Sudden onset methaemoglobinaemia in a previously well Ugandan child: a case report and literature review

Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limited settings are very rare but clinical signs can be a good guide. We set out to describe a case of Methaemoglobinaemia, raise awareness among practitioners in resource limited settings and to share experiences in its diagnosis and management. A previously well three and a half year old girl was admitted with central cyanosis of sudden onset. She underwent clinical, laboratory and radiological evaluation. Having been in a resource limited setting, the process of making a diagnosis was slow and difficult. After the diagnosis, the treatment was not available in the country but we managed to get it all the way from Nairobi, Kenya. A diagnosis of Methaemoglobinaemia was made using Spectrophotometry and she was successfully treated using 2 doses of intravenous Methylene blue. The cause of Methaemoglobinaemia was established to have been nitrites from food preservatives

Adherence to antiepileptic drugs among children attending a tertiary health unit in a low resource setting.

Introduction: Epilepsy is one of the neglected and highly stigmatised diseases, yet it is very common affecting about 70 million people worldwide. In Uganda, the estimated prevalence of epilepsy is 13% with  about 156 new cases per 100,000 people per year. Adherence to antiepileptic drugs is crucial in achieving seizure control yet in Uganda; there is lack of information on adherence to antiepileptic drugs and the factors that affect this among children. This study was therefore designed to determine the level of  adherence to antiepileptic drugs and the factors that are associated with non adherence. Methods: In a cross sectional study, 122 children who met the inclusion criteria were enrolled and interviewed using a pretested questionnaire. Assessment of adherence to antiepileptic drugs was done by self report and assay of serum drug levels of the antiepileptic drugs. Focus group discussions were held to further evaluate the factors that affect adherence. Results: Age range was 6 months - 16 years, male to female ratio 1.3:1 and majority had generalised seizures 76 (62.3%). Adherence to antiepileptic drugs by self report was 79.5% and 22.1% by drug levels. Majority of the children in both adherent and non adherent groups by self report had inadequate drug doses (95/122).Children were found to be more non-adherent if the caregiver had an occupation (p-value 0.030, 95%CI 1.18-28.78) Conclusion: Majority of children had good adherence levels when estimated by self report. The caregiver having an occupation was found to increase the likelihood of non adherence in a child.Key words: Adherence, antiepileptic drugs, children, Epilepsy, Low resource settin

Thyroid autoimmunity and function among Ugandan children and adolescents with type-1 diabetes mellitus

Introduction: Up to 30% of type-1 diabetes mellitus (T1DM) patients have co-existent thyroid   autoimmunity with up to 50% of them having associated thyroid dysfunction. Routine screening for  thyroid autoimmunity and dysfunction is recommended in all T1DM patients. However, this was not  currently practiced in Ugandan paediatric diabetes clinics. There was also paucity of data regarding   thyroid autoimmunity and dysfunction in African children and adolescents with diabetes mellitus. The objective of this study was to quantify the magnitude of thyroid autoimmunity and dysfunction in Ugandan children with TIDM.Methods: This was a cross sectional descriptive study to determine the prevalence of thyroid  autoantibodies and describe thyroid function among children and adolescents aged 1-19 years with  diabetes mellitus attending the paediatric diabetes clinic at Mulago National Referral Hospital, Kampala, Uganda. Following enrollment, we obtained details of clinical history and performed physical examination. Blood (plasma) was assayed to determine levels of antibodies to thyroid peroxidase (antiTPO), free  thyroxine (FT4) and thyrotropin (TSH). Results: The prevalence of thyroid autoimmunity was 7.3% (5/69). All antiTPO positive subjects were post pubertal, aged between 13-17 years with females comprising 3/5 of the antiTPO positive subjects. All study subjects were clinically euthyroid; however, 7.3% (5/69) of the study subjects had subclinical hypothyroidism. Conclusion: These data strengthen the argument for routine screening of all diabetic children and  adolescents for thyroid autoimmunity (particularly anti-TPO) as recommended by  international  guidelines. We also recommend evaluation of thyroid function in diabetic children and  adolescents to minimize the risk of undiagnosed thyroid dysfunction.Key words: Thyroid, autoimmunity, type 1 diabetes mellitus, childre

Climate change adaptation and ICT

Key recommendations include expanding observational networks and human resources of the Uganda National Meteorological Authority to support: generation of subcounty-specific seasonal forecasts and agricultural advisories; strengthening district-level governance for streamlining climate change adaptation activities; enhancing the Climate Change Department’s e-Library with localized climate change content; engaging mobile network operators to co-finance expansion of a climate information system; increasing the role of agricultural research organizations; and conducting further research to assess ways for scaling up ICT-based climate and agricultural information services. Research indicated that the use of timely and locally relevant information reduced smallholders’ crop losses by 6% to 37%

Alpha thalassemia among sickle cell anaemia patients in Kampala, Uganda

Background: Sickle cell anaemia is prevalent in sub Saharan Africa. While \u3b1+-thalassaemia is known to modulate sickle cell anaemia, its magnitude and significance in Uganda have hitherto not been described. Objectives: To determine the prevalence of \u3b1+thalassaemia among sickle cell anaemia patients in Mulago Hospital and to describe the clinical and laboratory findings in these patients. Methods: A cross sectional study was carried out on patients with sickle cell anaemia in Kampala. Dried blood spots were used to analyze for the deletional \u3b1+ thalassaemia using multiplex polymerase chain reaction. Results: Of the 142 patients with sickle cell anaemia, 110 (77.5%) had the \u3b1+thalassaemia deletion. The gene frequency of (-\u3b1) was 0.425. Ninety one percent (100/110) of those with \u3b1+thalassaemia were heterozygous (\u3b1/\u3b1-). Amongst the patients older than 60 months, 15 (83.3%) of those without \u3b1+thalassaemia had significant hepatomegaly of greater than 4 cm compared to 36 (45.6%) of those with \u3b1+thalassaemia (p=0.003). Conclusion: The gene frequency of (-\u3b1) of 0.425 noted in this study is higher than that reported from many places in Africa. Concurrent alpha thalassemia might be a protective trait against significant hepatomegaly in sickle cell anaemia patients more than 60 months of age at Mulago hospital. Keywords: Alpha thalassemia; sickle cell anaemia patient; Kampala; Ugand

Malariometric indices from Iganga, Uganda: baseline characterization in preparation of GMZ2 vaccine trial

Background: Malaria still remains the leading cause of childhood morbidity and mortality in Uganda. Interventions like malaria vaccines which reduce the malaria burden are needed in malaria endemic communities. There is need to establish baseline characteristics in vaccine trial study sites. This study determined the following baseline malariometric indices: spleen rates, bed net use, malaria parasitaemia and malaria episodes in an inception cohort of children aged 12 – 60 months in Iganga district, Uganda. Methods: In a longitudinal cohort study, 748 children were enrolled with 397 in an active follow up arm and 351 in a passive arm. The children in the two arms were followed for 6 months to determine the incidence of malaria episodes. Results: The overall baseline spleen rate was 8.2% (61/748) among the study participants. Of the households surveyed, about 36% reported using bed nets and almost 30% of the users had insecticide-treated nets. 274 (36.6%) of the study participants had a history of fever in the past 24 hrs at the time of the baseline survey. All participants had a peripheral blood smear for malaria parasites done at enrollment with 76.8% having the asexual form of malaria parasites. The malaria episodes per child per year were 1.5 and 0.79 in the active and passive follow up arms respectively. Conclusions: There is a high prevalence of malaria asexual parasitaemia in children below five years. The bed net usage still remains low among this population. These baseline malariometric indices have important implication for malaria control interventions

Using Information and Communication Technologies (ICTs) for water adaptation in Uganda

The Climate Change Adaptation and ICT (CHAI) project developed an information and communication system employing a mix of technologies to facilitate gathering, storing, analyzing, and sharing climate and weather-related data from fixed weather stations and market outlets. Drought is the major hazard, and communities suffer from severe water shortages for domestic and agricultural use. The project disseminated localized seasonal forecasts, weekly local livestock and crop market data, low-cost rainwater harvesting techniques, and drought and flood coping mechanisms. Short message service (SMS) broadcasts were targeted to specific farmer groups, community leaders, district technical officers, and politicians from local councils

Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda

<p>Abstract</p> <p>Background</p> <p>Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, Uganda</p> <p>Methods</p> <p>Three hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit.</p> <p>Results</p> <p>The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary) level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school.</p> <p>Conclusions</p> <p>Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.</p