Infectivity to cattle of metacyclic forms of Trypanosoma (Nannomonas) congolense propagated in vitro. I. Development of localized skin reactions following intradermal inoculation

Skin reactions similar to those induced by tsetse infected with Trypanosoma congolense were elicited in cattle at sites of intradermal inoculation of in vitro propagated parasites which morphologically resembled metacyclic trypanosomes. The time to detection of the reaction, the time to maximal size and the maximal size attained were dependent on the number of parasites inoculated, although it was possible to induce a skin reaction with as few as 20 trypanosomes. All cattle became infected with the initial detection of the skin reaction preceding parasitaemia by 3 to 7 days.     

Beer is the cattle of women: Sorghum beer commercialization and dietary intake of agropastoral families in Karamoja,Uganda

Karimojong agropastoralists of Uganda have employed a dual subsistence strategy of cattle herding and sorghum cultivation to survive in an unpredictable environment, one afflicted by a severe humanitarian crisis. Armed raiding since the 1970s has led to devastating cattle losses, high male mortality, and increased sedentarization of women and children in densely populated homesteads, where infectious diseases and malnutrition rates are prevalent. Fieldwork in 1998–1999 confirmed the detrimental effects of armed raiding on child growth and development. During this period, however, women maintained largely traditional subsistence patterns. Follow-up fieldwork in 2004 revealed surprising subsistence changes: sorghum beer, an important food and ritual item, was being brewed for sale, which had not been noted in previous literature on the Karimojong. We outline the role of beer in the diet by analyzing the nutritional profile of Karimojong women and children, nutrients supplied by beer, and those supplied by foodstuffs purchased with sales profits. Commercial beer supplied from 3 to 6% of energy intake, and grains leftover from brewing (dregs) supplied from 3 to 12%. Selling beer was women's preferred form of casual labor, with differing patterns of participation in brewing between rural and peri-urban areas. Women who were paid in currency relied on profits to purchase nutrient-rich supplemental foodstuffs important in an otherwise marginal diet, as well as beer. The households of women who worked for other brewers or purchased beer wholesale and sold it retail relied heavily on dregs for daily subsistence. Nutrient intake was highest among women with cattle and sorghum who brewed and sold beer from their homesteads, and lowest among women who lacked sorghum and worked for commercial brewers in urban centers. Because nutritional status remains marginal in Karamoja, beer commercialization as a consequence of subsistence changes could have dramatic health consequences for women and children.     

Longitudinal weight gain of immunized infants and toddlers in Moroto District,Uganda (Karamoja subregion)

This study examines longitudinal weight gain of a sample of 123 immunized children from Moroto District, northeast Uganda. The weight data were combined from two sources: (1) anthropometric examinations carried out between 1998 and 2004 by a research team from the University of Kansas, and (2) weights recorded on children's immunization records by local health care practitioners. Our findings conform generally to the pattern described in previous studies in this as well as other pastoralist populations in sub‐Sahara. Relative to international standards, the weight‐for‐age status of Karimojong children was best during the first 3 months of infancy. Noticeable declines in weight velocity occurred in the fourth month and after the sixth month. Weight gain was static after the second year, when upward of 40% of children were clinically underweight. Factors influencing weight gain in this sample include immunization status and maternal height, weight, and parity, but these effects explain relatively little of the variance in weight gain. We conclude that immunization is not sufficient to buffer Karimojong children from multiple stressors during teething and weaning. Of these, the practice of canine follicle extraction (CFE) is of most interest, although its effects in this study are ambiguous. The data also are suggestive of variability in the pattern of weight gain between closely spaced birth cohorts. This finding may be of particular importance for the interpretation of growth patterns described for other pastoralist populations in sub‐Saharan Africa. Am. J. Hum. Biol. 2010. © 2009 Wiley‐Liss, Inc.     

Acceptability of male circumcision for prevention of HIV infection among men and women in Uganda

In the last decade, three randomized controlled trials in Kenya, South Africa, and Uganda have shown that medical male circumcision (MMC) reduces the sexual transmission of HIV from women to men. Objectives of this assessment were to measure acceptability of adult MMC and circumcision of children to inform policies regarding whether and how to promote MMC as an HIV prevention strategy. This mixed-method study, conducted across four Ugandan districts, included a two-stage household survey of 833 adult males and 842 adult females, focus group discussions, and a health provider survey. Respondents' acceptability of MMC was positive and substantial after being informed about the results of recent randomized trials. In uncircumcised men, between 40% and 62% across the districts would consider getting circumcised. Across the four districts between 60% and 86% of fathers and 49% and 95% of mothers were supportive of MMC for sons. Widespread support exists among men and women in this study for promoting MMC as part of Uganda's current 'ABC + ' HIV prevention strategy.     

Mixed‐longitudinal growth of Karimojong girls and boys in Moroto District,Uganda

In this article we examine results of a mixed‐longitudinal study of child and adolescent growth among agropastoral Karimojong children in Moroto District, northeast Uganda. During a 5‐month period from August to December, 2004, longitudinal data were collected for a mixed sample of 104 Karimojong children, aged from birth to 18 years. During a previous study in 1998–1999,we had measured 26 of these children who then ranged in Age between 3 months and 7 years. Most of the children were small and thin relative to accepted growth standards, and prevalence of stunting and wasting in childhood was high. In the period from the end of childhood through adolescence, however, Karimojong girls showed marked variability in annual growth, with some attaining a large adult size relative to what we predicted based on their poor childhood growth. Developmental, evolutionary, and environmental determinants are considered. We conclude that growth of these children reflects exposure to environmental insults that vary unpredictably within relatively short intervals. Variability in the magnitude and timing of these insults among children from different birth‐cohorts is probably sufficient to account for so‐called “shifting” of growth percentiles in childhood and adolescence in this mixed sample. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Scaling up community provision of injectables through the public sector in Uganda

This case study presents service monitoring data and programmatic lessons from scaling up Uganda's community-based distribution of depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera) to the public sector in two districts. We describe the process and identify implementation opportunities and challenges, including modifications to the service model. Analysis of monitoring data indicates that the number of women initiating DMPA with a community health worker (CHW) was 56 percent higher than the number of new DMPA acceptors served by clinics. Including continuing DMPA users, about three of every four DMPA clients chose CHWs as their service delivery point. CHW provision appears to be the preferred method of delivery for new DMPA users in this study, and may appeal even more to continuing clients. Lessons from scaling up in Uganda's public sector include recognizing the needs for ongoing assessment of support, a process to gain community "ownership," and spontaneous innovations to supplement CHW supervision.     

Parasitological detection of Trypanosoma brucei gambiense in serologically negative sleeping-sickness suspects from north-western Uganda.

Forty-five parasitologically confirmed cases of sleeping sickness were diagnosed in north-western Uganda using a combination of two or three techniques. Forty of the cases were positive by the card agglutination test for trypanosomiasis (CATT), four were negative and one was not screened by the CATT. Trypanosomes isolated from the four CATT-negative but parasitologically positive cases were propagated for detailed biochemical genetic analysis. The aim was to demonstrate whether these four stocks lacked the LiTat 1.3 gene which encodes the antigen on which the CATT is based. All the DNA extracts isolated from these CATT-negative stocks and from six CATT-positive stocks of Trypanosoma brucei gambiense were targeted for amplification by the three variable-surface-glycoprotein genes thought to be ubiquitous in T. b. gambiense. The LiTat 1.3 gene was shown to be present in all 10 stocks. Trypanosome carriers may be CATT-negative because the CATT is not sensitive enough, because their parasites lack the LiTat 1.3 gene, or because their parasites have this gene but do not express it. The four sleeping-sickness cases who gave negative CATT results in the present study have very important implications in the diagnosis of T. b. gambiense infections using the CATT. Following treatment of the CATT-positive cases, the CATT-negative carriers of the trypanosomes remain as human reservoir hosts for continuous infection of the population. Because CATT-negative individuals are rarely examined further, the general prevalence of parasitologically positive but CATT-negative cases is unclear. This study demonstrates the value of co-ordinated use of serological and parasitological techniques in the diagnosis of Gambian sleeping sickness.