Background: In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer's disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. Methods: Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of older adults diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS. Ti software. Results: There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers' shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship.

Sweetpotato is a nutritional source worldwide. Soft rot caused by Rhizopus spp. is a major limiting factor in the storage of produce, rendering it potentially unsafe for human consumption. In this study, Rhizopus oryzae was used to develop a concept of postharvest disease control by weakening the pathogen through induction of spore germination under starvation conditions. We isolated the sweetpotato active fractions (SPAFs) that induce spore germination and used them at a low dose to enhance spore weakening caused by starvation. Germination in SPAF at 1 mg/ml weakened the pathogen spores by delaying their ability to form colonies on rich media and by increasing their sensitivity to heat stress. The weakening effect was also supported by reduced metabolic activity, as detected by Alarmar Blue fluorescent dye assays. Spores incubated with SPAF at 1 mg/ml showed DNA fragmentation in some of their nuclei, as observed by TUNEL assay. In addition, these spores exhibited changes in ultrastructural morphology (i.e., shrinkage of germ tubes, nucleus deformation, and vacuole formation) which are hallmarks of programmed cell death. We suggest that induction of spore germination under starvation conditions increases their susceptibility to stress and, therefore, might be considered a new strategy for pathogen control.

Pineapple pulp fiber is highly palatable but is usually wasted during the processing of pineapple juice resulting in a loss in the pineapple value chain. It is known to contain both soluble and insoluble dietary fiber, antioxidants, vitamins, bromelain, and many important minerals. Changing lifestyles associated with most western diets characterized by excess intake of calories has led to increased incidence of type 2 diabetes mellitus in Africa. Moreover, hyperglycemia in diabetes mellitus is linked to increased generation of reactive oxygen species (ROS) leading to oxidative stress. ROS are known to damage cellular macromolecules including oxidation of lipids and nucleic acids. The need to formulate dietary formulas to achieve both reductions of calories with enhanced antioxidant potential inspired us to design a wheat flour-based formula enriched with pineapple pulp fiber of up to 10% of its weight. Pineapple pulp fiber-enriched wheat flour positively impacts the pineapple value chain. This study aimed at determining the antioxidant potential of the pineple pulp fibre enriched wheat flour. Pineapple pulp fiber-enriched wheat flour was prepared by mixing 10 g of dry and milled pineapple pulp with 90g of all-purpose wheat flour. The total polyphenolic content, total flavonoid content, and ferric reducing antioxidant power of the enriched and non-enriched wheat flour were determined using spectrophotometric method. The results were statistically analysedusing t-tests at a p < 0.05 level of significance. Enrichment of wheat flour with pineapple pulp fiber significantly increased the total polyphenolic content (p = 0.001), total flavonoids content (p = 0.002), and Ferric Reducing Antioxidant Power (FRAP) (p = 0.001) of the flour. These results indicate that pineapple pulp fiber has a potential to enhancing the nutritional quality of wheat flour through added antioxidant properties.

Background HIV and mental illness comorbidity remain one of the healthcare challenges with limited information and medical care attention. The co-existence of the two, result in poor coping thereby increasing vulnerability and poor health-related wellbeing. A number of strategies for coping with HIV and mental illness have been reported for individual states of HIV and mental illness but there is limited data on comorbidity states. In this study, we aimed at exploring coping strategies for HIV and Mental illness comorbidity among adult patients in southwestern Uganda and potential points of intervention that can mitigate challenges they encounter. Methods A descriptive cross-sectional qualitative study design was used. Purposive sampling was used to recruit 26 adult (≥ 18 years) patients attending health care services at one hospital and one health Centre IV in Sheema and Isingiro district respectively, in southwestern Uganda. Data was collected using in-depth interviews, was audio recorded, transcribed verbatim from the local language and translated into English. Data was managed and analyzed using ATLAS.Ti software. Results A wide range of coping strategies categorized as individual centered, family support, healthcare and social support were reported. Avoidance of emotional stressors like quarrels, worries and annoyance was the most common. Other strategies were; seeking medical care, abstinence from sex, attending educational trainings, health status disclosure and caring for self. In coping with the comorbidity, several challenges were encountered, but various points of intervention including financial aid and scaling up training or educating masses on the causes, dangers and preventive measures of these diseases were suggested to improve the quality of life and also to prevent new infections. Conclusions We found variability in coping strategies categorized as individual centered, family support, healthcare support and social support. Avoidance of emotion stressors was a common coping strategy among the respondents. Several challenges are encountered in coping but potential points of interventions to mitigate the challenges were identified. Scaling up healthcare education for all, and tailored trainings to promote coping with HIV and mental illness comorbidity, together with adopting financial aid programs directed towards poverty alleviation among these patients were recommended.

Background: In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer’s disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. Methods: Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of elderly patients diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS.Ti software. Results: There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers’ shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter.. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship. Conclusions: Our study findings indicate that caregivers/families of patients with dementia went to different places both formal and informal care settings while seeking health care. However, hospital point of care was more frequent at initial health care visits while places of worship took the lead at subsequent visits. Although no specific pathway reported, most of them begin with hospital (formal) and end with non-formal. We recommend that health systems carry out public awareness on dementia. Key words: Alzheimer’s disease and related dementias, caregiver, dementia, pathways to health care and Southwestern Uganda.