Schistosomiasis is the second most important parasitic infection after malaria in terms of its socioeconomic impact and is endemic in 78 countries. It affects more than 240 million people worldwide, with 90% of cases occurring in sub-Saharan Africa. In Uganda, Schistosoma mansoni is the most common species, with more than seven million people infected and 17 million living at risk despite mass drug administration (MDA) of praziquantel initiated more than 16 years ago. There has been a shift in the WHO schistosomiasis goals from controlling morbidity to elimination as a public health problem. Understanding the drivers of infection in persistent transmission hotspots despite ongoing control interventions is paramount. We conducted a cross-sectional epidemiological study of 381 individuals in Bugoto community, Mayuge district, Eastern Uganda, along with a structured survey to ascertain drivers of S. mansoni infection. Bugoto has had community-wide MDA since 2003. We detected an S. mansoni prevalence of 52% across the whole community and a prevalence of 71% in school-age children. This qualifies Bugoto as a highly endemic community according to WHO guidelines. Using a multivariate logistic regression, we found that S. mansoni infection was best explained by age group, longer residence times, and at least 5 minutes of daily contact with lake water. Schistosoma mansoni infection remains a large burden across this community. This study identifies opportunities for interventions that reduce lake water contact, expand treatment eligibility to all at risk, and improve MDA coverage for long-term residents in these settings to control schistosomiasis in persistent transmission hotspots.

Background The renaissance of tuberculosis (TB) through certain groups of the population including patients with mental illness has been observed for the last 30 years. However, literature on treatment outcomes of patients with mental illness is still scarce. The following research examines the impact of concurrent mental health illness on TB treatment outcomes in Butabika National Referral Mental Hospital. Methods A retrospective analysis of data for registered TB patients with and without mental-illness for the period July 2013 to December 2015. Data was extracted for age, sex, human immunodeficiency virus (HIV) serostatus and Directly Observed Treatment (DOT) status, TB classification and history of TB treatment. For HIV co-infected patients, data on Co-trimoxazole preventative therapy (CPT) and anti-retroviral therapy (ART) uptake was collected. Treatment outcomes of patients with and without mental illness were analyzed. Results A total of 325 records were analyzed, of which 105 (32%) patients were found to have had mental illness. Of the patients with mental illness, 61 (58%) were HIV positive while of those without mental illness, 134 (61%) were HIV positive. Patients with mental illness were less likely to complete treatment (adj. OR 0.3, 95% CI 0.2 - 0.5, p = 0.000) more likely to die, (adj. OR 2.3, 95% CI 1.2 – 4.3, p = 0.01) and more likely to get lost to follow up during treatment (adj. OR 2.8, 95% CI 1.3 – 6.0, p = 0.005) compared to those without mental illness. Conclusion Mental illness is associated with unfavorable outcomes of TB treatment. We recommend targeted interventions for patient follow up at this hospital and further studies to guide improvement in the quality care in this patient population. We also recommend psychosocial assessment and counselling for all patients on TB treatment as practice to improve treatment outcomes for all TB patients in Kampala.