The emergence of nodding syndrome (NS) in Northern Uganda has generated controversial views with respect to patterns, natural history, and aetiology of the disease which is yet unknown. This study explored spatial pat...The emergence of nodding syndrome (NS) in Northern Uganda has generated controversial views with respect to patterns, natural history, and aetiology of the disease which is yet unknown. This study explored spatial patterns of NS using spatial-temporal methods to establish its clustering patterns across both space and time. Village and year of NS onset for individual patients between the years 1990 and 2014 were entered as input for spatial and temporal analysis in the 6 districts in northern Uganda where it is prevalent. Our temporal results showed that NS onset started before the population was moved in Internally Displaced People’s (IDPs) camps. It also shows that NS continued to be reported during the IDPs and after people had left the IDPs. Our spatial and spatiotemporal analysis showed that two periods had persistent NS clusters. These were 2000-2004 and 2010-2014, coinciding with the period when the population was in the IDP camps and when the population was already out of the camps, respectively. Our conclusion is that the view of associating NS outbreak with living conditions in IDP camps is thus coincidental. We, therefore, contend that the actual aetiological factor of NS is still at large.展开更多
Nel Noddings’ethics of care is an important lineage of Western moral education thought,which contains deep humanistic values.Service-learning advocates the equal importance of service and learning,and emphasizes more...Nel Noddings’ethics of care is an important lineage of Western moral education thought,which contains deep humanistic values.Service-learning advocates the equal importance of service and learning,and emphasizes more on the discovery of educational connotations in practice.Based on the social background of aging,this paper takes the“Care for the Elderly”service-learning program as an example,attempts to take the care ethics as the entry point,adopts interviews,questionnaires,and other research methods,and opens-up the service-learning practice path under the threshold of Nel Noddings’care education theory.展开更多
Background:Around 2007,a nodding syndrome(NS)epidemic appeared in onchocerciasis-endemic districts of northern Uganda,where ivermeain mass distribution had never been implemented.This study evaluated the effect of com...Background:Around 2007,a nodding syndrome(NS)epidemic appeared in onchocerciasis-endemic districts of northern Uganda,where ivermeain mass distribution had never been implemented.This study evaluated the effect of community-directed treatment with ivermectin(CDTI)and ground larviciding of rivers initiated after 2009 and 2012 respectively,on the epidemiology of NS and other forms of epilepsy(OFE)in some districts of northern Uganda.Methods:In 2012,a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts.In August 2017,we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data.In addition,two villages in Moyo distria(where CDTI was ongoing since 1993)served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented.The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95%level of significance.Results:A total of 2138 individuals in 390 households were interviewed.In the seleaed villages of Kitgum and Pader,there was no significant decrease in prevalence of NS and OFE between 2012 and 2017.However,the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100000 persons per year(P=0.002);that of NS decreased from 490 to 43 per 100000 persons per year(P=0.037);and for OFE from 675 to 87 per 100000 persons per year(P=0.024).The median age of affeaed persons(NS and OFE)shifted from 13.5(IQR:11.0-15.0)years in 2012 to 18.0(IQR:15.0-20.3)years in 2017;P<0.001.The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%,similar to 4.5%in Kitgum and Pader.Conclusions:Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy,and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.展开更多
Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were establis...Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation.However,a wide gap remained between the predefined care standards and the quality of routine care provided to those affected.This study is to qualitatively assess adherence to accepted clinical care standards for NS;identify gaps in the care of affected children and offer Clinical Support Supervision(CSS)to Primary Health Care(PHC)staff at the treatment centres;and identify psychosocial challenges faced by affected children and their caregivers.Methods:This case study was carried out in the districts of Gulu,Kitgum,Lamwo and Pader in Uganda from September to December in 2015.Employing the 5-stage approach of Clinical Audit,data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities,as well as with caregivers and political leaders.The qualitative data was analysed using Seidel model of data processing.Results:Clinical Audit and CSS revealed poor adherence to treatment guidelines.Many affected children had suboptimal NS management resulting in poor seizure control and complications including severe burns.Root causes of these outcomes were frequent antiepileptic drugs stock outs,migration of health workers from their work stations and psychosocial issues.There was hardly any specialized multidisciplinary team(MDT)to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed,leading to loss of skills learnt.Reported psychosocial and psychosexual issues associated with NS included early pregnancies,public display of sexual behaviours and child abuse.Conclusions:Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines,multidisciplinary care was not implemented in practice.There is urgent need to review the NS clinical guidelines.Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities.Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.展开更多
文摘The emergence of nodding syndrome (NS) in Northern Uganda has generated controversial views with respect to patterns, natural history, and aetiology of the disease which is yet unknown. This study explored spatial patterns of NS using spatial-temporal methods to establish its clustering patterns across both space and time. Village and year of NS onset for individual patients between the years 1990 and 2014 were entered as input for spatial and temporal analysis in the 6 districts in northern Uganda where it is prevalent. Our temporal results showed that NS onset started before the population was moved in Internally Displaced People’s (IDPs) camps. It also shows that NS continued to be reported during the IDPs and after people had left the IDPs. Our spatial and spatiotemporal analysis showed that two periods had persistent NS clusters. These were 2000-2004 and 2010-2014, coinciding with the period when the population was in the IDP camps and when the population was already out of the camps, respectively. Our conclusion is that the view of associating NS outbreak with living conditions in IDP camps is thus coincidental. We, therefore, contend that the actual aetiological factor of NS is still at large.
文摘Nel Noddings’ethics of care is an important lineage of Western moral education thought,which contains deep humanistic values.Service-learning advocates the equal importance of service and learning,and emphasizes more on the discovery of educational connotations in practice.Based on the social background of aging,this paper takes the“Care for the Elderly”service-learning program as an example,attempts to take the care ethics as the entry point,adopts interviews,questionnaires,and other research methods,and opens-up the service-learning practice path under the threshold of Nel Noddings’care education theory.
文摘Background:Around 2007,a nodding syndrome(NS)epidemic appeared in onchocerciasis-endemic districts of northern Uganda,where ivermeain mass distribution had never been implemented.This study evaluated the effect of community-directed treatment with ivermectin(CDTI)and ground larviciding of rivers initiated after 2009 and 2012 respectively,on the epidemiology of NS and other forms of epilepsy(OFE)in some districts of northern Uganda.Methods:In 2012,a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts.In August 2017,we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data.In addition,two villages in Moyo distria(where CDTI was ongoing since 1993)served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented.The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95%level of significance.Results:A total of 2138 individuals in 390 households were interviewed.In the seleaed villages of Kitgum and Pader,there was no significant decrease in prevalence of NS and OFE between 2012 and 2017.However,the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100000 persons per year(P=0.002);that of NS decreased from 490 to 43 per 100000 persons per year(P=0.037);and for OFE from 675 to 87 per 100000 persons per year(P=0.024).The median age of affeaed persons(NS and OFE)shifted from 13.5(IQR:11.0-15.0)years in 2012 to 18.0(IQR:15.0-20.3)years in 2017;P<0.001.The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%,similar to 4.5%in Kitgum and Pader.Conclusions:Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy,and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.
文摘Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation.However,a wide gap remained between the predefined care standards and the quality of routine care provided to those affected.This study is to qualitatively assess adherence to accepted clinical care standards for NS;identify gaps in the care of affected children and offer Clinical Support Supervision(CSS)to Primary Health Care(PHC)staff at the treatment centres;and identify psychosocial challenges faced by affected children and their caregivers.Methods:This case study was carried out in the districts of Gulu,Kitgum,Lamwo and Pader in Uganda from September to December in 2015.Employing the 5-stage approach of Clinical Audit,data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities,as well as with caregivers and political leaders.The qualitative data was analysed using Seidel model of data processing.Results:Clinical Audit and CSS revealed poor adherence to treatment guidelines.Many affected children had suboptimal NS management resulting in poor seizure control and complications including severe burns.Root causes of these outcomes were frequent antiepileptic drugs stock outs,migration of health workers from their work stations and psychosocial issues.There was hardly any specialized multidisciplinary team(MDT)to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed,leading to loss of skills learnt.Reported psychosocial and psychosexual issues associated with NS included early pregnancies,public display of sexual behaviours and child abuse.Conclusions:Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines,multidisciplinary care was not implemented in practice.There is urgent need to review the NS clinical guidelines.Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities.Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.
