Background We aimed to determine the rate of herbal medicine usage and the treatment-seeking patterns of children aged ≤5 y with presumed or confirmed malaria in an endemic area of Uganda. Methods We interviewed guardians of 722 children aged 6 months to 5 y, who had experienced an episode of presumed malaria in the previous 3 months, about the illness history. Results Overall, 36.1% of patients took herbal medicines but most also sought modern medical care; 79.2% received Artemether-Lumefantrine (AL), but only 42.7% received the correct AL dose. Of the 36.6% of patients treated in drug shops, 9.8% had a diagnostic test and 30.2% received the correct dose of AL. Antibiotics were frequently provided with AL at drug shops (62%) and formal health centers (45%). There were no significant differences in the self-reported outcomes associated with different treatments. Conclusion Almost all of the patients who took herbal medicine also took modern antimalarials, so further research is needed to explore potential interactions between them. Although formal health facilities provided the correct diagnosis and dose of AL to a majority of children with malaria, many children still received inappropriate antibiotics. Quality of care was worse in drug shops than in formal health facilities.

Aim To investigate the current prevalence and management of dyspepsia in rural Eastern Uganda. Methods Residents older than 18 years of age across 95 study sites in Namutumba District, Eastern Uganda were surveyed. Each respondent was administered a questionnaire about dyspepsia and pertinent health-seeking behaviors. Health workers at 12 different clinics were also assessed on their competence in managing dyspepsia. Proportion-based analysis was used to determine self-reported outcome variables reported in this study, including: prevalence of dyspepsia; breakdown of symptoms; initial diagnosis location; management strategies; and appropriate medication usage. Results 397 residents (average age of 41.2 years) participated in this study (54.4% males, 45.6% females). 57.9% self-reported currently having dyspepsia, of average duration 4.5 years. Of this subset, 87% reported experiencing epigastric pain, and 42.2% believed that ulcers were “wounds in the stomach.” Only 3% of respondents had heard of Helicobacter pylori (Hp) . Respondents varied in their management of dyspepsia, with frequent eating (39.1%), doing nothing (23.9%), and taking Western medicine (20%) being the most common strategies. The diagnosis of “peptic ulcer disease” was made by a health worker in 64.3% of cases, and 27% of cases were self-diagnosed. Notably, 70.3% of diagnoses at formal health centers were based on clinical symptoms alone and only 22.7% of respondents received treatment according to Ugandan Ministry of Health guidelines. Among the 12 health care workers surveyed, 10 cited epigastric pain as a common symptom of “ulcer,” although only two reported having heard of Hp. Only two out of 12 clinics had the capability to prescribe the triple therapy as treatment for presumed Hp. Conclusion There is a high incidence of dyspepsia in Eastern Uganda, and current management strategies are poor and inconsistent, and may contribute to antibiotic resistance. Further studies are needed to investigate the causes of dyspepsia to guide appropriate management.

BackgroundThe WHO recommends training lay first responders (LFRs) as the first step towards establishing emergency medical services (EMS) in low-income and middle-income countries. Understanding social and financial benefits associated with responder involvement is essential for LFR programme continuity and may inform sustainable development.MethodsA mixed-methods follow-up study was conducted in July 2019 with 239 motorcycle taxi drivers, including 115 (75%) of 154 initial participants in a Ugandan LFR course from July 2016, to evaluate LFR training on participants. Semi-structured interviews and surveys were administered to samples of initial participants to assess social and economic implications of training, and non-trained motorcycle taxi drivers to gauge interest in LFR training. Themes were determined on a per-question basis and coded by extracting keywords from each response until thematic saturation was achieved.ResultsThree years post-course, initial participants reported new knowledge and skills, the ability to help others, and confidence gain as the main benefits motivating continued programme involvement. Participant outlook was unanimously positive and 96.5% (111/115) of initial participants surveyed used skills since training. Many reported sensing an identity change, now identifying as first responders in addition to motorcycle taxi drivers. Drivers reported they believe this led to greater respect from the Ugandan public and a prevailing belief that they are responsible transportation providers, increasing subsequent customer acquisition. Motorcycle taxi drivers who participated in the course reported a median weekly income value that is 24.39% higher than non-trained motorcycle taxi counterparts (p<0.0001).ConclusionsA simultaneous delivery of sustained social and perceived financial benefits to LFRs are likely to motivate continued voluntary participation. These benefits appear to be a potential mechanism that may be leveraged to contribute to the sustainability of future LFR programmes to deliver basic prehospital emergency care in resource-limited settings.

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Background: Helicobacter pylori (H. pylori) infection is a common cause of chronic dyspepsia worldwide. Its prevalence in the developing world remains understudied, however. Given that H. pylori is the most significant risk factor for developing gastric cancer, an accurate assessment of the effectiveness of population-based screening and eradication of H. pylori is warranted. The objectives of this study were to determine the prevalence of H. pylori, to identify risk factors associated with H. pylori colonization, and to assess the efficacy of triple therapy on H. pylori eradication within a region of sub-Saharan Africa.Methods: We administered a dyspepsia questionnaire to 376 randomly selected adult residents of the Namutumba District in Uganda. Participants submitted a stool sample for H. pylori fecal antigen testing. H. pylori-positive participants were given standard triple therapy. The efficacy of triple therapy on H. pylori eradication was established by fecal H. pylori antigen testing and improvement in dyspepsia scores after treatment. Dyspeptic, H. pylori-negative participants were administered daily omeprazole for one month. Logistic regression analyses were used to identify factors associated with H. pylori positivity, chronic dyspepsia, and H. pylori eradication failure.Results: The prevalence of H. pylori within the study population was 48%. A higher level of education was significantly associated with H. pylori positivity. 87% of study participants reported at least one symptom of dyspepsia, with 43% reporting moderate or severe dyspepsia. Dyspepsia severity was independent of H. pylori status. Standard triple therapy resulted in ~90% eradication. Missing four or more doses of the triple therapy regimen was significantly associated with H. pylori eradication failure.Conclusions: Chronic dyspepsia is a common complaint in this sub-Saharan population but is not by itself a defining feature of H. pylori positivity. Clinical suspicion for H. pylori within this population should nonetheless remain high, given the high prevalence of positivity among all those with dyspepsia, including many with relatively mild dyspeptic symptoms. Population-based screening and adherence to standard triple therapy are effective at eradicating H. pylori within this region. Trial Registration: This study was registered in ClinicalTrials.gov (TRN: NCT04525664, registered 24 August 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04525664). This study adheres to CONSORT guidelines.