Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study.

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications

Lessons learnt in recruiting schoolchildren into a large asthma case-control study in urban Uganda

Schools present an excellent opportunity for research among children and adolescents. We share our experiences and lessons learnt in enrolling schoolchildren into a large asthma case-control study from schools in urban Uganda, and make recommendations for best practices. Our key lessons were as follows: working closely with the school administration and teachers was vital in gaining timely access to parents of the schoolchildren; having a meeting with parents, within their children�s school premises, was a cost-effective way of reaching a wide audience of potential research participants with our message and an opportunity to seek their participation; allowing flexibility within our processes enabled us to fit our research activities within the school schedule, and with minimal disruptions; however, obtaining informed written consent from parents of children in the boarding section of school remained a challenge. In conclusion, conducting research in schools in Uganda is feasible and may be a cost-effective way to make the most of limited resources to remedy the research and data deficiencies among school-age children in sub-Saharan Africa.</ns3:p

Risk factors associated with rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda.

BACKGROUND: The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. OBJECTIVES: To investigate the risk factors associated with ARDs among schoolchildren in Uganda. METHODS: We conducted a secondary data analysis of a large asthma case-control study involving 1700 schoolchildren, 5-17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP® . We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. RESULTS: The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42-4.99) compared to rural]; father's [2.62 (1.79-3.83)] and mother's history of allergic disease [2.12 (1.48-3.02)]; frequent de-worming in the last 12 months [2.01 (1.30-3.11), ≥2 versus none]; current high frequency of 'trucks passing on the street near home' [2.59 (1.48-4.52), 'almost all the time' versus rarely] and positive SPT [1.54 (1.09-2.18)] but not asIgE [1.38 (0.60-3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. CONCLUSION: We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema-similar to asthma risk factors-among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda

A Link Fabrication Attack Mitigation Approach (LiFAMA) for Software Defined Networks

In software defined networks (SDNs), the controller is a critical resource, yet it is a potential target for attacks as well. The conventional OpenFlow Discovery Protocol (OFPD) used in building the topological view for the controller has vulnerabilities that easily allow attackers to poison the network topology by creating fabricated links with malicious effects. OFDP makes use of the link layer discovery protocol (LLDP) to discover existing links. However, the LLDP is not efficient at fabricated link detection. Existing approaches to mitigating this problem have mostly been passive approaches that depend on observing unexpected behaviour. Examples of such behaviour include link latency and packet patterns to trigger attack alerts. The problem with the existing solutions is that their implementations cause longer link discovery time. This implies that a dense SDN would suffer from huge delays in the link discovery process. In this study, we propose a link fabrication attack (LFA) mitigation approach (LiFAMA), which is an active mitigation approach and one that minimises the link discovery time. The approach uses LLDP packet authentication together with keyed-hash-based message authentication code (HMAC) and a link verification database (PostgreSQL) that stores records of all known and verified links in the network. This approach was implemented in an emulated SDN environment using Mininet and a Python-based open-source OpenFlow (POX) controller. The results show that the approach detects fabricated links in an SDN in real time and helps mitigate them. Additionally, the link discovery time of LiFAMA out-competes that of an existing LFA mitigation approach

A Link Fabrication Attack Mitigation Approach (LiFAMA) for Software Defined Networks

In software defined networks (SDNs), the controller is a critical resource, yet it is a potential target for attacks as well. The conventional OpenFlow Discovery Protocol (OFPD) used in building the topological view for the controller has vulnerabilities that easily allow attackers to poison the network topology by creating fabricated links with malicious effects. OFDP makes use of the link layer discovery protocol (LLDP) to discover existing links. However, the LLDP is not efficient at fabricated link detection. Existing approaches to mitigating this problem have mostly been passive approaches that depend on observing unexpected behaviour. Examples of such behaviour include link latency and packet patterns to trigger attack alerts. The problem with the existing solutions is that their implementations cause longer link discovery time. This implies that a dense SDN would suffer from huge delays in the link discovery process. In this study, we propose a link fabrication attack (LFA) mitigation approach (LiFAMA), which is an active mitigation approach and one that minimises the link discovery time. The approach uses LLDP packet authentication together with keyed-hash-based message authentication code (HMAC) and a link verification database (PostgreSQL) that stores records of all known and verified links in the network. This approach was implemented in an emulated SDN environment using Mininet and a Python-based open-source OpenFlow (POX) controller. The results show that the approach detects fabricated links in an SDN in real time and helps mitigate them. Additionally, the link discovery time of LiFAMA out-competes that of an existing LFA mitigation approach