression of HLA-DR and CD38, was an independent risk factor for treatment failure (hazard ratio = 2.45, 95% confidence interval = 1.02-5.89, P = 0.05) in multivariate analysis controlling for age, baseline temperature, and pre-treatment parasite density. The results provide insight into the role of cellular immunity in response to antimalarial therapy and underscore the need to investigate the mechanisms behind immune activation.

IL-10-producing T cells have been shown to inhibit Ag-specific CD8+ T cell responses, and may play a role in the immune dysregulation observed in HIV-1 infection. We characterized the Gag-specific IL-10 responses by CD8+ T cells in HIV-1-positive volunteers from Uganda. HIV-specific IL-10 responses were detected in 32 of 61 (52.4%) antiretroviral naive and 2 of 15 (13.3%) volunteers with a complete virologic response on antiretroviral therapy (< 400 copies/ml). The frequency of HIV-specific IL-10-positive cells was significantly higher in volunteers with advanced disease (CD4+ T cell count <200 cells/mm3; p = 0.0004), and correlated positively with plasma HIV RNA (r = 0.43, p = 0.0004). Interestingly, the frequency of Gag-specific CD107a/b-, but not IFN-γ-, positive cells was significantly lower in individuals with detectable IL-10-positive CD8+ T cells (p = 0.004). Gag-specific IL-10-positive CD8+ T cells demonstrated a pattern of surface memory marker expression that is distinct compared with CD107a/b- and IFN-γ-positive CD8+ T cell populations (p < 0.0001). Our study describes a distinct population of IL-10-positive CD8+ T cells that may play a role in HIV-associated immune dysfunction.

Cytolytic T lymphocytes (CTL) play an important role in the control of HIV infection. The eventual failure to contain HIV-1 infection may arise because of a functional impairment of HIV-specific CTL. We evaluated Gag-specific cytotoxicity in HIV-1-positive Ugandans. Expression of CD107, a marker for cytolytic activity, was present in CD45RA(bright) and CD45RA(dim) CD8(+) T cell populations in HIV-infected individuals. The frequency of Gag-specific CD107(+)CD45RA(bright)CD28(-)CCR7(-) CD8(+) T cells decreased with CD4 cell depletion and correlated with the presence of Gag-specific T helper response. In contrast, the frequency of Gag-specific CD107(+)CD45RA(dim)CD28(-)CCR7(-) CD8(+) T cells within the same individuals has no significant association with viral load or CD4 cell count. The ratio of CD45RA(bright) to CD45RA(dim) CTL correlates significantly with CD4 cell count. This positive association decreases with antiretroviral treatment (ARV), indicating that suppression of viral replication alters the balance of circulating Gag-specific CD8(+) effector T cells. Subsets of cytolytic T cells may have distinct antiviral functions and further characterization of these effector CD8(+) T cells may yield important information on T cell regulation and dysfunction in HIV infection.

Immune activation during chronic HIV infection is a strong clinical predictor of death and may mediate CD4+ T cell depletion. Regulatory T cells (Tregs) are CD4+CD25brightCD62Lhigh cells that actively down-regulate immune responses. We asked whether loss of Tregs during HIV infection mediates immune activation in a cross-sectional study of 81 HIV-positive Ugandan volunteers. We found that Treg number is strongly correlated with both CD4+ and CD8+ T cell activation. In multivariate modeling, this relationship between Treg depletion and CD4+ T cell activation was stronger than any other clinical factor examined, including viral load and absolute CD4 count. Tregs appear to decline at different rates compared with other CD4+ T cells, resulting in an increased regulator to helper ratio in many patients with advanced disease. We hypothesize that this skewing may contribute to T cell effector dysfunction. Our findings suggest Tregs are a major contributor to the immune activation observed during chronic HIV infection.

Immune activation is thought to play a major role in the pathogenesis of human immunodeficiency virus (HIV). This effect may be particularly relevant in Africa, where endemic coinfections may contribute to disease progression, perhaps as a consequence of enhanced immune activation. We investigated the expression of CD38 and human leukocyte antigen (HLA)-DR on T cells in 168 HIV-seropositive volunteers in Uganda. We observed higher levels of CD4(+) and CD8(+) T cell activation in Uganda, compared with those reported in previous studies from Western countries. Coexpression of CD38 and HLA-DR on both CD4(+) and CD8(+) T cell subsets was directly correlated with viral load and inversely correlated with CD4(+) T cell counts. In antiretroviral therapy (ART)-naive volunteers, viral load and CD4(+) T cell count had stronger associations with CD8(+) and CD4(+) T cell activation, respectively. Virus suppression by ART was associated with a reduction in T cell activation, with a stronger observed effect on reducing CD8(+) compared with CD4(+) T cell activation. The presence of coinfection was associated with increased CD4(+) T cell activation but, interestingly, not with increased CD8(+) T cell activation. Our results suggest that distinct mechanisms differentially drive activation in CD4(+) and CD8(+) T cell subsets, which may impact the clinical prognostic values of T cell activation in HIV infection.

ABSTRACT Human immunodeficiency virus (HIV) or AIDS is currently the leading cause of death in Uganda, with at least three HIV clades (subtypes) accounting for most new infections. Whether an effective vaccine formulated on viruses from a single clade will be able to protect against infection from other local clades remains unresolved. We examined the T-cell immune responses from a cohort of HIV-seropositive individuals in Uganda with predominantly clade A and D infections. Surprisingly, we observed similar frequencies of cross-clade T-cell responses to the gag , env , and nef regions. Our data suggest that the level of viral sequence variability between distinct HIV strains does not predict the degree of cross-clade responses. High sequence homologies were also observed between consensus peptides and sequences from viral isolates, supporting the use of consensus amino acid sequences to identify immunogenic regions in studies of large populations.