The role of the home environment in neurocognitive development of children in Uganda

The dataset contains information on cognitive scores, home observation scores, sociodemographic information, illness history, and nutritional status of 163 5-year-old children who participated in the home-observation sub-study of the Entebbe Mother and Baby Study (EMABS). The purpose of the sub-study was to investigate the role of the home environment on neurocognitive function of children in a low income setting

Perspective Chapter: Pedagogical Approaches and Access to Education Among Early Childhood Education Learners with Disabilities in Africa During the COVID-19 Pandemic - Review of Available Literature

The COVID 19 pandemic suddenly hit the world disrupting access to education especially in Sub-Saharan Africa, threatening the future of millions of learners. This chapter discusses the effects of COVID-19 on early childhood education (ECE) for learners with disabilities in Africa, focusing on three questions: (1) What pedagogical approaches were used to enable access to education among ECE learners with disabilities during the COVID 19 pandemic? (2) How was access to education for ECE learners with disabilities, and what challenges and opportunities were experienced? (3) How can access to quality and equitable learning for ECE learners with disabilities during the crisis be improved? Literature revealed that the pandemic aggravated the hardships in accessing learning programs among learners with disabilities widening the gap between them and their counterparts. Countries resorted to remote and digital pedagogical approaches to enable continuity of learning; however, many did not cater for learners with disabilities. Where disabilities were catered for, the reach and utilization were limited by lack of resources and capacity. Concerted efforts promoting effective inclusive learning are critical for the current and future pandemics. Barriers to provision of equitable education, and long-term effects of COVID 19 on in ECE learners with disabilities should be investigated

Improving the quality of child-care centres through supportive assessment and ‘communities of practice’ in informal settlements in Nairobi : protocol of a feasibility study

Introduction Investing in children during the critical period between birth and age 5 years can have long-lasting benefits throughout their life. Children in Kenya’s urban informal settlements, face significant challenges to healthy development, particularly when their families need to earn a daily wage and cannot care for them during the day. In response, informal and poor quality child-care centres with untrained caregivers have proliferated. We aim to co-design and test the feasibility of a supportive assessment and skills-building for child-care centre providers.Methods and analysis A sequential mixed-methods approach will be used. We will map and profile child-care centres in two informal settlements in Nairobi, and complete a brief quality assessment of 50 child-care centres. We will test the feasibility of a supportive assessment skills-building system on 40 child-care centres, beginning with assessing centre-caregivers’ knowledge and skills in these centres. This will inform the subsequent co-design process and provide baseline data. Following a policy review, we will use experience-based co-design to develop the supportive assessment process. This will include qualitative interviews with policymakers (n=15), focus groups with parents (n=4 focus group discussions (FGDs)), child-care providers (n=4 FGDs) and joint workshops. To assess feasibility and acceptability, we will observe, record and cost implementation for 6 months. The knowledge/skills questionnaire will be repeated at the end of implementation and results will inform the purposive selection of 10 child-care providers and parents for qualitative interviews. Descriptive statistics and thematic framework approach will respectively be used to analyse quantitative and qualitative data and identify drivers of feasibility.Ethics and dissemination The study has been approved by Amref Health Africa’s Ethics and Scientific Review Committee (Ref: P7802020 on 20th April 2020) and the University of York (Ref: HSRGC 20th March 2020). Findings will be published and continual engagement with decision-makers will embed findings into child-care policy and practice

Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study

There is limited data on the burden of mental disorders among ‘healthy’ children in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using percentages and logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. None of the factors examined were associated with the disorders. Conclusions: The unexpectedly high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.</ns3:p

Schistosoma mansoni and HIV infection in a Ugandan population with high HIV and helminth prevalence.

OBJECTIVES: Recent reports suggest that Schistosoma infection may increase the risk of acquiring human immunodeficiency virus (HIV). We used data from a large cross-sectional study to investigate whether Schistosoma mansoni infection is associated with increased HIV prevalence. METHODS: We conducted a household survey of residents in island fishing communities in Mukono district, Uganda, between October 2012 and July 2013. HIV status was assessed using rapid test kits. Kato-Katz (KK) stool tests and urine-circulating cathodic antigen (CCA) were used to test for Schistosoma infection. Multivariable logistic regression, allowing for the survey design, was used to investigate the association between S. mansoni infection and HIV infection. RESULTS: Data from 1412 participants aged 13 years and older were analysed (mean age 30.3 years, 45% female). The prevalence of HIV was 17.3%. Using the stool Kato-Katz technique on a single sample, S. mansoni infection was detected in 57.2% (719/1257) of participants; urine CCA was positive in 73.8% (478/650) of those tested. S. mansoni infection was not associated with HIV infection. [KK (aOR = 1.04; 95% CI: 0.74-1.47, P = 0.81), CCA (aOR = 1.53; 95% CI: 0.78-3.00, P = 0.19)]. The median S. mansoni egg count per gram was lower in the HIV-positive participants (P = 0.005). CONCLUSIONS: These results add to the evidence that S. mansoni has little effect on HIV transmission, but may influence egg excretion

Effects of maternal and infant co-infections, and of maternal immunisation, on the infant response to BCG and tetanus immunisation.

Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigated factors that might influence responses to BCG and tetanus immunisation. Whole blood assay responses to crude culture filtrate proteins of Mycobacterium tuberculosis (cCFP)) and tetanus toxoid (TT) were examined among 1506 and 1433 one-year-olds, respectively. Maternal Mansonella perstans infection was associated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gamma interferon (IFN-γ), IL-5 and IL-13 responses; other maternal helminth infections showed little effect. Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternal BCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-γ, IL-5 and IL-13 to TT were reduced in HIV-exposed-uninfected infants; infant malaria and HIV were associated with lower IFN-γ, IL-5 and IL-13 responses to both immunogens. We conclude that maternal helminth infections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation on infant responses to vaccines should be explored. Prevention of infant malaria and HIV could contribute to effectiveness of immunisation programmes

Urban-rural differences in immune responses to mycobacterial and tetanus vaccine antigens in a tropical setting: A role for helminths?

Several vaccines elicit lower efficacy or impaired immune responses in rural compared to urban settings, and in tropical low-income countries compared to high-income countries. An unresolved hypothesis is that immunomodulation by parasitic infections such as helminths (prevalent in rural tropical settings) contributes to suppression of vaccine responses. Among 1-17-year-old Ugandan residents of rural Schistosoma mansoni (Sm)-endemic islands and proximate urban communities with lower helminth exposure, we assessed plasma antibody and whole blood assay cytokine responses to tetanus toxoid (TT) and purified protein derivative of Mycobacterium tuberculosis (PPD). These were taken to represent recall responses to tetanus and BCG vaccination in infancy. PPD-specific responses are additionally induced by tuberculous and non-tuberculous mycobacterial exposure. Urban-rural comparisons showed that PPD-specific IFN-? and IL-13 and TT-specific IL-13 and IgG concentrations were lower in the rural setting, but that PPD-specific IgE concentrations were higher. Among rural participants, Sm infection was inversely associated with PPD-specific IFN-?, while nematode infection was positively associated with PPD-specific IgG. Among urban participants, Sm infection was positively associated with PPD-specific responses but inversely associated with TT-specific responses, while nematode infection was inversely associated with TT-specific IgG and IgG4, but no associations were observed with PPD-specific responses. Despite these associations, for the urban-rural comparisons there were no notable changes in test statistics after adjusting for current helminth infections, suggesting that helminths were not the sole explanation for the urban-rural differences observed. Helminths likely work in concert with other environmental exposures and operational factors to influence vaccine response

Maternal HIV infection and other factors associated with growth outcomes of HIV-uninfected infants in Entebbe, Uganda.

OBJECTIVE: To assess the associations between maternal HIV infection and growth outcomes of HIV-exposed but uninfected infants and to identify other predictors for poor growth among this population. DESIGN: Within a trial of de-worming during pregnancy, the cohort of offspring was followed from birth. HIV status of the mothers and their children was investigated and growth data for children were obtained at age 1 year. Length-for-age, weight-for-age and weight-for-length Z-scores were calculated for each child; Z-scores ,22 were defined as stunting, underweight and wasting, respectively. SETTING: The study was conducted in Entebbe municipality and Katabi subcounty, Uganda. SUBJECTS: The sample consisted of 1502 children aged 1 year: HIV-unexposed (n 1380) and HIV-exposed not infected (n 122). RESULTS: Prevalence of stunting, underweight and wasting was 14.2%, 8.0% and 3.9%, respectively. There was evidence for an association between maternal HIV infection and odds of being underweight (adjusted OR52.32; 95% CI 1.32, 4.09; P=0.006) but no evidence for an association with stunting or with wasting. Young maternal age, low maternal education, low birth weight, early weaning and experiencing a higher number of episodes of malaria during infancy were independent predictors for stunting and underweight. A higher number of living children in the family was associated with wasting. CONCLUSIONS: Maternal HIV infection was associated with being underweight in HIV-exposed uninfected infants. The success of programmes for prevention of mother-to-child HIV transmission means that an increasing number of infants will be born to HIV-infected women without acquiring HIV. Therefore, viable nutritional interventions need to be identified for this population

Prevalence and associated factors of neurodevelopmental disability among infants in eastern Uganda: a population based study.

BACKGROUND: Neurodevelopmental disability (NDD) is increasingly acknowledged as one of the important causes of disease burden in low income countries. None the less, there is a dearth of data on the burden of NDD and its determinants in these settings. We aimed to establish the prevalence and factors associated with NDD among infants in Eastern Uganda. METHODS: We assessed 487 infants aged 9-12 months within Iganga-Mayuge Health Demographic Surveillance Site in Eastern Uganda using the Malawi Developmental Assessment Tool. The tool has four domains: gross motor, fine motor, language and social domains. An infant failed a domain if she/he failed more than two parameters of the expected at his/her age. We interviewed mothers on factors that could influence the infants' neurodevelopmental outcomes. Data were analysed using STATA version 14. We used odds ratios and 95% confidence intervals to assess statistical significance of associations. RESULTS: Of the 487 infants, 62(12.7%) had an NDD in at least one of the domains. The most affected was social behaviour where 52(10.7%) infants had an NDD. Severe impairment was seen among 9(1.8%) infants with NDD in either three or four domains. Factors associated with NDD at multivariate logistic regression included: parity of more than three children (aOR = 1.8, 95% CI: 1.02-3.18); failure to cry at birth (aOR = 3.6, 95% CI: 1.46-9.17) and post-neonatal complications (aOR = 4.15, 95% CI: 1.22-14.10). Low birth weight, immediate and exclusive breast feeding were not significantly associated with NDD. CONCLUSION: We found a high NDD burden among infants particularly in the social behaviour domain. To optimise the socio-neural development of infants, programs are needed to educate and work with families on how to engage and stimulate infants. Existing immunisation clinics and community health worker strategies provide an excellent opportunity for stemming this burden