Prevalence, Features and Risk Factors for Malaria Co-Infections amongst Visceral Leishmaniasis Patients from Amudat Hospital, Uganda

Visceral leishmaniasis (VL) and malaria are two major parasitic diseases sharing a similar demographic and geographical distribution. In areas where both diseases are endemic, such as Sudan, Uganda, India and Bangladesh, co-infection cases have been reported, but features and risk factors associated with these co-morbidities remain poorly characterized. In the present study, routinely collected data of VL patients admitted to Amudat Hospital, Uganda, were used to investigate the magnitude of VL-malaria co-infections and identify possible risk factors. Nearly 20% of the patients included in this study were found to be co-infected with VL and malaria, indicating that this is a common condition among VL patients living in malaria endemic areas. Young age (≤9 years) was identified as an important risk factor for contracting the VL-malaria co-infection, while being anemic or carrying a skin infection appeared to negatively correlate with the co-morbidity. Co-infected patients presented with slightly more severe symptoms compared to mono-infected patients, but had a similar prognosis, possibly due to early diagnosis of malaria as a result of systematic testing. In conclusion, these results emphasize the importance of performing malaria screening amongst VL patients living in malaria-endemic areas and suggest that close monitoring of co-infected patients should be implemented

Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial

Abstract Background Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students’ mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale. Objectives This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students. Methods Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness. Discussion This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children’s mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings. Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327) on May13, 2020. </jats:sec

Advancing Scalability and Impacts of a Teacher Training Program for Promoting Child Mental Health in Ugandan Primary Schools: Protocol for a Hybrid-Type II Effectiveness-Implementation Cluster Randomized Trial

Abstract Background: There are numerous challenges to promoting child mental health in low-and-middle income countries (LMICs). Most evidence-based interventions (EBIs) adapted to LMICs have not been scaled widely or evaluated for effectiveness and underlying mechanisms. Most mental health EBIs in LMICs rely on a task-shifting approach of implementation because of the shortage of mental health professionals; however, challenges related to task-shifting are understudied. Most EBIs have not been implemented using a scalable and sustainable model that leverages and strengthens existing structures. Through a cross-sector collaboration, we are carrying out a second generation investigation of implementation and effectiveness of a school-based mental health EBI for early childhood students that uses task-shifting and builds on existing educational structures. The ultimate shared goal of this collaboration is to scale and sustain the EBI country wide. The systems-level approach to promoting child mental health builds on ParentCorps, an EBI implemented in schools that has been shown in multiple trials to yield long-term benefits on mental health and school performance. Previous studies in Uganda found that ParentCorps Professional Development (PD) for teachers resulted in short-term benefits for classrooms, children and families. Objectives: This paper describes the rationale and protocol for an effectiveness-implementation study of ParentCorps-PD for teachers in urban and rural Ugandan schools. The study considers the added value (i.e. impact and costs) of a brief wellness intervention for teachers in their task-shifting role and explores mechanisms and outcomes. Methods: Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2,000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness. Discussion: This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers who are task-shifting as a potentially cost-effective strategy for promoting child mental health. Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327) on May13, 2020.</jats:p

Age-specific prevalence of human tungiasis.

<p>Data with the same index letter (a, b, c) are not significantly different from each other in a Chi-square test with p values corrected for multiple testing according to the Bonferroni-Holm method.</p

Life cycle of <i>T. penetrans</i> in a tropical environment.

<p>The human, domestic, and sylvatic cycles are linked but without close overlap.</p

Prevalence of tungiasis in the four animal species which were found to be infected with <i>T</i>. <i>penetrans</i>.

<p>^aFor the two villages, Makoma 1 and Masolya where unbiased sampling of goats was done, the combined prevalence of goat tungiasis was 1/382 (0.26%, 95% CI 0.05–1.46%)</p><p>Prevalence of tungiasis in the four animal species which were found to be infected with <i>T</i>. <i>penetrans</i>.</p

Correlation of prevalence of animal and human tungiasis.

<p>(A) Prevalence data of tungiasis in households was analyzed on the village level (rho = 0.85, p = 0.002). (B) Prevalences of tungiasis in humans and animals were compared on the household level (rho = 0.44, p<0.0001).</p