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As part of a multicentre study on kidney disease (ARK) undertaken in Malawi, South Africa and Uganda we undertook a social science component in Uganda to gather information on people's understandings and perceptions of a diagnosis of kidney dysfunction, treatment and treatment seeking. We recruited 46 people who had been given information about kidney dysfunction and had been found to have some, usually early, signs of mild impairment. Data were collected during two in-depth interviews. Most participants had heard of the condition, but half denied knowledge of the health status of their kidneys or receiving results of tests from the clinic team. This response may have been linked to a lack of symptoms, for those with early stage kidney dysfunction. The treatment people reported receiving caused some uncertainty about condition severity. This may be because several people were treated for other conditions (such as urinary tract infections) and did not require treatment specifically for kidney disease. In our study, participants assessed illness severity based on symptoms and treatment and compared with the progression of other conditions.

The use of audio recordings has become a taken-for-granted approach to generating transcripts of in-depth interviewing and group discussions. In this paper we begin by describing circumstances where the use of a recorder is not, or may not be, possible, before sharing our comparative analysis of audio-recorded transcriptions and interview scripts made from notes taken during the interview (by experienced, well-trained interviewers). Our comparison shows that the data quality between audio-recorded transcripts and interview scripts written directly after the interview were comparable in the detail captured. The structures of the transcript and script were usually different because in the interview scripts, topics and ideas were grouped, rather than being in the more scattered order of the conversation in the transcripts. We suggest that in some circumstances not recording is the best approach, not ‘second best’.

The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations.We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa.Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 mEstimating GFR using serum creatinine substantially underestimates the individual and population-level burden of impaired kidney function in Africa with implications for understanding disease progression and complications, clinical care, and service provision. Scalable and affordable ways to accurately identify impaired kidney function in Africa are urgently needed.The GSK Africa Non-Communicable Disease Open Lab.For the Luganda, Chichewa and Xitsonga translations of the abstract see Supplementary Materials section.

We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.

Much research on the impact of HIV and AIDS on older people fails to differentiate between age groups, and treats those aged from 50 years to the highest ages as homogeneous. The ‘oldest old’ or those aged over 75 years may be particularly vulnerable through declining health and independence as a result of the AIDS epidemic, which has forced some to take on roles that younger relatives would have performed had they lived. In this paper we describe the past and current experience of eight people in advanced old age living in rural Uganda who were informants for an ethnographic study of the impact of HIV and AIDS on households during 1991–92 and again in 2006–07. The aim of the study was to understand how they had coped with the impacts of the epidemic. From the eight case studies, it is concluded that family size, socio-economic status and some measure of good fortune in sustained good health enabled these people to live to an advanced age. While we recommend that targeted social protection is important in helping the poorest among the oldest, we suggest that sustaining respect for age and experience, and ensuring that older people do not feel discarded by family and society are as important as meeting their practical needs.

Background : Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. Objectives : To study specific personal barriers to ART adherence. Methods : Quantitative data on patients’ health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. Results : Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. Conclusions : ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability. Key words : Personal barriers, ART adherence, stigma, disclosure, children desire, sexual dysfunction

This study was conducted in order to understand how women in rural Uganda recognise malaria, their treatment-seeking behaviour when malaria is suspected and how the perception of cause may influence this behaviour. Focus group discussions and semi-structured interviews were held with women selected from the general population and from women attending health clinics for both preventive and curative services. The main finding of this study was that the word used for malaria in the local language, omusujja, covered a broad symptom complex which did not consistently correspond to the clinical case definition of malaria. Since there was no specific word for 'malaria', the study was broadened to encompass omusujja. The women reported that omusujja was an important health problem which had various causes, including poor diet, environmental conditions, and the bites of mosquitoes. The symptoms associated with omusujja were quite varied and ranged from generally 'feeling unwell' to a specific fever diagnosis (usually in children) of 'a rise in body temperature'. Women recognised that omusujja posed a particular threat to pregnant women. Preventive actions recommended by the women were in line with their perceptions of cause. The respondents usually mentioned the use of herbs as the first treatment action, followed by the purchase of tablets from shops, with the final recourse being the formal health sector if the previous actions had not effected a cure.(ABSTRACT TRUNCATED AT 250 WORDS)To facilitate the design of malaria prevention and control programs in tropical Africa, a qualitative investigation of treatment seeking behaviors and perceptions of the causes and symptoms of malaria was conducted in a rural area in South Western Uganda's Masaka District. Components of the investigation included focus group discussions involving 42 participants recruited from women's clubs and prenatal and child health clinics, semi-structured interviews with 395 female outpatients 13 years of age and above and adult women escorting young children to government subdispensaries for treatment of a new malaria episode, and household interviews with 64 mothers. In this rural community, there is no specific word for malaria; rather, the word "omusujja" is used to refer to malarial symptoms as well as any kind of fever. Respondents consistently identified omusujja as the most prevalent, serious disease in their community. They linked its causation to food and drink, environmental conditions, vectors such as mosquitoes, and other illnesses. There was widespread awareness that omusujja presents differently according to age group, e.g. fever, refusal to suck, crying, vomiting, and mouth sores in infants as compared to miscarriage, vomiting, weakness, chills, and joint pain in pregnant women. Treatment is initiated promptly, although it mainly consists of use of local herbs; if the herbs fail to reduce the fever, hospital care is sought. Preventive methods cited included boiling water, cleaning cooking utensils, avoiding raw mangoes and roasted maize, and keeping mosquitoes out of the home. Recommended is a health education campaign emphasizing the role of mosquitoes in malaria transmission and the need for prompt medical intervention.