BackgroundPoor retention in HIV care of mother-baby pairs remains a public health challenge in the elimination of mother-to-child transmission (eMTCT) of HIV. We determined the rate of non-retention and time to non-retention of mother-baby pairs and associated factors in Gulu district, Northern Uganda.MethodsMother-baby pairs enrolled into the eMTCT programme at Gulu Regional Referral Hospital (GRRH) and Lacor Hospital (LH) were retrospectively followed for 18 months. The primary outcomes were the rate of non-retention and time to non-retention of mother-baby pairs in HIV care. Data were abstracted from the antiretroviral treatment and early infant diagnosis (EID) registers, and mother/baby appointment books at the health facilities. Additional data on possible reasons for non-retention were obtained from cross-sectional interviews of mothers. Time to non-retention was calculated as the duration between enrolment of mother-baby pair into care and the date when the mother and/or baby missed a scheduled visit and did not return within 30 days. Factors associated with time to non-retention were assessed using Cox proportional hazards regression analysis. The measures of association were expressed as hazards ratio (HR) with 95% confidence intervals. Alpha was set at 0.05. The adjusted analysis includes variables with p <0.2 in the bivariable analysis or considered potential confounders. The Analysis used Stata version 12.ResultsA total of 410 mother-baby pairs were enrolled in this study. Overall, non-retention by 18 month was 30.5%; higher at GRRH (34.7%) than LH (25.8%), p = 0.049. Non-retention was higher among pairs where the infant had no EID, adjusted (adj) HR = 5.81; 95% CI (2.55, 13.24), non-disclosure of mother’s HIV status, adj.HR = 1.86; 95% CI (1.22, 2.85), and lack of privacy during counselling session, adj.HR = 1.86; 95% CI (1.26, 2.85). Non-retention was about 60% lower [adj.HR = 0.43; 95% CI (0.20, 0.92)] among pairs where the mothers understood and appreciated the importance of adhering to all clinic appointments together with the baby.ConclusionNearly a third of mother-baby pairs are not retained in HIV care. Lack of EID services, poor quality service, non-disclosure of mother’s HIV status, and understanding the importance of adhering to all appointments together with the baby, were associated with time to non-retention.

Exclusive breastfeeding (EBF) for the first six months of life is effective in preventing infant morbidity and mortality. However, 36% of Ugandan children below 6 months are not breastfed exclusively despite its active promotion. This study determined the prevalence and factors associated with exclusive breastfeeding among mothers working in the informal sector in Kampala district. A community based cross-sectional study targeting 428 interviews with mothers with children aged 0-5 months was conducted. Analysis was done using modified Poisson regression in Stata version 14. The prevalence of exclusive breastfeeding was 42.8%. The factors associated with exclusive breastfeeding included: attending antenatal care at least 4 times (

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Background Pesticides can have negative effects on human and environmental health, especially when not handled as intended. In many countries, agro-input dealers sell pesticides to smallholder farmers and are supposed to provide recommendations on application and handling. This study investigates the role of agro-input dealers in transmitting safety information from chemical manufacturers to smallholder farmers, assesses the safety of their shops, what products they sell, and how agro-input dealers abide by laws and recommendations on best practices for preventing pesticide risk situations. Methods Applying a mixed-methods approach, we studied agro-input dealers in Central and Western Uganda. Structured questionnaires were applied to understand agro-input dealers’ knowledge, attitude and practices on pesticides (n = 402). Shop layout (n = 392) and sales interaction (n = 236) were assessed through observations. Actual behavior of agro-input dealers when selling pesticides was revealed through mystery shopping with local farmers buying pesticides (n = 94). Results While 97.0% of agro-input dealers considered advising customers their responsibility, only 26.6% of mystery shoppers received any advice from agro-input dealers when buying pesticides. 53.2% of products purchased were officially recommended. Sales interactions focused mainly on product choice and price. Agro-input dealers showed limited understanding of labels and active ingredients. Moreover, 25.0% of shops were selling repackaged products, while 10.5% sold unmarked or unlabeled products. 90.1% of shops were lacking safety equipment. Pesticides of World Health Organization toxicity class I and II were sold most frequently. Awareness of health effects seemed to be high, although agro-input dealers showed incomplete hygiene practices and were lacking infrastructure. One reason for these findings might be that only 55.7% of agro-input dealers held a certificate of competency on safe handling of pesticides and even fewer (5.7%) were able to provide a government-approved up-to-date license. Conclusion The combination of interviews, mystery shopping and observations proved to be useful, allowing the comparison of stated and actual behavior. While agro-input dealers want to sell pesticides and provide the corresponding risk advice, their customers might receive neither the appropriate product nor sufficient advice on proper handling. In light of the expected increase in pesticide use, affordable, accessible and repeated pesticide training and shop inspections are indispensable.

ObjectivesThe risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda.MethodsWe conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA1c) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA1c and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consumption of fruits and vegetables, alcohol and tobacco.ResultsContrary to our hypothesis, our mixed effect models showed significant correlation between low AChE/Hb and low HbA1c. Adjusted mean HbA1c was 0.74 (95% CI 0.17 to 1.31) mmol/mol lower for subjects with AChE/Hb=24.3 U/g (35th percentile) compared with subjects with AChE/Hb=25.8 U/g (50th percentile). Similar results were demonstrated for FPG. Fixed effect models showed less clear correlations for between-phase changes in AChE/Hb and HbA1c.ConclusionsOur results do not clearly support a causal link between exposure to cholinesterase-inhibiting insecticides and elevated blood glucose levels (expressed as HbA1c and FPG), but results should be interpreted with caution due to the risk of reverse causality.