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ObjectivesThe overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts.DesignA comparative case study approach, analysing variation in outcomes across different settings.SettingStudies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case.Participants28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria.InterventionsThe interventions included different mRDT training packages, supervision, supplies and community sensitisation.Outcome measuresAnalysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial).ResultsOutcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs.ConclusionsBasic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.

Nodding syndrome as a distinctive entity was reported from southern Sudan in the 1990s and investigated by local authorities and the World Health Organization (WHO) during 2001-2002 (1,2). In retrospect, [...]

Objective To compare the safety and quality of contraceptive injections by community-based health workers with those of clinicbased nurses in a rural African setting. Metheds A nonrandomized community trial tested provision of injectable Depo Provera (DMPA) by community reproductive health workers and compared it with routine DPMA provision at health units in Nakasongola District, Uganda. The primary outcome measures were safety, acceptability and continuation rates. Findings A total of 945 new DMPA users were recruited by community workers, clinic-based nurses and midwives. Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients. Ninety-five percent of community-worker clients were "satisfied" or "highly satisfied" with services, and 85% reported receiving information on side-effects. There were no serious injection site problems in either group. Similarly, there was no significant difference between continuation to second injection (88% among clients of community-based workers, 85% among clinic-going clients), nor were there significant differences in other measures of safety, acceptability and quality. Conclusion Community-based distribution (CBD) of injectable contraceptives is now routine in some countries in Asia and Latin America, but is practically unknown in Africa, where arguably the need for this practice is greatest. This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections. Une traduction en francais de ce resume figure 2, la fin de l&apos;artide. Al final del articulo se facilita una traducci6n al espanol. Resume Injections contraceptives par des agents de sante communautaires en Ouganda : essai en communaute non randomise Objectif Comparer I&apos;innocuite et la qualite d&apos;injections contraceptives effectuees par des agents de sante communautaires avec celles d&apos;injections realisees par du personnel infirmier en milieu clinique dans des zones rurales africaines. Methodes Dans le cadre d&apos;un essai en communaute non randomise, on a etudie la delivrance de Depo Provera injectable (DMPA) par des agents communautaires formes a la sante genesique et on l&apos;a comparee avec la delivrance habituelle de ce contraceptif dans les etablissements sanitaires de district de Nakasongola en Ouganda. Les principales mesures de performance etaient I&apos;innocuite, I&apos;acceptabilite et le taux de continuation de la contraception. Resultats Des agents de sante communautaires, ainsi que du personnel infirmier et des sages-femmes exercant en milieu clinique, ont recrute au total 945 nouvelles utilisatrices de DMPA. Les chercheurs ont reussi a suivre 777 (soit 82 %) d&apos;entre elles, clont 449 clientes d&apos;agents de sante communautaires et 328 clientes d&apos;etablissements cliniques. 95 % des clientes d&apos;agents communautaires se sont declarees << satisfaites )) ou << tres satisfaites >> de la prestation et 85 % ont signa]e avoir recu des informations sur Tes effets secondaires. Aucun probleme grave lie au site d&apos;injection n&apos;est apparu dans aucun des groupes. De meme, aucune difference notable en termes de continuation avec la deuxieme injection (88 % chez les clientes des agents de sante communautaires et 85 % chez les clientes d&apos;etablissements cliniques), ou d&apos;innocuite, d&apos;acceptabilite et de qualite, n&apos;a ete relevee. Conclusion La delivrance dans le cadre communautaire (CBD) de contraceptifs injectables est maintenant courante dans certains pays d&apos;Asie et d&apos;Amerique latine, mais pratiquement inconue en Afrique, on cette pratique est peut etre la plus necessaire. La presente etude confirme I&apos;experience acquise dans d&apos;autres regions, qui laisse e penser que des agents de sante communautaires convenablement formes peuvent pratiquer sans risque des injections contraceptives. Resumen Administracion de anticonceptivos inyectables por agentes de salud comunitarios en Uganda: ensayo comunitario no aleatorizado Objetivo Comparar la seguridad y calidad de las inyecciones anticonceptivas administradas por agentes de salud comunitarios con la de las administradas por personal de enfermeria de dispensario en un entorno rural de africa. Metodos Se llevo a cabo un ensayo comunitario no aleatorizado para analizar la administracion de Depo Provera (DMPA)inyectable por agentes de salud reproductiva comunitarios y comparada con la administracion ordinaria de DPMA en unidades de salud del distrito de Nakasongola en Uganda. Las medidas de resultado principales fueron la seguridad, la aceptabilidad y las tasas de continuacion. Resultados Agentes comunitarios, enfermeras de ambulatorio y parteras reclutaron en total a 945 nuevas usuarias de DMPA. Los investigadores siguieron con exito a 777 de ellas (82%): 449 mujeres atendidas por agentes comunitarios y 328 tratadas en dispensarios. El 95% de las mujeres atendidas por los primeros declararon estar << satisfechas>> o <> con los servicios, y el 85% dijeron que habian recibido informacion sobre los efectos secundarios. No se registraron problemas graves relacionados con el punto de inyeccion en ninguno de los grupos. De forma similar, no se observaron diferencias importantes ni en lo tocante a la continuacion hasta la segunda inyeccion (88% de las mujeres atendidas por agentes comunitarios, 85% de las que acudieron a un dispensario) ni en otras medidas de la seguridad, aceptabilidad y calidad. Conclusion La distribucion comunitaria de anticonceptivos inyectables es hoy dia algo corriente en algunos paises de Asia y America Latina, pero es practicamente desconocida en efrica, precisamente donde se diria que mas necesaria es dicha practica. Esta investigacion confirma la experiencia de otras regiones y parece indicar que los agentes de salud comunitarios debidamente adiestrados para ello pueden administrar de manera segura las inyecciones anticonceptivas., Introduction Africa is home to dozens of programmes for community-based distribution (CBD) of contraceptives. However, the popularity and impact of programmes that use paramedical workers to distribute condoms and oral [...]

Abstract Background Limited data are available on the distribution of human papillomavirus (HPV) genotypes in the general population and in invasive cervical cancer (ICC) in Uganda. Yet, with the advent of preventive HPV vaccines that target HPV 16 and 18 responsible for causing about 70% of ICC cases in the world, such information is crucial to predict how vaccination and HPV-based screening will influence prevention of ICC. Methods To review the distribution of HPV infection and prevalent genotypes, electronic databases (e.g. PubMed/MEDLINE and HINARI) were searched for peer reviewed English articles on HPV infection up to November 30, 2010. Eligible studies were selected according to the following criteria: DNA-confirmed cervical or male genital HPV prevalence and genotypes, HPV incidence estimates and HPV seroprevalence among participants. Results Twenty studies were included in the review. Among HIV negative adult women, the prevalence of HR-HPV infections ranged from 10.2% -40.0% compared to 37.0% -100.0% among HIV positive women. Among HIV positive young women aged below 25 years, the prevalence of HR-HPV genotypes ranged from 41.6% -75.0% compared to 23.7% -67.1% among HIV negative women. Multiple infections with non vaccine HR-HPV genotypes were frequent in both HIV positive and HIV negative women. The main risk factors for prevalent HPV infections were age, lifetime number of sexual partners and HIV infection. Incident infections with HR-HPV genotypes were more frequent among adult HIV positive than HIV negative women estimated at 17.3 and 7.0 per 100 person-years, respectively. Similarly, incident HR-HPV among young women aged below 25 years were more frequent among HIV positive (40.0 per 100 person-years) than HIV negative women (20.3 per 100 person-years) women. The main risk factor for incident infection was HIV infection. HPV 16 and 18 were the most common genotypes in ICC with HPV 16/18 contributing up to 73.5% of cases with single infections. Among uncircumcised adult HIV positive males, HR-HPV prevalence ranged from 55.3% -76.6% compared to 38.6% -47.6% in HIV negative males. Incident and multiple HR-HPV infections were frequent in HIV positive males. Being uncircumcised was the main risk factor for both prevalent and incident HPV infection. Conclusion Infections with HR-HPV genotypes were very common particularly among HIV positive individuals and young women irrespective of HIV status. Given the high prevalence of HIV infection, HPV-associated conditions represent a major public health burden in Uganda. However, although the most common HPV genotypes in ICC cases in Uganda were those targeted by current preventive vaccines, there were a large number of individuals infected with other HR-HPV genotypes. Technology allowing, these other HR-HPV types should be considered in the development of the next generation of vaccines.

Abstract Background National malaria control programmes and international agencies are keen to scale-up the use of effective rapid diagnostic tests (RDTs) for malaria. The high proportion of the Ugandan population seeking care at drug shops makes these outlets attractive as providers of malaria RDTs. However, there is no precedent for blood testing at drug shops and little is known about how such tests might be perceived and used. Understanding use of drug shops by communities in Uganda is essential to inform the design of interventions to introduce RDTs. Methods We conducted a qualitative study, with 10 community focus group discussions, and 18 in-depth interviews with drug shop attendants, health workers and district health officials. The formative study was carried out in Mukono district, central Uganda an area of high malaria endemicity from May-July 2009. Results Drug shops were perceived by the community as important in treating malaria and there was awareness among most drug sellers and the community that not all febrile illnesses were malaria. The idea of introducing RDTs for malaria diagnosis in drug shops was attractive to most respondents. It was anticipated that RDTs would improve access to effective treatment of malaria, offset high costs associated with poor treatment, and avoid irrational drug use. However, communities did express fear that drug shops would overprice RDTs, raising the overall treatment cost for malaria. Other fears included poor adherence to the RDT result, reuse of RDTs leading to infections and fear that RDTs would be used to test for human immune deficiency virus (HIV). All drug shops visited had no record on patient data and referral of cases to health units was noted to be poor. Conclusion These results not only provide useful lessons for implementing the intervention study but have wide implications for scaling up malaria treatment in drug shops.