Times to drink: cross-cultural variations in drinking in the rhythm of the week

Objectives  

The time of drinking in terms of daytime versus evening and weekday versus weekend is charted for regular drinkers in 14 countries in Europe, Asia, Latin America, Africa and Oceania.     

Risk factors for pre-eclampsia in Mulago Hospital, Kampala, Uganda

Objective Pre‐eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. The risk factors for pre‐eclampsia have not been well documented in Uganda. In this paper, we describe the risk factors for pre‐eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Methods This casecontrol study was conducted from 1st May 2008 to 1st May 2009. 207 women with pre‐eclampsia were the cases, and 352 women with normal pregnancy were the controls. The women were 15–39 years old, and their gestational ages were 20 weeks or more. They were interviewed about their socio‐demographic characteristics, past medical history and, their past and present obstetric performances. Results The risk factors were low plasma vitamin C (OR 3.19, 95% CI: 1.54–6.61), low education level (OR 1.67, 95% CI: 1.12–2.48), chronic hypertension (OR 2.29, 95% CI 1.12–4.66), family history of hypertension (OR 2.25, 95% CI: 1.53–3.31) and primiparity (OR 2.76, 95% CI: 1.84–4.15) and para≥5 (3.71, 95% CI:1.84–7.45). Conclusion The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre‐eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.     

Acceptability of intrauterine contraception among women living with human immunodeficiency virus: a randomised clinical trial

Objectives: The aim of our study was to compare acceptability of the copper intrauterine device (Cu-IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) among women living with the human immunodeficiency virus (HIV). Methods: We randomly assigned 703 HIV-positive women in Uganda to receive either a Cu-IUD or an LNG-IUS and followed them for at least one year. During the follow-up visits, face-to-face interviews were conducted with the women and acceptability of the Cu-IUD or LNG-IUS was assessed, using a Likert scale, at one, three, six and twelve months. At the final follow-up visit, women were also assessed for satisfaction with either method. Results: Between 9 September 2013 and 31 December 2014, 703 women were recruited and assigned as follows: 349 to a Cu-IUD group and 354 to an LNG-IUS group. Acceptability decreased from 94.3% at one month to 87.7% at 12 months in the Cu-IUD group and from 96.3% at one month to 86.7% at 12 months in the LNG-IUS group (p?=?0.97). Satisfaction with intrauterine contraception was reported by 83.7% (283/338) in the Cu-IUD group and by 90.4% (302/334) in the LNG-IUS group (p = 0.50). Conclusions: There was no significant difference in acceptability between the LNG-IUS and Cu-IUD among HIV-positive women. Satisfaction rates were high and similar in the two groups. Both the Cu-IUD and LNG-IUS are acceptable forms of contraception for HIV-positive women and should be made available to women in HIV care to increase their contraceptive method options. Clinical trial registration: The trial is registered at the Pan African Clinical Trials Registry (PACTR 201308000561212).     

S-adenosyl-methionine-induced apoptosis in PC12 cells

Our previous studies showed that S-adenosyl-methionine (SAM) induced Parkinson's disease-like changes in rat. It caused death to dopamine neurons in the substantia nigra, which appeared shrunken and fragmented, indicative of apoptosis-like changes (Charlton and Crowell [1995] Mol. Chem. Neuropathol. 26:269-284; Charlton [1997] Life Sci. 61:495-502). In this study, we investigated whether SAM causes apoptosis in both undifferentiated PC12 (PC12) cells and nerve growth factor (NGF)-differentiated PC12 (D-PC12) cells. S-adenosyl-homocysteine (SAH), the nonmethyl analog of SAM, was also tested. SAM and SAH (1.0 nM to 10.0 microM) caused lactate dehydrogenase (LDH) release from the PC12 cells and D-PC12 cells; cells with morphological changes and fluorescent DNA fragmentation staining were detected among both PC12 cell and D-PC12 cell. Compared with the PC12 cell, the D-PC12 cell, a postmitotic cell, was more sensitive to the toxic effects of SAM or SAH and presented much greater LDH release, suggesting a lethal effect; surprisingly, the amounts of apoptotic cells did not differ significantly between the two kinds of cells. In medium deprived of exogenous methionine, a decline in LDH release was observed in PC12 and D-PC12 cells. Also, lower levels of intracellular SAM and SAH were observed in the methionine-deleted media, which were reversed by the addition of either SAM or SAH. An antivitamin B(12) monoclonal antibody was added to methionine-depleted medium, resulting in deficiency of both endogenous and exogenous methionine, which caused further decreases in LDH release and reduction in the levels of intracellular SAM and SAH. The preliminary data showed different sensitivities to SAM or SAH between PC12 cell and D-PC12 cells, which suggests that PC12 cell may be more stable as a metabolic model. Apoptosis of PC12 cells was also assessed by PARP cleavage detection, Western blot analysis of Bax and Bcl-2 proteins, and DNA laddering on agarose gel electrophoresis. The proapoptoic protein Bax was dominantly expressed, whereas Bcl-2 was slightly down-regulated by SAM. SAH weakly induced the expression of Bax and slightly decreased Bcl-2 levels. The effects of SAM and its analog, SAH, were demonstrated conclusively to induce apoptosis in PC12 cells.     

Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

Aim

The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda.

Methods

We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key informant interviews. The HCW inventory was done to determine the rate of generation of infectious waste and general waste in one public and one private hospital. Observations using an observation checklist were done to establish HCW management practices in three hospitals.

Results

The average generation rate for infectious waste from Nsambya hospital (private hospital) was 0.23?kg/patient/day as compared to 0.25?kg/patient/day for Mulago (public hospital). Generation is influenced by type and state of sickness/condition, the level or seriousness of the sickness, the number of people nursing the patient, the visitation rate/number of people visiting a patient and the items they carry to the ward. These factors can be used by health facility managers to minimize the quantities of healthcare waste generated.

Conclusion

The study found no evidence that either public or private ownership is a decisive factor for the successful management of healthcare waste. However, contracting of healthcare waste management services to a private party as was seen in the public hospital had resulted in improved services and this strategy should also be tried in private hospitals.     

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.     

Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research

ObjectiveThis paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors.Study designA three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP.ResultsAbility to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (<25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles.ConclusionAWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education.Implications statement: Private providers should institute price discrimination for FP services by region, gender and socioeconomic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed.