BACKGROUND & AIMS: :In limited-resource countries, cancer kills more people annually than AIDS, tuberculosis and malaria combined. Programs targeting early detection and treatment of cancer are virtually non-existent due to insufficient funding and attention given to this emerging health challenge. Breast cancer is the most common cancer in women worldwide and is also the leading cause of cancer-related death in females. In developing countries such as Uganda, breast cancer incidence is increasing and typically presents at an advanced stage of disease, for which treatment options are limited. Inadequate knowledge and understanding of the disease, social stigma, and barriers to care all contribute to a poorer prognosis. There are many challenges to reducing breast cancer incidence and mortality globally; however, there is evidence to suggest that advocacy and education, in particular through the efforts of breast cancer survivors and their partners, can play a critical role in improving overall outcomes in limited-resource countries.

背景与目标： : 在资源有限的国家，癌症每年造成的死亡人数超过艾滋病、结核病和疟疾的总和。针对癌症早期发现和治疗的计划几乎不存在，因为对这一新兴健康挑战的资金不足和关注不足。乳腺癌是全世界女性最常见的癌症，也是女性癌症相关死亡的主要原因。在乌干达等发展中国家，乳腺癌的发病率正在增加，通常出现在疾病的晚期，而治疗选择有限。对疾病的知识和理解不足，社会污名和护理障碍都导致预后较差。在全球范围内降低乳腺癌发病率和死亡率面临许多挑战; 然而，有证据表明，宣传和教育，特别是通过乳腺癌幸存者及其合作伙伴的努力，可以在改善资源有限的国家的总体成果方面发挥关键作用。

BACKGROUND & AIMS: :Fatal infectious disease acquired during international travel is less likely to be captured through existing surveillance when diagnosis is delayed or missed, especially as autopsy rates decline. Death of a young girl owing to malaria demonstrates needs for increased examination of travel-related deaths through postmortem investigation, autopsy, and expanded surveillance.

背景与目标： : 在国际旅行中获得的致命传染病在诊断延迟或漏诊时不太可能通过现有的监视来捕获，尤其是在尸检率下降的情况下。一名年轻女孩因疟疾死亡表明，需要通过死后调查、尸检和扩大监测来增加对旅行相关死亡的检查。

BACKGROUND & AIMS: BACKGROUND:Rhipicephalus microplus, an invasive tick species of Asian origin and the main vector of Babesia species, is considered one of the most widespread ectoparasites of livestock. The tick has spread from its native habitats on translocated livestock to large parts of the tropical world, where it has replaced some of the local populations of Rhipicephalus decoloratus ticks. Although the tick was reported in Uganda 70 years ago, it has not been found in any subsequent surveys. This study was carried out to update the national tick species distribution on livestock in Uganda as a basis for tick and tick-borne disease control, with particular reference to R. microplus. METHODS:The study was carried out in Kadungulu, Serere district, south-eastern Uganda, which is dominated by small scale livestock producers. All the ticks collected from 240 cattle from six villages were identified microscopically. Five R. microplus specimens were further processed for phylogenetic analysis and species confirmation. RESULTS:The predominant tick species found on cattle was Rhipicephalus appendiculatus (86.9 %; n = 16,509). Other species found were Amblyomma variegatum (7.2 %; n = 1377), Rhipicephalus evertsi (2.3 %; n = 434) and R. microplus (3.6 %; n = 687). Phylogenetic analysis of the 12S rRNA, 16S rRNA and ITS2 gene sequences of R. microplus confirmed the morphological identification. CONCLUSIONS:It is concluded that R. microplus has replaced R. decoloratus in the sampled villages in Kadungulu sub-county, since the latter was not any longer found in this area. There is currently no livestock movement policy in force in Uganda, which could possibly limit the further spread of R. microplus ticks. Future surveys, but also retrospective surveys of museum specimens, will reveal the extent of distribution of R. microplus in Uganda and also for how long this tick has been present on livestock without being noticed.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. METHODS:A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0-11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. RESULTS:Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2-1.0 and 0.5, 0.3-0.8, respectively). CONCLUSION:Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In 2012, the World Health Organization recommended that pregnant women in malaria-endemic countries complete at least three (optimal) doses of intermittent preventive treatment (IPTp) using sulfadoxine-pyrimethamine (SP) to prevent malaria and related adverse events during pregnancy. Uganda adopted this recommendation, but uptake remains low in East-Central and information to explain this low uptake remains scanty. This analysis determined correlates of uptake of optimal doses of IPTp-SP in East-Central Uganda. METHODS:This was a secondary analysis of the 2016 Uganda Demographic Health Survey data on 579 women (15-49 years) who attended at least one antenatal care (ANC) visit and had a live birth within 2 years preceding the survey. Uptake of IPTp-SP was defined as optimal if a woman received at least three doses; partial if they received 1-2 doses or none if they received no dose. Multivariate analysis using multinomial logistic regression was used to determine correlates of IPTp-SP uptake. RESULTS:Overall, 22.3% of women received optimal doses of IPTp-SP, 48.2% partial and 29.5% none. Attending ANC at a lower-level health centre relative to a hospital was associated with reduced likelihood of receiving optimal doses of IPTp-SP. Belonging to other religious faiths relative to Catholic, belonging to a household in the middle relative to poorest wealth index, and age 30 and above years relative to 25-29 years were associated with higher likelihood of receiving optimal doses of IPTp-SP. CONCLUSIONS:In East-Central Uganda, uptake of optimal doses of IPTp-SP is very low. Improving institutional delivery and household wealth, involving religious leaders in programmes to improve uptake of IPTp-SP, and strengthening IPTp-SP activities at lower level health centers may improve uptake of IPTp-SP in the East-Central Uganda.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With the increasing number of people surviving into older age in Africa, dementia is becoming a public health concern. Understanding the social dynamics of dementia in resource-limited settings is critical for developing effective interventions. We explored community perceptions about people with dementia in southwestern Uganda. METHODS:Fifty-nine individuals (aged 19-85 years, 56% female) participated in seven focus group discussions. In addition, 22 individual in-depth interviews were conducted among individuals (aged 22-84 years, 36% female). Both interviews and focus group discussions were audio recorded, transcribed verbatim, and evaluated using a quantitative content analysis approach. RESULTS:Five themes were generated during content analysis: i) Labeling of the illness, ii) Presentation of the person with dementia, iii) Causation, iv) Impact of the disease on people with dementia and their caregivers and v) Views on how to address unmet needs in dementia care. Dementia was commonly referred to as "okuhuga"or "okwebwayebwa" (also, oruhuzyo/ empugye / akahuriko) which translates as "mental disorientation". The participants reported that most people with dementia presented with forgetfulness, defecating and urinating on themselves, wandering away from home, going out naked, and picking up garbage. Some participants perceived memory problems as a normal part of the aging process, while others attributed the cause of dementia to syphilis, cancer, allergy, old age, satanic powers, witchcraft, poor nutrition, or life stress. Participants reported multiple sources of stress for caregivers of people with dementia, including financial, social, and emotional burdens. Finally, participants suggested that community and governmental organizations should be involved in meeting the needs of people with dementia and their caregivers. CONCLUSIONS:Community members in southwestern Uganda largely identified dementia as a problem that comes with older age, and can identify key features of dementia presentation. Participants identified significant stressors affecting people with dementia and their caregivers, and reported that families and caregivers would benefit from education on the management of symptoms of dementia, and assistance in overcoming associated financial, social, and emotional burdens related to caretaking.

背景与目标：

BACKGROUND & AIMS: Background:In resource-limited settings, the Filmer & Pritchett asset index is frequently used to measure household economic status. Little is known about how its validity is affected by differential reporting or recall within households. Methods:As part of a whole-population survey in a rural region of southwestern Uganda, we elicited household asset information from married dyads (404 men and 404 matched women) residing within the same households. We assessed the extent to which the asset index yielded differing measures of relative household wealth, depending on whether the husband's or wife's survey data were used in its calculation. To estimate agreement, we used Cohen's κ for binary and categorical variables, and Cronbach's α for continuous variables. We also assessed the extent to which asset wealth quintiles assigned based on husbands' vs wives' reporting were concordant, and whether discordance was related to demographic characteristics. Results:For most individual assets, agreement ranged from moderate to very good. Asset index scores based on husbands' vs wives' reporting were positively correlated (Pearson r = 0.85). Corresponding wealth quintiles were moderately concordant (weighted κ = 0.65); 171 households (43%) differed by one or more quintiles when the husbands' vs wives' reporting was used, and 43 (11%) differed by two or more quintiles. Concordance in asset wealth quintile could not be explained by joint educational attainment, age, or age difference. Conclusions:There is significant intra-household variability in household asset reporting that can materially affect how households are classified on a widely used measure of relative household asset wealth.

背景与目标：

BACKGROUND & AIMS: SUMMARY OBJECTIVES:To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) and feasibility and effectiveness of reporting HIV-exposed infants born in facilities with no PMTCT services so as to receive NVP. METHODS:From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of south-west Uganda. Twenty-five of them were HIV-surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined. RESULTS:Women with incomplete primary or no education, aged 25-34 years or not living with their partners were at increased risk of being HIV infected. Seventy-seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25-34 years, on antiretroviral therapy (ART) or came from study villages. CONCLUSIONS:The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.

背景与目标：

BACKGROUND & AIMS: West Nile virus, first isolated in 1937, is among the earliest arthropod-borne viruses discovered by humans. Its broad geographical distribution, not uncommon infection of humans, transmission by mosquitoes, and association with wild birds as enzootic hosts were well documented by the mid-1960s. However, West Nile virus was not considered to be a significant human pathogen because most infections appeared to result in asymptomatic or only mild febrile disease. Several epidemics had been documented prior to 1996, some involving hundreds to thousands of cases in mostly rural populations, but only a few cases of severe neurological disease had been reported. The occurrence between 1996 and 1999 of three major epidemics, in southern Romania, the Volga delta in southern Russia, and the northeastern United States, involving hundreds of cases of severe neurological disease and fatal infections was totally unexpected. These were the first epidemics reported in large urban populations. A significant factor that appeared in common to all three outbreaks was the apparent involvement of the common house mosquito, Culex pipiens, as a vector. This species had not previously been implicated as important in the transmission of West Nile virus. In addition the epidemic in the northeastern United States was unusual in the association of West Nile virus infection with fatal disease of birds, suggesting a change in the virulence of the virus toward this host. Understanding the risk factors that contributed to these three urban epidemics is important for minimizing the potential for future occurrences. This review will attempt to compare observations on the biology of West Nile virus made over about 60 years prior to the recent epidemics to observations made in association with these urban epidemics.

背景与目标： 西尼罗河病毒是最早分离的1937年，是人类发现的最早的节肢动物传播的病毒之一。20世纪60年代中期充分证明了其广泛的地理分布，人类感染，蚊子传播以及与野生鸟类作为动物宿主的关联。然而，西尼罗河病毒不被认为是重要的人类病原体，因为大多数感染似乎导致无症状或仅导致轻度发热性疾病。1996年前已经记录了几起流行病，其中一些涉及大多数农村人口的数百至数千例病例，但仅报告了少数严重的神经系统疾病病例。在罗马尼亚南部，俄罗斯南部的伏尔加河三角洲和美国东北部，涉及数百例严重神经系统疾病和致命感染的三个主要流行病的发生1996年和1999完全出乎意料。这是在大城市人口中首次报告的流行病。所有这三起疫情共同出现的一个重要因素是普通家蚊库蚊 (Culex pipiens) 作为媒介的明显参与。该物种以前从未被认为在西尼罗河病毒的传播中很重要。此外，在美国东北部，西尼罗河病毒感染与鸟类致命疾病的联系是不寻常的，这表明病毒病毒对该宿主的毒力发生了变化。了解导致这三种城市流行病的风险因素对于最大程度地减少未来发生的可能性非常重要。这篇评论将试图将最近流行之前大约60年对西尼罗河病毒生物学的观察结果与与这些城市流行病相关的观察结果进行比较。

BACKGROUND & AIMS: :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.

背景与目标： : 在撒哈拉以南非洲的大部分地区，标准化和可靠的公共卫生数据的可用性很差或微不足道。尽管不断呼吁在贫困地区优先考虑改进的健康数据集，但公共卫生监测仍然是一项重大的全球健康挑战。因此，监测和收集公共卫生数据的替代方法引起了越来越多的兴趣，尽管评估这些方法用于公共卫生的研究仍然相对有限。在此，我们以乌干达人类非洲锥虫病 (HAT) 的媒介分布为例，提出了一个案例研究，该案例应用和评估了专家知识来源在公共卫生数据集开发中的使用。具体目标包括: 1) 审查在公共卫生监测中使用专家知识采购方法，2) 审查乌干达关于公共健康重要性的采采蝇媒介分布的当前知识以及非洲采采蝇制图使用的方法; 3) 根据专家举报人的报告，量化乌干达采采蝇的存在或不存在的信心，4) 评估专家知识的可靠性和潜在效用，作为一般公共卫生监测的替代或补充方法，特别是采采蝇图。通过与地区昆虫学家和兽医官员的访谈，收集了有关采采蝇存在或不存在以及相关信心的信息，以建立乌干达952个县的采采蝇分布数据库。结果显示与现有地图的高度一致性，表明建模方法的潜在可靠性，尽管未能为过去几十年成功的采采蝇控制提供证据。专家采购方法提供了一种新颖，低成本且快速的互补方法，用于在基于现场的验证不可行的情况下对预测模型中的数据进行三角测量。但是，数据质量取决于支持数据报告置信度的专业知识和文档水平。结果强调需要增加对数据收集的替代方法和方法的评估。

BACKGROUND & AIMS: BACKGROUND:To determine the dietary patterns, anthropometric status, prevalence and risk factors for anaemia among school children aged 5-11 years in a peri-urban area of Central Uganda. METHODS:A cross-sectional study involving both qualitative and quantitative methods was used. Anthropometric data were taken using standardised equipment, whereas haemoglobin was assessed using a haemoglobin meter. Food intake was assessed using a food frequency questionnaire. One hundred and twenty-two primary school children, aged 5-11 years, and their carers were recruited in the study. RESULTS:The proportion of anaemic children (haemoglobin <12 g/dl) was 37.7%; 36.9% of these had mild and 0.8% had moderate anaemia. The unadjusted odds ratio (OR) showed that children who never consumed fish had a nine-fold increased odds of being anaemic [OR = 9.0, 95% confidence interval (CI) = 1.6-50.7; P = 0.018], whereas those who had fewer meals (1-2 per day) had a 27.0% increased risk (OR = 3.7, 95% CI = 1.1-12.6; P = 0.021). The adjusted OR showed number of meals per day as the only independent predictor of anaemia (OR = 3.5, 95% CI = 1.1-11.8; P = 0.031). The proportion of malnutrition (<-2 SD) for wasting (body mass index for age) was 3.3%, being underweight was 5.8% and stunting was 6.6%. Children aged >8 years were associated with wasting (P = 0.041) and stunting (P = 0.034). One main dietary pattern was identified explaining approximately 20.4% of the variability of intake in the population. However, scores of this pattern were not significantly associated with child haemoglobin levels. CONCLUSIONS:Anaemia but not macronutrient malnutrition in this cohort of school children is high. Patterns of the dietary intake observed did not explain nutritional status in this population.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To investigate trends in all-cause adult mortality after the roll-out of an antiretroviral therapy (ART) programme in rural Uganda. METHODS:Longitudinal population-based cohort study of approximately 20,000 residents in rural Uganda. Mortality in adults aged 15-59 years was determined for the 5-year period (1999-2003) before introduction of ART in January 2004 and for the 5-year period afterwards. Poisson regression was used to estimate mortality rate ratios (RRs) for the period before ART, 1 year after ART introduction (from January 2004 to January 2005) and more than 1 year after ART introduction. Trends in mortality were analysed by HIV status, age and sex. RESULTS:Before ART became available, the mortality rate (deaths per 1000 person-years) was 4.0 (95% CI = 3.3-4.8) among HIV-negative individuals and 116.4 (95% CI = 101.9-133.0) among HIV-positive individuals. During the period January 2004-end November 2009, 279 individuals accessed ART. In the year after ART was introduced, the mortality rate (deaths per 1000 person-years) among HIV-negative individuals did not change significantly (adjusted RR = 0.95, 95% CI = 0.61-1.47), but among HIV-positive individuals dropped by 25% to 87.4 (adjusted RR = 0.75, 95% CI = 0.53-1.06). In the period 2005-2009, the mortality rate (deaths per 1000 person-years) among HIV-positive individuals fell further to 39.9 (adjusted RR = 0.33, 95% CI = 0.26-0.43). The effect was greatest among individuals aged 30-44 years, and trends were similar in men and women. CONCLUSION:The substantially reduced mortality rate among HIV-positive individuals after ART roll-out lends further support to the intensification of efforts to ensure universal access to ART.

背景与目标：

BACKGROUND & AIMS: :The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness to participate in HIV vaccine trials. A baseline survey assessed knowledge and attitudes toward vaccination and potential HIV vaccines among 14,177 participants aged 15-49 years, in a population cohort. Willingness to participate in HIV-preventive vaccine trials was assessed during a follow-up survey 10 months later after providing community education on HIV vaccines. Knowledge of the preventive utility of vaccines was high (71%), but higher in men than women (P<0.001), and increased with education levels (P<0.001). Vaccines were considered appropriate for children and women (99 and 88%, respectively), but not for adult men (28%). Participants felt that adolescents were the most appropriate subjects for HIV preventive vaccine trials (93.7%) but also thought that HIV-positive persons were eligible for trials (60.2%), and only 20% thought a preventive vaccine could help control HIV. HIV vaccine awareness increased from 68% at baseline to 81% at follow-up (P<0.001). Willingness to participate in HIV-preventive vaccine trials was 77%. Vaccine knowledge and willingness to participate in trials are high in this population. However, there still is need for education on the potential role of preventive HIV vaccines in the control of the epidemic and the importance of vaccination for men, especially in the context of an HIV vaccine.

背景与目标： : 该研究的目的是评估有关疫苗的知识和信念以及参与HIV疫苗试验的意愿。一项基线调查评估了14,177名年龄在15-49岁之间的参与者对疫苗接种和潜在HIV疫苗的知识和态度。在提供艾滋病毒疫苗社区教育后10个月的后续调查中，评估了参与艾滋病毒预防疫苗试验的意愿。对疫苗的预防效用的了解很高 (71%)，但男性高于女性 (P<0.001)，并且随着教育水平的提高 (P<0.001)。疫苗被认为适用于儿童和妇女 (分别为99和88%)，但不适用于成年男子 (28%)。参与者认为青少年是最适合进行HIV预防疫苗试验的对象 (93.7%)，但也认为HIV阳性的人有资格进行试验 (60.2%)，只有20% 认为预防性疫苗可以帮助控制HIV。HIV疫苗意识从基线时的68% 提高到随访时的81% (P<0.001)。77% 了参与艾滋病毒预防疫苗试验的意愿。在这一人群中，疫苗知识和参与试验的意愿很高。然而，仍然需要就预防性艾滋病毒疫苗在控制这一流行病中的潜在作用以及对男子接种疫苗的重要性进行教育，特别是在艾滋病毒疫苗的背景下。

BACKGROUND & AIMS: BACKGROUND:Microbial contamination of hospital environment, especially in operating theatres (OT) and other specialized units has greatly contributed to continuous and multiple exposure to nosocomial infections by patients and the public. We purposed to assess microbial contamination of operating theatres and antibacterial sensitivity pattern of bacteria isolated from theatres of Mbale Regional Referral Hospital, Eastern Uganda. METHODS:We employed a laboratory based cross-sectional study design. Swabbing of different surfaces and settle plate establishment in 4 various operating theatres was carried out. A total of 109 samples were collected, 31 air samples and 78 swabs from four operating theatres. Samples were collected in the mornings after disinfection prior to start of daily operations. Antibacterial sensitivity testing of isolated bacterial pathogens was performed by Kirby Bauer disc diffusion method following standard operating procedure. Colony counts for the settle plates were carried out using a colony counter. RESULTS:All the four theatres had their mean colony counts exceeding the acceptable limit of 5 cfu/dm2/h. Gynaecology theatre had up to 261 cfu/dm2/h and Ophthalmology operating theatre had approximately 43 cfu/dm2/h. A total of 14 different organisms were isolated with Pseudomonas spp. [23.9%]; Bacillus spp. [17.5%] and Aspergillus spp. [15.8%] being the most common contaminants respectively. Other isolates included Enterococcus spp., Rhizopus spp. and Coagulate Negative Staphylococcus isolates especially from settle plates. Most bacterial isolates showed considerable resistance to antibacterial agents. Pseudomonas spp. was resistant to chloramphenicol (53.6%) and cotrimoxazole (57.1%). Most of the bacterial pathogens were sensitive to imipenem [83.3%]. CONCLUSIONS:There is moderate contamination of operating theatres of Mbale Regional Referral Hospital. Common organisms were Pseudomonas, Bacillus, and Aspergillus spps. Resistance was observed against chloramphenicol and cotrimoxazole. More caution is necessary to carefully disinfect the operating theatres at Regional referral settings and similar tertiary health care centres with more emphasis on obstetrics and gynecology theatres. Diagnosis and care of patients at such clinical settings should consider the possibility of antibiotic resistance.

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BACKGROUND & AIMS: BACKGROUND:Although there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. METHODS:A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. RESULTS:Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. CONCLUSION:Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.

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