Predictors of recovery from complicated severe acute malnutrition among children 6-59 months admitted at Mbale Hospital, Uganda

Introduction: In Uganda, 300,000 children under 5 years are acutely malnourished with 1.3% suffering from Severe Acute Malnutrition (SAM). Mbale Regional Referral hospital (MRRH) nutrition unit admits SAM children with comorbidities into inpatient care striving to ensure recovery, reduce morbidity and mortality. We assessed the incidence and predictors of time to recovery among SAM children admitted as inpatients in MRRH nutrition unit. Methods: We reviewed records of children 6-59 months old managed at the inpatient unit for SAM at MRRH from 2013 to 2016. Data on patient demographics, comorbidities, medications administered, and treatment outcomes were collected from the integrated nutrition register and patient charts. Recovery incidence was determined using Kaplan Meier survival analysis. Cox proportional hazards regression competing risks model with death, default and transfer as competing risks was fit to identify predictors of time to recovery. Results: Overall, 322 patient records were reviewed of which 183 (56.8%) were males with median age of 19 months (IQR; 14-26 months). Of these, 246 (76.4%) recovered with recovery incidence of 31.3 per 1000 person days and a median recovery time of 27 days (IQR; 16-38 days). Children with SAM who were dewormed during treatment were 33% more likely to recover faster compared to their counterparts who were not dewormed (AHR= 1.33; C.I = 1.01-1.74). Conclusion: Recovery was in acceptable range of Sphere standards and deworming was a predictor of time to recovery. The Uganda Ministry of health should ensure nutritional rehabilitation units follow the stipulated guidelines for management of SAM. Findings were limited by missing data

Survival time and its predictors among preterms in the neonatal period post-discharge in Busoga region-Uganda June – July 2017

Introduction: Globally, out of 15 million babies born preterm each year, one million die. In Uganda, preterm deaths contribute 30% of the neonatal mortality rate. There is a paucity of information on the most critical time to conduct high impact interventions among neonate born preterm especially post-discharge from hospital. We determined the survival time to mortality and its predictors among preterm infants in the neonatal period post-discharge from hospital. Methods: We conducted a prospective cohort study in which 128 preterm infants were recruited from six hospitals including Jinja Regional Referral, St. Francis Buluba, Kamuli mission, Iganga, Kamuli and Bugiri district hospitals were prematurity was confirmed using gestation age and birth weight. Initially, background characteristics of the participants were assessed and then followed prospectively until 28 days. Kaplan-Meier survival analysis was used to estimate survival probabilities while time to preterm mortality was described using the 5thpercentile. Cox proportional hazards regression was used to determine predictors of survival. Results: Overall, 8% (10/128) of the preterm infants died; the 5th percentile survival time was 17 days. There was a 6-fold increase in hazard to mortality among preterm infants who had Kangaroo Mother Care (KMC) compared to those who did not (adjusted HR: 6.4, 95%CI: 1.7 – 24.5), a 5-fold increase in the hazard to preterm mortality among preterm infants born to HIV positive mothers compared to their counterparts who had HIV negative mothers (adjusted HR: 4.9, 95%CI: 1.1 – 22.2); and a 4-fold increase in the hazard to preterm mortality among preterm infants who were not exclusively breastfed compared to those who were exclusively breastfed (adjusted HR: 4.4, 95%CI: 1.1 – 18.3). Conclusion: Among babies who died, death occurred in the first 17 days while factors negatively associated with preterm survival included; not practicing Kangaroo Mother Care, not being breastfed exclusively and being born to an HIV positive mother. We recommend follow-up care for preterm infants following hospital discharge, implementation of prevention of mother to child transmission of HIV and exclusive breastfeeding of preterm babies

A new look at population health through the lenses of cognitive, functional and social disability clustering in eastern DR Congo: a community-based cross-sectional study

and its covariates at primary healthcare level in DR Congo. METHOD: We conducted a community-based cross-sectional study in adults with diabetes or hypertension, mother-infant pairs with child malnutrition, their informal caregivers and randomly selected neighbours in rural and sub-urban health zones in South-Kivu Province, DR Congo. We used the WHO Disability Assessment Schedule 2.0 (WHODAS) to measure functional, cognitive and social disability. The study outcome was health status clustering derived from a principal component analysis with hierarchical clustering around the WHODAS domains scores. We calculated adjusted odds ratios (AOR) using mixed-effects ordinal logistic regression. RESULTS: Of the 1609 respondents, 1266 had WHODAS data and an average age of 48.3 (SD: 18.7) years. Three hierarchical clusters were identified: 9.2% of the respondents were in cluster 3 of high dependency, 21.1% in cluster 2 of moderate dependency and 69.7% in cluster 1 of minor dependency. Associated factors with higher disability clustering were being a patient compared to being a neighbour (AOR: 3.44; 95% CI: 1.93-6.15), residency in rural Walungu health zone compared to semi-urban Bagira health zone (4.67; 2.07-10.58), female (2.1; 1.25-2.94), older (1.05; 1.04-1.07), poorest (2.60; 1.22-5.56), having had an acute illness 30 days prior to the interview (2.11; 1.24-3.58), and presenting with either diabetes or hypertension (2.73; 1.64-4.53) or both (6.37; 2.67-15.17). Factors associated with lower disability clustering were being informally employed (0.36; 0.17-0.78) or a petty trader/farmer (0.44; 0.22-0.85). CONCLUSION: Health clustering derived from WHODAS domains has the potential to suitably classify individuals based on the level of health needs and dependency. It may be a powerful lever for targeting appropriate healthcare service provision and setting priorities based on vulnerability rather than solely presence of disease

Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study

Abstract Background Lifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facility-based data could underestimate retention in the absence of measures to account for self-transfers to other facilities. We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to ascertain transfers to other facilities. Methods In a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+ between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews). Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13. Results A total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation, 278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per 1000 months of observation (pmo) (95% CI: 55.9–64.3) at 12, and 46.3/1000pmo (95% CI: 42.0–50.5) at 25 months. Overall, 237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was 71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28–2.30); those with no education, aHR = 5.55 (95% CI: 3.11–9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16–2.19) were more likely to be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive spouses, were barriers to retention in care. Conclusions Retention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance disclosure to partners, targeting the uneducated, and those < 25 years

Effects and factors associated with indoor residual spraying with Actellic 300 CS on malaria morbidity in Lira District, Northern Uganda

Abstract Background Indoor residual spraying (IRS) with Actellic 300 CS was conducted in Lira District between July and August 2016. No formal assessment has been conducted to estimate the effect of spraying with Actellic 300 CS on malaria morbidity in the Ugandan settings. This study assessed malaria morbidity trends before and after IRS with Actellic 300 CS in Lira District in Northern Uganda. Methods The study employed a mixed methods design. Malaria morbidity records from four health facilities were reviewed, focusing on 6 months before and after the IRS intervention. The outcome of interest was malaria morbidity defined as; proportion of outpatient attendance due to total malaria, proportion of outpatient attendance due to confirmed malaria and proportion of malaria case numbers confirmed by microscopy or rapid diagnostic test. Since malaria morbidity was based on count data, an ordinary Poisson regression model was used to obtain percentage point change (pp) in monthly malaria cases before and after IRS. A household survey was also conducted in 159 households to determine IRS coverage and factors associated with spraying. A modified Poisson regression model was fitted to determine factors associated with household spray status. Results The proportion of outpatient attendance due to malaria dropped from 18.7% before spraying to 15.1% after IRS. The proportion of outpatient attendance due to confirmed malaria also dropped from 5.1% before spraying to 4.0% after the IRS intervention. There was a decreasing trend in malaria test positivity rate (TPR) for every unit increase in month after spraying. The decreasing trend in TPR was more prominent 5–6 months after the IRS intervention (Adj. pp = − 0.60, P-value = 0.015; Adj. pp = − 1.19, P-value < 0.001). The IRS coverage was estimated at 89.3%. Households of respondents who were formally employed or owned any form of business were more likely to be unsprayed; (APR = 5.81, CI 2.72–12.68); (APR = 3.84, CI 1.20–12.31), respectively. Conclusion Coverage of IRS with Actellic 300 CS was high and was associated with a significant decline in malaria related morbidity 6 months after spraying

Geospatial Distribution of Pedestrian Injuries and Associated Factors in the Greater Kampala Metropolitan Area, Uganda

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29-year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar &amp; entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries

Geospatial distribution of pedestrian injuries and associated factors in the greater Kampala Metropolitan Area, Uganda

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29-year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar &amp; entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries

Prevalence of non-fatal injuries and associated factors in Mbarara Municipality, Western Uganda, December 2016-June 2017

Background: Injuries are a significant public health problem but poorly quantified especially in low and middle-income countries. In Uganda, the burden of injuries is poorly quantified with most of the data reported being facility and mortality based. Many non-fatal injuries, therefore, remain unreported in communities. We conducted a household survey in Mbarara Municipality to identify and describe all non-fatal injury events and the associated factors. Methods: We conducted a cross-sectional study of non-fatal injuries among 966 household members in Mbarara Municipality, from May to June 2017. The most recent non-fatal injury (within a six-month recall period; December 2016 to June 2017) resulting in loss of at least one day of usual daily operating activity was considered. We conducted a descriptive statistical analysis to estimate the counts and frequencies of non-fatal injuries. We identified factors associated with non-fatal injuries using a modified Poisson regression model. Results: The prevalence of non-fatal injuries was 18.2% (176/966) with 92% (162/176) of the non-fatal injuries being unintentional. Falls 27.3% (48/176) were the most common cause of injury followed by road traffic injuries (RTI), 26.7% (47/176), burns 16.5% (29/176) and the least being poisoning 2.8% (5/176). Occupation as casual laborer (Adjusted PR=2.1, 95% CI: 1.2 - 3.7), urban residency (Adjusted PR=1.5, 95% CI: 1.1 - 1.9) and being a non-native of the study area (Adjusted PR=1.7, 95% CI: 1.3 - 2.3) were independently associated with non-fatal injuries. Conclusion: Almost one out of five people had suffered a non-fatal injury in the past six months in Mbarara Municipality. Majority of the non-fatal injuries were unintentional, caused by falls and RTIs, and were amongst casual labourers and urban residents. These findings reveal a gap in injury prevention in Uganda that needs to be addressed to improve the quality of life