BackgroundChildhood undernutrition is a major challenge in Uganda with a prevalence of wasting and stunting at 5% and 33%, respectively. Community and family practices of the Integrated Management of Childhood Illnesses (C-IMCI) was introduced in sub-Saharan Africa early after the year 2000. C-IMCI was postulated to address major childhood morbidity and mortality challenges with nutrition as one of the outcomes. The association between knowledge patterns of C-IMCI and undernutrition has not been fully established especially in sub-Saharan Africa. This study was done to address the prevalence of stunting and wasting and the association with the knowledge and practices of C-IMCI among caretakers in Gulu district, Northern Uganda.MethodsThis was a community-based cross-sectional study among 442 caretaker-child pairs. A standardized questionnaire was employed to assess the knowledge and practices of the C-IMCI among caretakers including four practices: breastfeeding, immunization, micronutrient supplementation and complementary feeding. Weight and height of children (6–60 months) were recorded. Wasting and stunting were defined as weight-for-height and height-for-age z-score, respectively, with a cut-off < -2 according to the World Health Organization growth standards. Logistic regression analysis reporting Odds Ratios (OR) with 95% confidence intervals (CI) was used to explore associations using SAS statistical software.ResultsThe percentage of caretakers who had adequate knowledge on C-IMCI (basic knowledge within each pillar) was 13%. The prevalence of wasting and stunting were 8% and 21%, respectively. Caretakers’ lack of knowledge of C-IMCI was associated with both wasting (OR 24.5, 95% CI 4.2-143.3) and stunting (OR 4.0, 95% CI 1.3-12.4). Rural residence was also associated with both wasting (OR = 3.1, 95% CI 1.5-6.5) and stunting (OR = 1.7, 95% CI 1.0-2.7). Children younger than 25 months were more likely to be wasted (OR = 3.3, 95% CI 1.7-10.0).ConclusionWe found a low level of overall knowledge of the C-IMCI of 13.3% (n = 59). There is also a high prevalence of childhood undernutrition in Northern Uganda. Caretakers’ limited knowledge of the C-IMCI and rural residence was associated with both wasting and stunting. Interventions to increase the knowledge of the C-IMCI practices among caretakers need reinforcement.

IntroductionAccurate and affordable laboratory testing is key to timely diagnosis and appropriate management of patients with COVID-19. New laboratory test protocols are released into the market under emergency use authorisation with limited evidence on diagnostic test accuracy. As such, robust evidence on the diagnostic accuracy and the costs of available tests is urgently needed to inform policy and practice especially in resource-limited settings. We aim to determine the diagnostic test accuracy, cost-effectiveness and utility of laboratory test strategies for COVID-19 in low-income and middle-income countries.Methods and analysisThis will be a multistaged, protocol-driven systematic review conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy studies. We will search for relevant literature in at least six public health databases, including PubMed, Google Scholar, MEDLINE, Scopus, Web of Science and the WHO Global Index Medicus. In addition, we will search Cochrane Library, COVID-END and grey literature databases to identify additional relevant articles before double-screening and abstraction of data. We will conduct a structured narrative and quantitative synthesis of the results guided by the Fryback and Thornbury framework for assessing a diagnostic test. The primary outcome is COVID-19 diagnostic test accuracy. Using the GRADE approach specific to diagnostic accuracy tests, we will appraise the overall quality of evidence and report the results following the original PRISMA statement. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero/).Ethics and disseminationEthical review was done by the School of Biomedical Sciences Research Ethics Committee and the Uganda National Council for Science and Technology. The published article will be accessible to policy and decision makers. The findings of this review will guide clinical practice and policy decisions and highlight areas for future research.PROSPERO registration number CRD42020209528.

Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs. Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA. Results Thirteen articles were from studies in China and one from Turkey. All studies included used the Real-time polymerase chain reaction test (RT-PCR) as their reference test. 21.4% (n = 3) of articles were determining the diagnostic accuracy of the PCR test. The remaining studies (n = 11) used other COVID-19 tests as the index tests. It is generally observed that the tests were more specific than sensitive pooled sensitivity and specificity was 87.6%, (95% CI: 82.2% − 93%), 98.1% (95% CI: 96.4%-100%) respectively. The Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) tests had the highest sensitivity as compared to RT-PCR, serological and chemiluminescent immunoassays (CLIA). The specificity and sensitivity of the tests were highest when bronchial lavage samples were used and lowest with the use of serum specimens/sample. No study documented cost of the diagnostic test used. Conclusion The evidence on COVID-19 testing in LMICs is summarized in this systematic review. The RT-PCR was used as the reference test in all studies. The diagnostic assays' combined sensitivity and specificity were 87.55% and 98.10%, respectively. In the reviewed literature, no study reported on the cost and cost effectiveness of diagnostic tests. Finally, no studies were carried out on the African continent. Registration: This review was registered in PROSPERO No. CRD42020209528. And the protocol published here https://bmjopen.bmj.com/content/11/10/e050296

Background Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. Methods We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. Results Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0% – 92.2%) achieved VLS. Age (aPR = 1.01, 95%Cl = 1.00-1.01), male gender (aPR = 0.95, 95%Cl = 0.95–0.95), divorced (aPR = 0.89, 95%Cl = 0.87–0.91), widowed (aPR = 0.84, 95%Cl = 0.79–0.90), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.82–0.95), and fair (85–94%) ART adherence level (aPR = 0.68, (95%Cl = 0.54–0.87) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. Conclusion and recommendations HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.