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Oxidative stress during pregnancy has been a mechanistic pathway implicated in autism development, yet few studies have examined this association directly. Here, we examined the association of prenatal levels of 8-iso-PGF2α, a widely used measure of oxidative stress, and several neurodevelopmental outcomes related to autism in children. Participants included 169 mother-child pairs from the Early Autism Risk Longitudinal Investigation (EARLI), which enrolled mothers who had an autistic child from a previous pregnancy and followed them through a subsequent pregnancy and until that child reached age 3 years. Maternal urine samples were collected during the second trimester of pregnancy and were later measured for levels of isoprostanes. Child neurodevelopmental assessments included the Mullen Scales of Early Learning (MSEL), the Social Responsiveness Scale (SRS), and the Vineland Adaptive Behavior Scale (VABS), and were conducted around 36 months of age. Primary analyses examined associations between interquartile range (IQR) increases in 8-iso-PGF2α levels, and total composite scores from each assessment using quantile regression. In adjusted analyses, we did not observe statistically significant associations, though estimates suggested modestly lower cognitive scores (β for MSEL = −3.68, 95% CI: -10.09, 2.70), and minor increases in autism-related trait scores (β for SRS T score = 1.68, 95% CI: -0.24, 3.60) with increasing 8-iso-PGF2α. These suggestive associations between decreased cognitive scores and increased autism-related traits with increasing prenatal oxidative stress point to the need for continued investigation in larger samples of the role of oxidative stress as a mechanistic pathway in autism and related neurodevelopmental outcomes.

Seasonal malaria chemoprevention (SMC) aims to prevent malaria in children during the high malaria transmission season. The Achieving Catalytic Expansion of SMC in the Sahel (ACCESS-SMC) project sought to remove barriers to the scale-up of SMC in seven countries in 2015 and 2016. We evaluated the project, including coverage, effectiveness of the intervention, safety, feasibility, drug resistance, and cost-effectiveness.

ABSTRACTThis paper examines the effect of an asset-based intervention on academic performance and school transition among orphaned and vulnerable children in Uganda. Participants were randomly assigned to either the control arm or two treatment arms receiving an asset-based intervention. Participants in the treatment arms scored better grades; and had higher odds of transitioning to post-primary education relative to the control arm. Programmes which target financial insecurity may have a positive impact on the educational achievement and progression of orphaned children. There is a need to consider incorporating asset-based interventions within the development of educational policy, especially in low-income countries.

Tuberculosis (TB) is the leading cause of death in persons living with HIV (PLHIV). PLHIV carry a disproportionate burden of TB infection with risks 20–37 times greater than HIV-negative populations. While isoniazid preventive treatment (IPT) is regarded as a crucial component of HIV care to prevent active TB, the uptake among PLHIV remains very poor. Studies on the factors associated withIPT interruption and completion among PLHIV in Uganda are scarce. Thus, in Gombe Hospital in Uganda, this study assessed the factors associated withIPT interruption and completion among PLHIV.

The introduction of user-payment for health services is frequently followed by concern about the impact on equity of access for poor people. Decentralizing governments often try to remedy the created inequities by putting in place safety nets in the form of exemptions and waivers in the user-fee systems. However, where user payments merely operate as local government strategies for health financing, without national policy they are likely to be self-defeating, as local governments are frequently more interested in raising revenue to meet recurrent costs of devolved services than in promoting equity. Thus guidelines put in place by the central government to operationalize safety nets are seen by local governments as being contradictory to this goal, and are thus ignored or altered to suit the district revenue aims. This study was carried out to investigate the context and the constraints in implementing exemption schemes. Data were collected in two selected administrative districts of Uganda (Mbarara and Mukono). Qualitative approaches to data collection were adopted, namely focus group discussions and key informant interviews with policy-makers, health administrators, service providers and community members. These methods were combined with document review.
We found little evidence of safety-net guidelines initiated by decentralized/local governments, since district local governments had little motivation to extend exemptions, waivers or credits. The conclusion is that safety nets such as waivers and exemptions will only be effective if they are backed by a national health financing policy, they reconcile the often competing demands of local government revenue needs, and are strictly enforced and supervised by both the local and central governments. The implications of the findings for remedying the tension between the needs for cost recovery and for attainment of equity goals through exemption policies for the poor and indigent are discussed.

IntroductionMakerere and Mulago Palliative Care Unit (MPCU) provides quality, evidence-based palliative care (PC) for patients and families through a centre of excellence delivering: an integrated clinical service within the national referral hospitals site; carrying out research, training and capacity-building in collaboration with partners; and developing leaders in PC.MethodsAn evaluation of the 2011–2016 strategic plan was undertaken. A review of indicators was completed including: care provision; training numbers; collation of impact assessments; an online survey and qualitative interviews addressing research capacity, and the qualifications attained by MPCU staff.ResultsA total of 9858 patients seen (3189 directly by MPCU with 6669 by link nurses. 4630 individuals trained including undergraduates, postgraduate, and in-service short courses. 1223 of those trained came from 8 other countries within the region. MPCU staff gained: 5 BSc, 2 Masters, 1 PhD qualifications. 103 abstracts presented at national and international conferences and 11 papers published. Impact assessments include: evaluation of integrated model including link nurses; outcome of PC interventions; educational impact; research capacity building; morphine use; experience of patients and staff; and evaluation of specific projects.ConclusionsDeveloping a strategic plan embedding a coherent and integrated approach to PC ensures evidence based practice has become routine and outcomes regularly assessed.. Partnerships have allowed for wide project work and dissemination. An integrated model allows generalist PC to be empowered with specialist support This review is helping shape the next strategic plan.

BackgroundAccess to palliative care (PC) in Uganda has been hampered by the lack of prescribers. Thus PC care trained nurses have been able to prescribe since 2004, however, no full scale evaluation had been undertaken, despite the fact that PC stakeholders are advocating for nurse prescribing in other countries. Thus an evaluation was undertaken to determine the effectiveness of PC nurse prescribing in Uganda.MethodologyThe mixed methods evaluation was undertaken in three parts:Preparation of the nurses for the role;Assessing and managing pain & symptoms;An appraisal of the system in which the nrses are working.Ethical approval was gained prior to the evaluation commencing.ResultsTraining: the curriculum prepares the nurses well, however, a few adaptions are recommended to strengthen it further. Themes identified from 18 interviews included: the training itself, supervision and mentorship, compentency, and beliefs.Assessing and managing pain: 22 nurses were recruited to care for 20 PC patients each, visiting them on at least 2 occassions, assessing and managing their pain and other symptoms, and utilising the APCA POS. Analysis demonstrates nurses are able to assess and manage pain, giving appropriate mediciations and reassessing.The appraisal in 10 districts, showed nurses are working in a system which can impact negatively on care provision e.g. stck–outs of analgesics, limited understanding of PC generally: and many myths exist re the use of morphine and provision of PC.Trained palliative care nurses can assess and manage patients pain, prescribing morphine and associated medications appropriately. Whilst challenges exist, recommendations are made to improve the system, this evaluation has clearly shown the benefit and safety of nurse prescribing for PC in Uganda. This study has important implications for the global debate on issues of access to oral morphine and task shifting.Conclusion

BackgroundIn order for palliative care to be provided to all in need, an integrated approach to service delivery is needed, where a mixture of specialist and generalist care is provided. A needs assessment in 2010 showed 40% of patients in Mulago hospital have palliative care needs. Thus the Makerere Palliative Care Unit (MPCU) developed a programme to train link–nurses across the hospital supported by a referral pathway and identification process.AimsTo integrate palliative care into all wards of Mulago Hospital through a link-nurse programme.Methods27 link nurses from 11 clinical areas, were trained and mentored over the past 2 years. An evaluation of the programme was carried out using quantitative and qualitative data collection methods including; pre and post course confidence ratings; course evaluation forms; review of link-nurse activity sheets and action plans; review of MPCU patient documentation; Most Significant Change (MSC); and focus group discussions (FGDs).ResultsLink nurses cared for 1,684 patients during 2012, of these, 336 (20%) were referred to MPCU for specialist input. Referral patterns suggest the complexity of patients referred to MPCU has increased with >75% of MPCU patients having complex needs requiring specialist input. Results of the evaluation suggest the link-nurse programme has helped integrate PC throughout the hospital. There has been a change in attitudes, the nurses have developed new skills and knowledge, there is improved relationships and better outcomes of care. Challenges identified include heavy work-load and the need for training for other staff.ConclusionThe link-nurses felt they were able to provide better PC to those that needed it, and had a stronger relationship with the MPCU both in terms of support, but also for referrals. The integration of PC throughout hospitals is vital, and the link-nurse programme demonstrates a successful model.