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Search Results: 1 - 10 of 1557 matches for " Alfred Andama "
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Physico-Chemical Quality of Selected Drinking Water Sources in Mbarara Municipality, Uganda  [PDF]
Ben Lukubye, Morgan Andama
Journal of Water Resource and Protection (JWARP) , 2017, DOI: 10.4236/jwarp.2017.97047
Abstract: The study assessed the physico-chemical quality of selected drinking water sources (springs, boreholes, shallow wells and rainfall) in Mbarara municipality with respect to World Health Organization (WHO) drinking water guidelines and other guidelines in light of the increased anthropogenic activities in the municipality. A total of 70 water samples were collected from purposively selected boreholes, springs, wells and rainwater in Nyamitanga, Kamukuzi and Kakoba divisions of Mbarara municipality with various human activities. The samples were analysed for physico-chemical parameters: Temperature, pH, Dissolved Oxygen (DO), Biological Oxygen Demand (BOD), Total Dissolved Solids (TDS), Electrical Conductivity (EC) and Total hardness using American Public Health Association (APHA) standard methods. The mean temperature and pH ranged between 18.07 °C - 23.45 °C and 5.74 - 7.54, respectively. The mean DO values were found to be between 4.84 and 12.86 mg/l; whereas mean BOD was within the range of 1.83 - 7.71 mg/l. The mean TDS and EC of the water samples ranged, between 33.40 - 569.20 mg/l and 29.30 - 1139.90 μS/cm respectively. Furthermore, the lowest and highest mean total hardness were 70.00 and 264.00 mg/l, respectively. The recorded mean water temperatures for each of the water sources were above the WHO threshold temperature (15 °C) which makes drinking water palatable. Boreholes in Nyamitanga and Shuhaddea Secondary Schools, spring in Kiswahili, well in Kisenyi and rainwater in Mbarara University of Science and Technology (MUST) had mean pH below the WHO minimum guideline value (6.5) hence acidic. Borehole in Nyamitanga secondary school, spring in Kisenyi, shallow well in Nyamitanga and the rainwater in MUST had mean DO values below the WHO range (10 - 12 mg/l). Borehole in Shuhaddea Secondary School and the well in Kisenyi had average BOD values above the range of European Union guideline values (3 - 6 mg/l). TDS and EC of all the water sources were below the WHO maximum guideline limits of 1000 mg/l and 1500 μs/cm respectively. Total hardness was also below the WHO harmless limit of 1000 mg/l. However rainwater in MUST was moderately soft while the other drinking water sources exhibited moderate to full total hardness. The physicochemical parameters of some of the selected water sources in Mbarara municipality have been compromised mainly by the increased human activities especially croplands, latrines, landfills, transportation, animal and municipal wastes at the vicinity of the water sources. Mbarara municipal council should therefore ensure
Bacterial Analysis of Selected Drinking Water Sources in Mbarara Municipality, Uganda  [PDF]
Ben Lukubye, Morgan Andama
Journal of Water Resource and Protection (JWARP) , 2017, DOI: 10.4236/jwarp.2017.98066
Abstract: Surveillance of water quality to ensure microbiological safety is a vital public health function to prevent water borne diseases. Bacterial total coliform and Escherichia coli (E. coli) examination provide indication of the hygienic condition of drinking water and are major tools in the assessment of the health risk borne by pathogen in water. Unfortunately, there is insufficient information on the total coliform and E. coli amounts in the common drinking water sources in Mbarara Municipality, Uganda despite the eminent anthropogenic sources of contamination. Hence the study established the sanitary risk and quantified the total coliform and E. coli load in selected drinking water sources in Mbarara Municipality, Uganda. A total of 70 water samples were collected from selected boreholes, springs, wells and rainwater in Nyamitanga, Kamukuzi and Kakoba divisions of Mbarara municipality. The water samples were analysed for total coliform and E. coli abundance using the American Public Health Association (APHA) standard method. The total coliform and Escherichia coli counts were compared with the World Health Organization (WHO) drinking water standard guidelines. The findings indicate that all the studied groundwater sources (boreholes, springs and wells) in Mbarara Municipality were not compliant to either both or one of the WHO total coliform (<10 CFU/100 ml) and E. coli (0 CFU/100 ml) criteria for drinking water hence they are unsuitable for drinking without treatment e.g. boiling etc. Only rainwater collected from Mbarara University of Science and Technology met the WHO total coliform and E. coli criteria for drinking water thus is suitable for drinking without any treatment. There is a strong linkage between bacterial (total coliforms and E. coli) water quality and water source sanitation, as well as the proximity of latrines, animal farms and landfills around the water sources. Mbarara municipal council should therefore ensure effective and regular operation and maintenance of the drinking water sources through the adoption and promotion of appropriate water safety plans.
Proliferation of Salvinia molesta at Lake Kyoga Landing Sites as a Result of Anthropogenic Influences  [PDF]
Morgan Andama, Robert Ongom, Ben Lukubye
Journal of Geoscience and Environment Protection (GEP) , 2017, DOI: 10.4236/gep.2017.511012
Abstract: Salvinia molesta (native of south-eastern Brazil) is a free floating aquatic fern that has spread to several countries around the globe including Uganda. Under optimum growing conditions, the plant is capable of spreading rapidly where it can have immense environmental, economic and human health impacts. Thick mats of the weed have been recorded in some parts of Lake Kyoga, Uganda where it hinders the abstraction of water, docking and boat take-off, bathing and swimming activities. Therefore this study aimed to determine the extent of S. molesta at selected landing sites in Lake Kyoga and the influence of anthropogenic activities on the weed coverage as well as the effect of physico-chemical parameters of the water on the development of the weed. Quadrats were used to ascertain the coverage of S. molesta while the physico-chemical parameters were determined by standard methods. The results showed significant positive correlation of S. molesta weed coverage with phosphates (PO4-P) and negative correlations with pH, dissolved oxygen (DO) and water flow rate. Though statistically insignificant waste sites recorded the highest overall S. molesta coverage (82.61 ± 21.12 m2) per 400 m2 quadrat followed by boat docks (82.24 ± 19.45 m2), gardens (50.93 ± 11.82 m2) and finally fishing areas (27.94 ± 5.93 m2) respectively. The overall weed coverage was highest around the shoreline locations of Acholi inn landing site (101.72 ± 22.89 m2 per 400 m2) followed by Masindi port (60.39 ± 15.64 m2), Waitumba (41.89 ± 10.55 m2) and the least in the offshore location at Kayei landing site (39.71 ± 10.17 m2). Salvinia molesta distribution in Lake Kyoga is linked to nutrient (PO4-P) supply, proximity to the shoreline and the associated anthropogenic activities. Hence waste sites, gardens and boat docks enhance S. molesta invasion in Lake Kyoga. Therefore, sources of nutrients (phosphates) into Lake Kyoga that favour the proliferation of S. molesta should be minimized through adequate waste treatment and prohibition of cultivation close to the lake. Salvinia molesta coverage along the routes of moving boats should also be contained so as to reduce the spread of the weed in the lake through boat movements. Furthermore, eradication efforts of S. molesta weed in Lake Kyoga should be heightened at the shoreline
Bronchoalveolar Lavage Enzyme-Linked Immunospot for Diagnosis of Smear-Negative Tuberculosis in HIV-Infected Patients
Adithya Cattamanchi, Isaac Ssewenyana, Rose Nabatanzi, Cecily R. Miller, Saskia Den Boon, J. Lucian Davis, Alfred Andama, William Worodria, Samuel D. Yoo, Huyen Cao, Laurence Huang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039838
Abstract: Background Peripheral blood interferon-gamma release assays (IGRAs) have sub-optimal sensitivity and specificity for diagnosis of active pulmonary tuberculosis (TB). However, assessment of local immune responses has been reported to improve the accuracy of TB diagnosis. Methods We enrolled HIV-infected adults with cough ≥2 weeks’ duration admitted to Mulago Hospital in Kampala, Uganda and referred for bronchoscopy following two negative sputum acid-fast bacillus smears. We performed an ELISPOT-based IGRA (T-SPOT.TB?, Oxford Immunotec, Oxford, UK) using peripheral blood and bronchoalveolar lavage (BAL) fluid mononuclear cells, and determined the accuracy of IGRAs using mycobacterial culture results as a reference standard. Results 94 HIV-infected patients with paired peripheral blood and BAL IGRA results were included. The study population was young (median age 34 years [IQR 28–40 years]) and had advanced HIV/AIDS (median CD4+ T-lymphocyte count 60 cells/μl [IQR 22–200 cells/μl]). The proportion of indeterminate IGRA results was higher in BAL fluid than in peripheral blood specimens (34% vs. 14%, difference 20%, 95% CI 7–33%, p = 0.002). BAL IGRA had moderate sensitivity (73%, 95% CI 50–89%) but poor specificity (48%, 95% CI 32–64%) for TB diagnosis. Sensitivity was similar (75%, 95% CI 57–89%) and specificity was higher (78%, 95% CI 63–88%) when IGRA was performed on peripheral blood. Conclusions BAL IGRA performed poorly for the diagnosis of smear-negative TB in a high HIV/TB burden setting. Further studies are needed to examine reasons for the large proportion of indeterminate results and low specificity of BAL IGRA for active TB in high HIV/TB burden settings.
Oral Antimicrobial Rinse to Reduce Mycobacterial Culture Contamination among Tuberculosis Suspects in Uganda: A Prospective Study
Nelson Kalema, Saskia Den Boon, Adithya Cattamanchi, J. Lucian Davis, Alfred Andama, Winceslaus Katagira, Charles Everett, Nicholas Walter, Patrick Byanyima, Sylvia Kaswabuli, William Worodria, Laurence Huang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038888
Abstract: Rationale Contamination by bacterial or fungal organisms reduces the effectiveness of mycobacterial culture for diagnosis of pulmonary tuberculosis (TB). We evaluated the effect of an anti-microbial and an anti-fungal oral rinse prior to expectoration on culture-contamination rates. Methods We enrolled a consecutive random sample of adults with cough for ≥2 weeks and suspected TB admitted to Mulago Hospital (Kampala, Uganda) between October 2008 and June 2009. We randomly assigned patients to oral rinse (60 seconds with chlorhexidine followed by 60 seconds with nystatin) vs. no oral rinse prior to initial sputum collection. Uganda National Tuberculosis Reference Laboratory technicians blinded to the method of sputum collection (with or without oral rinse) processed all sputum specimens for smear microscopy (direct Ziehl-Neelsen) and mycobacterial culture (Lowenstein-Jensen media). Results Of 220 patients enrolled, 177 (80%) were HIV-seropositive (median CD4-count 37 cells/uL, IQR 13–171 cells/uL). Baseline characteristics were similar between patients in the oral-rinse (N = 110) and no oral-rinse (N = 110) groups. The proportion of contaminated cultures was significantly lower in the oral-rinse group compared to the no oral-rinse group (4% vs. 15%, risk difference ?11%, 95% CI ?18 to ?3%, p = 0.005). Oral rinse significantly reduced the proportion of contaminated cultures among HIV-infected patients (3% vs. 18%, risk difference ?14%, 95% CI ?23 to ?6%, p = 0.002) but not HIV-uninfected (6% vs. 4%, risk difference 2%, 95% CI ?12 to +15%, p = 0.81) patients. However, the proportion of smear-positive specimens (25% vs. 35%, p = 0.10) and culture-positive specimens (48% vs. 56%, p = 0.24) were lower in the oral-rinse compared to the no oral-rinse group, although the differences were not statistically significant. Conclusions Oral rinse prior to sputum expectoration is a promising strategy to reduce mycobacterial culture contamination in areas with high HIV prevalence, if strategies can be devised to reduce the adverse impact of oral rinse on smear- and culture-positivity.
The Role of Speciation in Positive Lowenstein-Jensen Culture Isolates from a High Tuberculosis Burden Country
William Worodria, Jillian Anderson, Adithya Cattamanchi, J. Lucian Davis, Saskia den Boon, Alfred Andama, Samuel D. Yoo, Moses Joloba, Laurence Huang, Midori Kato-Maeda
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0027017
Abstract: Objective To determine the need for routine speciation of positive Lowenstein-Jensen mycobacterial cultures in HIV-infected patients suspected of having pulmonary tuberculosis at Mulago Hospital in Kampala, Uganda. Methods Sputum and bronchoalveolar lavage Lowenstein-Jensen mycobacterial culture isolates from consecutive, HIV-infected patients admitted to Mulago Hospital with 2 weeks or more of cough were subjected to IS6110 PCR and rpoB genetic analysis to determine the presence of Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM). Results Eighty (100%) mycobacterial cultures from 65 patients were confirmed to be members of MTBC. Subsequent analysis of the cultures from 54 patients by PCR and sequence analyses to identify co-infection with NTM confirmed the presence of MTBC as well as the presence of Micrococcus luteus (n = 4), Janibacter spp. (n = 1) and six cultures had organisms that could not be identified. Conclusions Presumptive diagnosis of tuberculosis on the basis of a positive Lowenstein-Jensen culture is sufficient in HIV-infected Ugandans suspected of having tuberculosis. Routine molecular confirmation of positive Lowenstein-Jensen cultures is unnecessary in this low resource setting.
Role of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infection
Adithya Cattamanchi, Isaac Ssewenyana, J Lucian Davis, Laurence Huang, William Worodria, Saskia den Boon, Samuel Yoo, Alfred Andama, Philip C Hopewell, Huyen Cao
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-75
Abstract: We enrolled HIV-infected patients admitted to Mulago Hospital in Kampala, Uganda with cough ≥ 2 weeks. All patients underwent standard medical evaluation. We collected peripheral blood specimens at enrollment and performed a commercial, ELISPOT-based IGRA according to the manufacturer's recommendations. IGRA sensitivity and specificity were determined using mycobacterial culture results as the reference standard.Overall, 236 patients were enrolled. The median CD4+ T-lymphocyte count was 49 cells/μl and 126 (53%) patients were diagnosed with active pulmonary tuberculosis. IGRAs were not performed in 24 (10%) patients due to insufficient mononuclear cell counts. In the remaining 212 patients, results were indeterminate in 54 (25%). IGRAs were positive in 95 of 158 (60%) patients with interpretable results. The proportion of positive test results was similar across CD4+ count strata. IGRA sensitivity was 73% and specificity 54%. IGRA results did not meaningfully alter the probability of active tuberculosis in patients with negative sputum smears.An ELISPOT-based IGRA detected a high prevalence of latent tuberculosis infection in a hospitalized population of tuberculosis suspects with advanced HIV/AIDS but had limited utility for diagnosis of active tuberculosis in a high prevalence setting. Further research is needed to identify stronger and more specific immune responses in patients with active tuberculosis.T-cell interferon-gamma release assays (IGRAs) measure interferon-gamma release by sensitized T-lymphocytes stimulated with Mycobacterium tuberculosis (M. TB)-specific antigens. Though IGRAs are highly accurate for diagnosis of latent tuberculosis infection (LTBI) [1], their use as a diagnostic tool for active tuberculosis (TB) poses several challenges. IGRAs measure the host immune response to M. TB rather than the presence or absence of the organism in clinical specimens. In addition, IGRAs cannot distinguish an immune response to current active TB from an immune
Suitability of Drinking Water Sources from Nyaruzinga Wetland for Domestic Use in Bushenyi Municipality, Uganda  [PDF]
Lauben Muhangane, John Bosco Nkurunungi, Jane Yatuha, Morgan Andama
Journal of Water Resource and Protection (JWARP) , 2017, DOI: 10.4236/jwarp.2017.913100
Abstract: This study determined the physico-chemical and bacterial quality of raw (bore-hole, springs, wells) and tap water sources from Nyaruzinga wetland for domestic use in Bushenyi Municipality. Forty samples of raw water were randomly collected from Kacuncu, Kyeitembe and Kikuba tributaries of the wetland and 40 samples of tap water generated from the same wetland were randomly drawn from Ishaka, Nyakabirizi and Central divisions of the Municipality. The samples were analyzed for apparent colour (AC), turbidity, electrical conductivity (EC), total hardness, pH, total iron, residual alum, free residual chlorine and faecal coliforms using standard methods and their values compared with standard local UNBS (2008) and international WHO (2011) drinking water quality guidelines. The results showed that the mean pH of the protected spring below Kikuba Hill (5.21); the AC (Pt/Co) of the borehole below Bweranyangi Junior School (17.28) and the surface well below Nyandozo Primary School (157.58) both situated in Kacuncu as well as the free residual chlorine (mg/L) in tap water at Kanyamabona Trading Centre, Ishaka division (0.192) were below the standard values of WHO (pH, 6.0 - 8.0; free residual chlorine, 0.2 - 0.5) and UNBS (AC, <15). The electrical conductivity, EC (μS/cm) and total hardness (mg/L) of all the selected water sources were within the WHO standards (EC, <1500 (raw water), 0 - 300 (tap water); total hardness, <1500 (raw water), <100 (tap water)). The residual alum (mg/L) in all the tap water sources was also within the WHO guideline (<0.2). On the other hand, the turbidity (27.38 NTUs) and total iron content (0.32 mg/L) of the surface well below Nyandozo Primary School were above WHO guidelines of <15 and <0.3 respectively. Furthermore, the mean faecal coliform counts (CFU/100 ml) in the surface well below Nyandozo Primary School (6.90) and the borehole below Bweranyangi Junior School (16.83) including the surface well below Kyeitembe Trading Centre (9.25) were above the WHO standard faecal coliform count (≤3 TCUs). Only the tap water at Kanyamabona Trading Centre recorded mean faecal coliform counts (0.25 TCUs) beyond the WHO standard (0 TCU). Hence the quality of tap water within the municipality tapped from Nyaruzinga wetland was generally better than the raw drinking water sources (borehole, springs, wells) from the same wetland. Thus the use of piped tap water by the urban inhabitants as opposed to raw water sources needs to be promoted to increase access to safe water.
Impact of Xpert MTB/RIF Testing on Tuberculosis Management and Outcomes in Hospitalized Patients in Uganda
Christina Yoon, Adithya Cattamanchi, J. Lucian Davis, William Worodria, Saskia den Boon, Nelson Kalema, Winceslaus Katagira, Sylvia Kaswabuli, Cecily Miller, Alfred Andama, Heidi Albert, Pamela Nabeta, Christen Gray, Irene Ayakaka, Laurence Huang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048599
Abstract: Rationale The clinical impact of Xpert MTB/RIF for tuberculosis (TB) diagnosis in high HIV-prevalence settings is unknown. Objective To determine the diagnostic accuracy and impact of Xpert MTB/RIF among high-risk TB suspects. Methods We prospectively enrolled consecutive, hospitalized, Ugandan TB suspects in two phases: baseline phase in which Xpert MTB/RIF results were not reported to clinicians and an implementation phase in which results were reported. We determined the diagnostic accuracy of Xpert MTB/RIF in reference to culture (solid and liquid) and compared patient outcomes by study phase. Results 477 patients were included (baseline phase 287, implementation phase 190). Xpert MTB/RIF had high sensitivity (187/237, 79%, 95% CI: 73–84%) and specificity (190/199, 96%, 95% CI: 92–98%) for culture-positive TB overall, but sensitivity was lower (34/81, 42%, 95% CI: 31–54%) among smear-negative TB cases. Xpert MTB/RIF reduced median days-to-TB detection for all TB cases (1 [IQR 0–26] vs. 0 [IQR 0–1], p<0.001), and for smear-negative TB (35 [IQR 22–55] vs. 22 [IQR 0–33], p = 0.001). However, median days-to-TB treatment was similar for all TB cases (1 [IQR 0–5] vs. 0 [IQR 0–2], p = 0.06) and for smear-negative TB (7 [IQR 3–53] vs. 6 [IQR 1–61], p = 0.78). Two-month mortality was also similar between study phases among 252 TB cases (17% vs. 14%, difference +3%, 95% CI: ?21% to +27%, p = 0.80), and among 87 smear-negative TB cases (28% vs. 22%, difference +6%, 95% CI: ?34 to +46%, p = 0.77). Conclusions Xpert MTB/RIF facilitated more accurate and earlier TB diagnosis, leading to a higher proportion of TB suspects with a confirmed TB diagnosis prior to hospital discharge in a high HIV/low MDR TB prevalence setting. However, our study did not detect a decrease in two-month mortality following implementation of Xpert MTB/RIF possibly because of insufficient powering, differences in empiric TB treatment rates, and disease severity between study phases.
Low Prevalence of Pneumocystis pneumonia (PCP) but High Prevalence of Pneumocystis dihydropteroate synthase (dhps) Gene Mutations in HIV-Infected Persons in Uganda
Steve M. Taylor, Steven R. Meshnick, William Worodria, Alfred Andama, Adithya Cattamanchi, J. Lucian Davis, Samuel D. Yoo, Patrick Byanyima, Sylvia Kaswabuli, Carol D. Goodman, Laurence Huang, International HIV-associated Opportunistic Pneumonias (IHOP) Study
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049991
Abstract: Pneumocystis jirovecii pneumonia (PCP) is an important opportunistic infection in patients infected with HIV, but its burden is incompletely characterized in those areas of sub-Saharan Africa where HIV is prevalent. We explored the prevalence of both PCP in HIV-infected adults admitted with pneumonia to a tertiary-care hospital in Uganda and of putative P. jirovecii drug resistance by mutations in fungal dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr). In 129 consecutive patients with sputum smears negative for mycobacteria, 5 (3.9%) were diagnosed with PCP by microscopic examination of Giemsa-stained bronchoalveolar lavage fluid. Concordance was 100% between Giemsa stain and PCR (dhps and dhfr). PCP was more prevalent in patients newly-diagnosed with HIV (11.4%) than in patients with known HIV (1.1%; p = 0.007). Mortality at 2 months after discharge was 29% overall: 28% among PCP-negative patients, and 60% (3 of 5) among PCP-positive patients. In these 5 fungal isolates and an additional 8 from consecutive cases of PCP, all strains harbored mutant dhps haplotypes; all 13 isolates harbored the P57S mutation in dhps, and 3 (23%) also harbored the T55A mutation. No non-synonymous dhfr mutations were detected. PCP is an important cause of pneumonia in patients newly-diagnosed with HIV in Uganda, is associated with high mortality, and putative molecular evidence of drug resistance is prevalent. Given the reliability of field diagnosis in our cohort, future studies in sub-Saharan Africa can investigate the clinical impact of these genotypes.
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