Aims: To determine the prevalence and associated risk factors of diabetic peripheral neuropathy (DPN) among newly diagnosed diabetes mellitus patients in Mulago Hospital. Methods: A cross-sectional study was conducted among 248 newly diagnosed adult diabetic patients. Using the standard Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) criteria, we screened them for neuropathy. Data on the socio-demographics, age, duration of symptoms and history of diabetic ulcer were analyzed using a multiple logistic regression. A p-value <0.05 was considered significant. Results: The majority of study patients (62.1%) were male. The overall prevalence of DPN was 29.4 %. Nearly sixteen percent had moderate neuropathy and only five percent had severe neuropathy. Age above 60 years was significantly associated with the presence of DPN; (OR 3.72; 95% CI 1.25 -11.03; p=0.018). The history of ever having a foot ulcer was significantly associated with peripheral neuropathy (OR 2.59; 95% CI: 1.03 -6.49, p = 0.042). Conclusion: DPN occurs in 1 in 4 of newly diagnosed diabetic patients in Mulago hospital. Two thirds of these patients had moderate to severe neuropathy. DPN was independently associated with increasing age. Early diagnosis of diabetes mellitus, increased diabetes knowledge and regular blood sugar screenings would play an important role in identifying this problem.

Background The potential effects of SARS-CoV-2 and Plasmodium falciparum co-infection on host susceptibility and pathogenesis remain unknown. We aimed to establish the prevalence of malaria and describe the clinical characteristics of SARS-CoV-2 and P falciparum co-infection in a high-burden malaria setting. Methods This was an exploratory prospective, cohort study of patients with COVID-19 who were admitted to hospital in Uganda. Patients of all ages with a PCR-confirmed diagnosis of SARS-CoV-2 infection who had provided informed consent or assent were consecutively enrolled from treatment centres in eight hospitals across the country and followed up until discharge or death. Clinical assessments and blood sampling were done at admission for all patients. Malaria diagnosis in all patients was done by rapid diagnostic tests, microscopy, and molecular methods. Previous P falciparum exposure was determined with serological responses to a panel of P falciparum antigens assessed using a multiplex bead assay. Additional evaluations included complete blood count, markers of inflammation, and serum biochemistries. The main outcome was overall prevalence of malaria infection and malaria prevalence by age (including age categories of 0–20 years, 21–40 years, 41–60 years, and >60 years). The frequency of symptoms was compared between patients with COVID-19 with P falciparum infection versus those without P falciparum infection. The frequency of comorbidities and COVID-19 clinical severity and outcomes was compared between patients with low previous exposure to P falciparum versus those with high previous exposure to P falciparum . The effect of previous exposure to P falciparum on COVID-19 clinical severity and outcomes was also assessed among patients with and those without comorbidities. Findings Of 600 people with PCR-confirmed SARS-CoV-2 infection enrolled from April 15, to Oct 30, 2020, 597 (>99%) had complete information and were included in our analyses. The majority (502 [84%] of 597) were male individuals with a median age of 36 years (IQR 28–47). Overall prevalence of P falciparum infection was 12% (95% CI 9·4–14·6; 70 of 597 participants), with highest prevalence in the age groups of 0–20 years (22%, 8·7–44·8; five of 23 patients) and older than 60 years (20%, 10·2–34·1; nine of 46 patients). Confusion (four [6%] of 70 patients vs eight [2%] of 527 patients; p=0·040) and vomiting (four [6%] of 70 patients vs five [1%] of 527 patients; p=0·014] were more frequent among patients with P falciparum infection than those without. Patients with low versus those with high previous P fal...

Background In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. Main body We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda’s social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda’s responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda’s initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. Conclusion The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.

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Background: As COVID-19 disease surges across much of the world, researchers in different settings have a unique opportunity to address the various research priorities that have been identified. The challenges that containment and mitigation strategies present for research, especially in resource limited settings, could be significant and negatively impact the essential contribution of these settings to COVID-19 research. Objectives: To describe experiences of conducting research during this pandemic, discuss challenges faced and present strategies implemented to address these challenges Methods: Malaria Consortium recently initiated an observational case series study to assess the magnitude and clinical consequences of co-infection of COVID-19, malaria, and other common infections. This study is being conducted in eight COVID-19 treatment centres in Uganda. Qualitative methods including observations and interviews were utilized to document experiences and mitigating strategies for identified challenges. The main outcomes were a descriptive narrative of experiences conducting this research, discussion of challenges faced, and presentation of strategies implemented to address these challenges. Results: Expedited ethical review and approval facilitated timely initiation of research activities.  The primary clinical care teams at each treatment centre performed all study procedures to minimize infection. Given concerns about fomite transmission, considerations arose on how best to handle consent forms that had been signed or thumb-printed by patients to ensure that both hospital and research staff were not exposed to infection. Consenting severely ill or mentally impaired patients was also a challenge, especially when the next of kin was not available. Patient compensation was done through a mobile money/digital platform to avoid potential risks associated with cash. Patients, health care workers and study staff faced significant psychosocial challenges and anxiety that needed to be addressed. Conclusions: These experiences demonstrate that more adaptable and innovative approaches may be needed to support the implementation of research activities during this COVID-19 pandemic. This pandemic should also spur institutional review boards and investigators to respond to emerging challenges by updating policies and procedures around research review and approvals, and modifications in research methods.

Background: Consumption of a varied diet reduces the risk of developing a deficiency or excess of any one nutrient. One of the three corner stones of diabetes management is diet and therefore, dietary diversity is key among diabetes patients. Objective: The objective of this study was to establish the impact of nutrition education on the dietary diversity scores (DDS) among type 2 diabetes patients. Methods: Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 21). Pair sample t-test was used to compare total DDS after and before nutrition education. P< 0.05 was considered as statistically significant.Subjects: One hundred type 2 diabetic patients were randomly selected and divided into two groups of intervention and control (50 patients in each group) to participate in the study. Data were collected using a pre-tested questionnaire before and after intervention every after one month for a period of four months of intervention.Results: The average age of patients who participated in the study was 48 (40–51) years. Most of the patients were females (65.39%), compared to males (34.01%). At the end of the study period of four months, DDS in the control group decreased from 40.08% to 38.49% (p=0.064) while in the intervention group, DDS increased from 35.30 % to 54.20% (p<0.001). Conclusion: Dietary diversity increased after nutrition education among type 2 diabetes patients.Trial registration: The study was registered and approved on 17th April 2013 by the Research and Ethics committee of Mulago Hospital and Institutional Review Board of Mulago hospital (Protocol MREC 113).

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