20 results on '"Berrang‐Ford, Lea"'
Search Results
2. Geography, Climate Change and Health Adaptation Planning in Uganda
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Namanya, Didacus B., Berrang-Ford, Lea, Harper, Sherilee L., Ford, James, Bikaitwoha, Everd M., Lwasa, Shuaib, Wright, Carlee J., Kazaana, Christopher, Crooks, Valorie, Series Editor, and Makanga, Prestige Tatenda, editor
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- 2021
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3. Relative Undernourishment and Food Insecurity Associations with Plasmodium falciparum Among Batwa Pygmies in Uganda: Evidence from a Cross-Sectional Survey
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Lewnard, Joseph A, Berrang-Ford, Lea, Lwasa, Shuaib, Namanya, Didacus Bambaiha, Patterson, Kaitlin A, Donnelly, Blánaid, Kulkarni, Manisha A, Harper, Sherilee L, Ogden, Nicholas H, Carcamo, Cesar P, and 2013, the Indigenous Health Adaptation to Climate Change Research Team
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Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Malaria ,Infectious Diseases ,Nutrition ,Vector-Borne Diseases ,Rare Diseases ,Clinical Research ,2.2 Factors relating to the physical environment ,Aetiology ,Infection ,Zero Hunger ,Good Health and Well Being ,Adolescent ,Adult ,Child ,Cross-Sectional Studies ,Ethnicity ,Female ,Food Supply ,Humans ,Malaria ,Falciparum ,Male ,Malnutrition ,Middle Aged ,Nutritional Status ,Parasitemia ,Plasmodium falciparum ,Prevalence ,Uganda ,Ethnic Groups ,Medical and Health Sciences ,Tropical Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
Although malnutrition and malaria co-occur among individuals and populations globally, effects of nutritional status on risk for parasitemia and clinical illness remain poorly understood. We investigated associations between Plasmodium falciparum infection, nutrition, and food security in a cross-sectional survey of 365 Batwa pygmies in Kanungu District, Uganda in January of 2013. We identified 4.1% parasite prevalence among individuals over 5 years old. Severe food insecurity was associated with increased risk for positive rapid immunochromatographic test outcome (adjusted relative risk [ARR] = 13.09; 95% confidence interval [95% CI] = 2.23-76.79). High age/sex-adjusted mid-upper arm circumference was associated with decreased risk for positive test among individuals who were not severely food-insecure (ARR = 0.37; 95% CI = 0.19-0.69). Within Batwa pygmy communities, where malnutrition and food insecurity are common, individuals who are particularly undernourished or severely food-insecure may have elevated risk for P. falciparum parasitemia. This finding may motivate integrated control of malaria and malnutrition in low-transmission settings.
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- 2014
4. Food security variation among Indigenous communities in South-western Uganda.
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Patterson, Kaitlin, Berrang-Ford, Lea, Lwasa, Shuaib, Namanya, Didacus B., Ford, James, Research Team, IHACC, and Harper, Sherilee L.
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FOOD security ,MULTILEVEL models ,FOOD chemistry ,COMMUNITIES - Abstract
We assess whether the household is an apt scale of analysis to examine food insecurity of Indigenous Batwa of Kanungu District, Uganda. Our objectives were: 1) estimate the prevalence and range of food insecurity, 2) estimate the variation in food insecurity associated with household and community factors. The survey was administered 6 times at 3-month intervals (Jan 2013-April 2014). Multilevel modeling was used to determine household and community associations with food insecurity. The Batwa were highly food insecure (97%). Variation in food insecurity that is explained by household and community factors was low. Food insecurity analyses should be considered scale-dependent. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Vulnerability to the health effects of climate variability in rural southwestern Uganda
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Labbé, Jolène, Ford, James D, Berrang-Ford, Lea, Donnelly, Blanaid, Lwasa, Shuaib, Namanya, Didacus Bambaiha, Twesigomwe, Sabastian, Harper, Sherilee L, and IHACC Research Team
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- 2016
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6. Identifying Predictors for Minimum Dietary Diversity and Minimum Meal Frequency in Children Aged 6–23 Months in Uganda.
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Scarpa, Giulia, Berrang-Ford, Lea, Galazoula, Maria, Kakwangire, Paul, Namanya, Didacus B., Tushemerirwe, Florence, Ahumuza, Laura, and Cade, Janet E.
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Adequate complementary foods contribute to good health and growth in young children. However, many countries are still off-track in achieving critical complementary feeding indicators, such as minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD). In this study, we used the 2016 Ugandan Demographic Health Survey (UDHS) data to assess child feeding practices in young children aged 6–23 months. We assess and describe complementary feeding indicators (MMF, MDD and MAD) for Uganda, considering geographic variation. We construct multivariable logistic regression models—stratified by age—to evaluate four theorized predictors of MMF and MDD: health status, vaccination status, household wealth and female empowerment. Our findings show an improvement of complementary feeding practice indicators in Uganda compared to the past, although the MAD threshold was reached by only 22% of children. Children who did not achieve 1 or more complementary feeding indicators are primarily based in the northern regions of Uganda. Cereals and roots were the foods most consumed daily by young children (80%), while eggs were rarely eaten. Consistent with our hypotheses, we found that health status, vaccination status and wealth were significantly positively associated with MDD and MMF, while female empowerment was not. Improving nutrition in infant and young children is a priority. Urgent nutritional policies and acceptable interventions are needed to guarantee nutritious and age-appropriate complementary foods to each Ugandan child in the first years of life. [ABSTRACT FROM AUTHOR]
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- 2022
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7. 'The Gloomy Forebodings of This Dread Disease', Climate, Famine and Sleeping Sickness in East Africa
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Endfield, Georgina H., Ryves, David B., Mills, Keely, and Berrang-Ford, Lea
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- 2009
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8. '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.
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Brubacher, Laura Jane, Berrang-Ford, Lea, Clark, Sierra, Patterson, Kaitlin, Lwasa, Shuaib, Namanya, Didacus B., Twesigomwe, Sabastian, and Harper, Sherilee L.
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GASTROINTESTINAL disease treatment , *THERAPEUTICS , *ATTITUDE (Psychology) , *HELP-seeking behavior , *QUALITATIVE research , *RESEARCH funding , *ACUTE diseases - 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. [ABSTRACT FROM AUTHOR]
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- 2022
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9. Sleeping Sickness in Southeastern Uganda: A SystemsApproach
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Berrang-Ford, Lea, Waltner-Toews, David, Charron, Dominique, Odiit, Martin, McDermott, John, and Smit, Barry
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- 2005
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10. Factors influencing antenatal care attendance for Bakiga and Indigenous Batwa women in Kanungu District, Southwestern Uganda.
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Steele, Vivienne, Patterson, Kaitlin, Berrang-Ford, Lea, Nia King, Kulkarni, Manisha, Namanya, Didacus, Kesande, Charity, Twesigomwe, Sabastian, Asaasira, Grace, and Harper, Sherilee L.
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Introduction: The number of maternal deaths remains high in sub-Saharan Africa. Effective antenatal care (ANC) reduces maternal morbidity and mortality; therefore, provision of improved antenatal care services has been prioritised across sub-Saharan Africa. Yet, research is limited on the ANC experiences of Indigenous women in sub-Saharan Africa. This study characterised ANC attendance patterns at a hospital, and characterised factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda. Methods: A community-based, mixed-methods approach was used. Quantitative data were collected from a local hospital (records for 2299 ANC visits) and analysed by using descriptive statistics and multivariable regression analysis. Qualitative data from eight key informant interviews (n=9 healthcare providers) and 16 focus group discussions (n=120 Batwa and Bakiga women) were analysed by thematic analysis. Results: Most ANC patients attended between one and three ANC visits per pregnancy (n=1259; 92.57%), and few attended the recommended four or more visits (n=101; 7.43%). Distance from a woman's home to the hospital was significantly associated with lower ANC attendance (p<0.05, 95% confidence interval 0.01--0.96), after adjusting for maternal age and number of previous pregnancies. The qualitative data revealed that many factors influenced ANC attendance for both Batwa and Bakiga: long distances from the home to a health centre, high direct and indirect costs of ANC, lack of power in household decision-making, and poor interactions with healthcare providers. While the types of barriers were similar among Batwa and Bakiga, some were more pronounced for Indigenous Batwa women. Conclusion: This study partnered with and collected in-depth data with Indigenous Peoples who remain underrepresented in the literature. The findings indicated that Indigenous Batwa continue to face unique and more pronounced barriers to accessing ANC in Kanungu District, Uganda. Ensuring access to ANC for these populations requires an in-depth understanding of their experiences within the local healthcare context. To reduce health inequities that Indigenous Peoples experience, policy-makers and healthcare workers need to adequately understand, effectively address, and appropriately prioritise factors influencing ANC attendance. [ABSTRACT FROM AUTHOR]
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- 2021
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11. Acute gastrointestinal illness in an African Indigenous population: the lived experience of Uganda's Batwa.
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Patterson, Kaitlin, Clark, Sierra, Berrang-Ford, Lea, Lwasa, Shuaib, Namanya, Didacus, Twebaze, Fortunate, and Harper, Sherilee L.
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Introduction: Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness (AGI) in an Indigenous Batwa population in south-western Uganda. Methods: Quantitative data analyses were conducted on data from three cross-sectional census surveys of Batwa conducted in January 2013 (n=583), January 2014 (n=569) and April 2014 (n=540). Using a 14-day recall period, cases of AGI were defined as three or more loose stools or any vomiting in a 24-hour period. These analyses were supplemented by qualitative data from key informant interviews (n=11 interviews) and Batwa focus group discussions (n=61 participants). Results: From the surveys, episodes of diarrhea and episodes of vomiting lasted on average 3.6 (95%CI 2.3-4.3) and 3.0 (95%CI 2.1-3.9) days, and individuals experienced an average of 4.3 (95%CI 3.9-4.8) and 2.6 (95%CI 2.1-3.1) loose stools and vomiting episodes in 24 hours. Focus group participants and key informants indicated that episodes of AGI for Batwa were not limited to symptom-based consequences for the individual, but also had economic, social and nutritional impacts. Conclusion: Despite efforts to increase health literacy in disease transmission dynamics, risks and prevention measures, the perceived barriers and a lack of benefits still largely underscored adopting positive AGI prevention behaviors. This study moved beyond surveillance and provided information on the broader community-level burden of AGI and highlighted the current challenges and opportunities for improved uptake of AGI prevention measures for the Batwa. [ABSTRACT FROM AUTHOR]
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- 2020
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12. Vulnerability to the health effects of climate variability in rural southwestern Uganda
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Labbé, Jolene, Ford, James D., Berrang-Ford, Lea, Donnelly, Blanaid, Lwasa, Shuaib, Namanya, Didacus Bambaiha, Twesigomwe, Sabastian, Harper, Sherilee L., and Indigenous Health Adaptation to Climate Change Research Group
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010504 meteorology & atmospheric sciences ,Kanungu ,Psychological intervention ,Vulnerability ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Photovoice ,Climate change ,Uganda ,030212 general & internal medicine ,Traditional knowledge ,Adaptation ,0105 earth and related environmental sciences ,Bakiga ,Global and Planetary Change ,Adaptive capacity ,Ecology ,Land use ,Sub-Saharan Africa ,Agricultural diversification ,business.industry ,Environmental resource management ,Livelihood ,East Africa ,purl.org/pe-repo/ocde/ford#1.06.13 [https] ,Geography ,Health ,business - Abstract
Vulnerability to the health impacts of climate change will be shaped by the existing burden of ill- health and is expected to be highest in poor and socio-economically marginalized populations. Sub-Saharan Africa, in particular, is considered a highly vulnerable region. This paper analyses the vulnerability and adaptive capacity of rural Bakiga communities in southwestern Uganda to climate-sensitive health risks. The objectives were threefold: i) identify key climate-sensitive, community-identified health priorities; ii) describe and characterize determinants of sensitivity to these health priorities at the individual, community and regional levels; and iii) assess the adaptive capacity of Bakiga. Data collection employed a combination of individual and key informant interviews, biographies, future storylines, and Photovoice. Three key health risks were identified by the study communities (malaria, food insecurity, and gastrointestinal illnesses) – all affected by local climatic and environmental conditions, livelihoods, land use changes, and socio-economic conditions. Adaptation within these communities is dependent on their capacity to reduce sensitivities to identified health challenges among the potential of increasing exposures. Crop diversification, reducing deforestation, expanding of livestock rearing, transfer of traditional knowledge, and access to affordable health services are among potential strategies identified. We demonstrate significant existing vulnerabilities to present day climate-related health risks and highlight the importance of non-climatic processes and local conditions in creating sensitivity to health risks. Our place-based understanding is useful to inform interventions or policies aimed to reduce exposure and sensitivity and support adaptive capacity as the conditions these communities face are consistent with many other sub-Saharan African countries.
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- 2015
13. Is the effect of precipitation on acute gastrointestinal illness in southwestern Uganda different between Indigenous and non-Indigenous communities?
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Busch, Johanna, Berrang-Ford, Lea, Clark, Sierra, Patterson, Kaitlin, Windfeld, Emma, Donnelly, Blanaid, Lwasa, Shuaib, Namanya, Didacus, Harper, Sherilee L., and null, null
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ACUTE diseases , *METEOROLOGICAL precipitation , *INDIGENOUS peoples , *PANEL analysis , *HEALTH equity , *CLIMATE change & health - Abstract
Acute gastrointestinal illness (AGI) is a global public health priority that often disproportionately effects Indigenous populations. While previous research examines the association between meteorological conditions and AGI, little is known about how socio-cultural factors may modify this relationship. This present study seeks to address this research gap by comparing AGI prevalence and determinants between an Indigenous and non-Indigenous population in Uganda. We estimate the 14-day self-reported prevalence of AGI among adults in an Indigenous Batwa population and their non-Indigenous neighbours using cross-sectional panel data collected over four periods spanning typically rainy and dry seasons (January 2013 to April 2014). The independent associations between Indigenous status, precipitation, and AGI are examined with multivariable multi-level logistic regression models, controlling for relative wealth status and clustering at the community level. Estimated prevalence of AGI among the Indigenous Batwa was greater than among the non-Indigenous Bakiga. Our models indicate that both Indigenous identity and decreased levels of precipitation in the weeks preceding the survey period were significantly associated with increased AGI, after adjusting for confounders. Multivariable models stratified by Indigenous identity suggest that Indigenous identity may not modify the association between precipitation and AGI in this context. Our results suggest that short-term changes in precipitation affect both Indigenous and non-Indigenous populations similarly, though from different baseline AGI prevalences, maintaining rather than exacerbating this socially patterned health disparity. In the context of climate change, these results may challenge the assumption that changing weather patterns will necessarily exacerbate existing socially patterned health disparities. [ABSTRACT FROM AUTHOR]
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- 2019
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14. An analysis of the nutrition status of neighboring Indigenous and non-Indigenous populations in Kanungu District, southwestern Uganda: Close proximity, distant health realities.
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Sauer, Jeffery, Berrang-Ford, Lea, Patterson, Kaitlin, Donnelly, Blanaid, Lwasa, Shuaib, Namanya, Didas, Zavaleta, Carol, Ford, James, and Harper, Sherilee
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MALNUTRITION , *AGE distribution , *COMMUNITY health services , *CONFIDENCE intervals , *ETHNIC groups , *ETHNOPSYCHOLOGY , *NUTRITIONAL assessment , *REGRESSION analysis , *SEX distribution , *SURVEYS , *EDUCATIONAL attainment , *DISEASE prevalence , *CROSS-sectional method , *RETROSPECTIVE studies , *SEVERITY of illness index , *ACUTE diseases , *ARM circumference - Abstract
Abstract Objectives Malnutrition is a persistent health concern throughout the world. Globally, Indigenous peoples experience poorer health outcomes compared to their non-Indigenous neighbours. Despite this, malnutrition among Indigenous populations is poorly understood. This analysis estimated the prevalence, and modeled possible determinants of, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) for Indigenous Batwa and non-Indigenous Bakiga of Kanungu District in Southwestern Uganda. We then characterize possible mechanisms driving differences in malnutrition. Methods Retrospective cross-sectional surveys were administered to 10 Batwa communities and 10 matched Bakiga Local Councils during April of 2014 (n = 1167). Individuals were classified as MAM and SAM based on middle upper-arm circumference (MUAC) for their age-sex strata. Mixed-effects regression models quantified the variation in malnutrition occurrence, considering individual, household, and community-ethnicity level effects. Models controlled for age, sex, number of dependents, education, and relative wealth. Results Malnutrition is high among Batwa children and adults, with nearly half of Batwa adults (45.34%, 95% CI 34.82 to 55.86 for males; 45.86%, 95% CI 37.39 to 54.33 for females) and nearly a quarter of Batwa children (20.31%, 95% CI 13.07 to 26.93 for males; 25.81%, 95% CI 17.56 to 32.84 for females) meeting MAM criteria. SAM prevalence is lower than MAM prevalence, with SAM highest among adult Batwa males (11.60%, 95% CI 4.83 to 18.37) and adult Batwa females (3.00%, 95% CI 0.10 to 5.90). SAM prevalence among children was higher for Batwa males (7.03%, 95% CI 1.36 to 12.70) compared to Bakiga males (0.57%, 95% CI 0 to 1.69). Models that incorporated community ethnicity explained the greatest variance (>60%) in MUAC values. Conclusion This research demonstrates a malnutrition inequality between the Indigenous Batwa and non-Indigenous Bakiga of Kanungu District, Uganda, with model results suggesting further investigation into the role of ethnicity as an upstream social determinant of health. Highlights • Malnutrition disparities exist among Indigenous and non-Indigenous groups in Uganda. • Distinct malnutrition factors appear at individual, household, and community levels. • Ethnic distinction within communities may act as an upstream determinant of health. [ABSTRACT FROM AUTHOR]
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- 2018
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15. Relative undernourishment and food insecurity associations with Plasmodium falciparum among Batwa pygmies in Uganda: evidence from a cross-sectional survey
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Lewnard, Joseph A., Berrang-Ford, Lea, Lwasa, Shuaib, Namanya, Didacus Bambaiha, Patterson, Kaitlin A., Donnelly, Blánaid, Kulkarni, Manisha A., Harper, Sherilee L., Ogden, Nicholas H., Cárcamo Cavagnaro, César Paul Eugenio, Ford, J.D., Edge, V.L., and Llanos Cuentas, Elmer Alejandro
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Adult ,Falciparum ,Male ,Adolescent ,Cross-sectional study ,Plasmodium falciparum/physiology ,Plasmodium falciparum ,Nutritional Status ,Ethnic Groups ,Parasitemia ,Malaria, Falciparum/complications/ethnology/parasitology ,Food Supply ,Virology ,Environmental health ,Parasitemia/complications/ethnology/parasitology ,parasitic diseases ,medicine ,Ethnicity ,Prevalence ,Humans ,Uganda ,Malaria, Falciparum ,Child ,2. Zero hunger ,Food security ,biology ,business.industry ,Malnutrition ,Uganda/epidemiology ,Articles ,Middle Aged ,medicine.disease ,biology.organism_classification ,Confidence interval ,3. Good health ,Malaria ,Infectious Diseases ,Cross-Sectional Studies ,Relative risk ,Immunology ,Parasitology ,Female ,business ,Malnutrition/complications/ethnology/parasitology ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Although malnutrition and malaria co-occur among individuals and populations globally, effects of nutritional status on risk for parasitemia and clinical illness remain poorly understood. We investigated associations between Plasmodium falciparum infection, nutrition, and food security in a cross-sectional survey of 365 Batwa pygmies in Kanungu District, Uganda in January of 2013. We identified 4.1% parasite prevalence among individuals over 5 years old. Severe food insecurity was associated with increased risk for positive rapid immunochromatographic test outcome (adjusted relative risk [ARR] = 13.09; 95% confidence interval [95% CI] = 2.23–76.79). High age/sex-adjusted mid-upper arm circumference was associated with decreased risk for positive test among individuals who were not severely food-insecure (ARR = 0.37; 95% CI = 0.19–0.69). Within Batwa pygmy communities, where malnutrition and food insecurity are common, individuals who are particularly undernourished or severely food-insecure may have elevated risk for P. falciparum parasitemia. This finding may motivate integrated control of malaria and malnutrition in low-transmission settings.
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- 2014
16. Incorporating scale dependence in disease burden estimates: the case of human African trypanosomiasis in Uganda
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Hackett, Finola, Berrang Ford, Lea, Fèvre, Eric, and Simarro, Pere
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Adult ,Male ,lcsh:Arctic medicine. Tropical medicine ,Epidemiology ,lcsh:RC955-962 ,Global Health ,Social and Behavioral Sciences ,Human Geography ,African Trypanosomiasis ,Disease Mapping ,Cost of Illness ,parasitic diseases ,Humans ,Disabled Persons ,Uganda ,Spatial Analysis ,Geography ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Trypanosomiasis, African ,Infectious Diseases ,Medicine ,Female ,Quality-Adjusted Life Years ,Research Article ,Neglected Tropical Diseases - Abstract
Background The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000–2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale. Methodology/Principal Findings Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000–2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS. Conclusions/Significance These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses., Author Summary Since the 1990s the World Health Organisation has established the disability-adjusted life year (DALY) as a metric for the burden of human disease and injury. However, disease burden has primarily been estimated at the national scale, which does not account for sub-country variations in burden levels. We used the case of human African trypanosomiasis (HAT), a highly focal NTD, in Uganda to calculate and map burden in DALYs. Our results show that HAT burden is highly sensitive to under-reporting estimates, and is particularly high in heavily affected parishes and districts of Uganda. Some districts in southeastern Uganda had HAT burden rates comparable to the national burden rates of major infectious diseases such as malaria and HIV/AIDS. Thus, the spatial scale of burden estimation is crucial, especially for focal diseases such as HAT, and national-level estimates may not reflect the level of impact in afflicted communities. We recommend sub-country burden estimation to identify key areas for prioritization of disease surveillance and targeted interventions.
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- 2014
17. How seasonality and weather affect perinatal health: Comparing the experiences of indigenous and non-indigenous mothers in Kanungu District, Uganda.
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MacVicar, Sarah, Berrang-Ford, Lea, Harper, Sherilee, Steele, Vivienne, Lwasa, Shuaib, Bambaiha, Didacus Namanya, Twesigomwe, Sabastien, Asaasira, Grace, and Ross, Nancy
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AGRICULTURE , *CHILD health services , *CLIMATE change , *COMPARATIVE studies , *FOCUS groups , *INDIGENOUS peoples , *INTERVIEWING , *MEDICAL personnel , *MOTHERS , *SEASONS , *WEATHER , *HEALTH equity , *FOOD security - Abstract
Maternal and newborn health disparities and the health impacts of climate change present grand challenges for global health equity, and there remain knowledge gaps in our understanding of how these challenges intersect. This study examines the pathways through which mothers are affected by seasonal and meteorological factors in sub-Saharan Africa in general, and Kanungu District (Uganda), in particular. We conducted a community-based study consisting of focus group discussions with mothers and interviews with health care workers in Kanungu District. Using a priori and a posteriori coding, we found a diversity of perspectives on the impacts of seasonal and weather exposures, with reporting of more food available in the rainy season. The rainy season was also identified as the period in which women performed physical labour for longer time periods, while work conditions in the dry season were reported to be more difficult due to heat. The causal pathways through which weather and seasonality may be affecting size at birth as reported by Kanungu mothers were consistent with those most frequently reported in the literature elsewhere, including maternal energy balance (nutritional intake and physical exertion output) and seasonal illness. While both Indigenous and non-Indigenous mothers described similar pathways, however, the severity of these experiences differed. Non-Indigenous mothers frequently relied on livestock assets or opportunities for less taxing physical work than Indigenous women, who had fewer options when facing food shortages or transport costs. Findings point to specific entry points for intervention including increased nutritional support in dry season periods of food scarcity, increased diversification of wage labour opportunities, and increased access to contraception. Interventions should be particularly targeted towards Indigenous mothers as they face greater food insecurity, may have fewer sources of income, and face greater overall deprivation than non-Indigenous mothers. [ABSTRACT FROM AUTHOR]
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- 2017
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18. Plasmodium falciparum malaria parasitaemia among indigenous Batwa and non-indigenous communities of Kanungu district, Uganda.
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Donnelly, Blánaid, Berrang-Ford, Lea, Labbé, Jolène, Twesigomwe, Sabastian, Lwasa, Shuaib, Namanya, Didacus B., Harper, Sherilee L., Kulkarni, Manisha, Ross, Nancy A., and Michel, Pascal
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PLASMODIUM falciparum , *PARASITEMIA , *INDIGENOUS peoples , *MALARIA , *QUESTIONNAIRES - 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. [ABSTRACT FROM AUTHOR]
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- 2016
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19. A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution.
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Clark, Sierra, Berrang-Ford, Lea, Lwasa, Shuaib, Namanya, Didacus, Twesigomwe, Sabastian, null, null, and Kulkarni, Manisha
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INSECTICIDES , *MOSQUITO nets , *BATWA (African people) , *SOCIOECONOMICS , *CROSS-sectional method - Abstract
Major efforts for malaria prevention programs have gone into scaling up ownership and use of insecticidal mosquito nets, particularly in sub-Saharan Africa where the malaria burden is high. Socioeconomic inequities in access to long lasting insecticidal nets (LLINs) are reduced with free distributions of nets. However, the relationship between social factors and retention of nets after a free distribution has been less studied, particularly using a longitudinal approach. Our research aimed to estimate the ownership and use of LLINs, and examine the determinants of LLIN retention, within an Indigenous Batwa population after a free LLIN distribution. Two LLINs were given free of charge to each Batwa household in Kanungu District, Uganda in November 2012. Surveyors collected data on LLIN ownership and use through six cross-sectional surveys pre- and post-distribution. Household retention, within household access, and individual use of LLINs were assessed over an 18-month period. Socioeconomic determinants of household retention of LLINs post-distribution were modelled longitudinally using logistic regression with random effects. Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs. Three months post-distribution, only 73% of households owned at least one LLIN and this period also saw the greatest reduction in ownership compared to other study periods. Eighteen-months post distribution, only a third of households still owned a LLIN. Self-reported age-specific use of LLINs was generally higher for children under five, declined for children aged 6–12, and was highest for older adults aged over 35. In the model, household wealth was a significant predictor of LLIN retention, controlling for time and other variables. This research highlights on-going socioeconomic inequities in access to malaria prevention measures among the Batwa in southwestern Uganda, even after free distribution of LLINs, and provides critical information to inform local malaria programs on possible intervention entry-points to increase access and use among this marginalized population. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
20. Expert knowledge sourcing for public health surveillance: National tsetse mapping in Uganda.
- Author
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Berrang-Ford, Lea and Garton, Kelly
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INTERVIEWING , *PUBLIC health surveillance , *TRYPANOSOMIASIS , *HEALTH literacy - Abstract
Abstract: In much of sub-Saharan Africa, availability of standardized and reliable public health data is poor or negligible. Despite continued calls for the prioritization of improved health datasets in poor regions, public health surveillance remains a significant global health challenge. Alternate approaches to surveillance and collection of public health data have thus garnered increasing interest, though there remains relatively limited research evaluating these approaches for public health. Herein, we present a case study applying and evaluating the use of expert knowledge sources for public health dataset development, using the case of vector distributions of Human African Trypanosomiasis (HAT) in Uganda. Specific objectives include: 1) Review the use of expert knowledge sourcing methods for public health surveillance, 2) Review current knowledge on tsetse vector distributions of public health importance in Uganda and the methods used for tsetse mapping in Africa; 3) Quantify confidence of the presence or absence of tsetse flies in Uganda based on expert informant reports, and 4) Assess the reliability and potential utility of expert knowledge sourcing as an alternative or complimentary method for public health surveillance in general and tsetse mapping in particular. Information on tsetse presence or absence, and associated confidence, was collected through interviews with District Entomologist and Veterinary Officers to develop a database of tsetse distributions for 952 sub-counties in Uganda. Results show high consistency with existing maps, indicating potential reliability of modeling approaches, though failing to provide evidence for successful tsetse control in past decades. Expert-sourcing methods provide a novel, low-cost and rapid complimentary approach for triangulating data from prediction modeling where field-based validation is not feasible. Data quality is dependent, however, on the level of expertise and documentation to support confidence levels for data reporting. Results highlight the need for increased evaluation of alternate approaches and methods to data collection. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
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