Re-admission of preterm babies below one year at the Paediatric ward at Wyne Stone Medical Centre, Wakiso district. A cross-sectional study.

Background. In Uganda, the readmission rate for preterm infants is 69.4% indicating that 7 out of 10 preterm infants are readmitted. The purpose of the study was to determine factors associated with re-admission of preterm babies below one year at the Pediatric Ward, Wyne Stone Medical Center, Wakiso District.  Methods. A descriptive cross-sectional study design employing a quantitative research method was used to collect data within four days involving 40 mothers who were selected using a simple random sampling method. A structured questionnaire was used to collect data and involved closed-ended questions. Data collected was analyzed manually after findings were entered into a Microsoft Excel (2013) version, which was then presented in the form of tables, pie-charts, and graphs.  Results. (42.5%) were between 18 and 25 years, and (65%) had attained secondary education. On mother-related factors, more than half (52.5%) were not knowledgeable about neonatal care, the majority (67.5%) did not exclusively breastfeed their babies after discharge, and 62.5%) leave was not enough. In line with health facility-related factors, the majority (60%) waited for long, and the vast majority (85%) rated health costs as high. Regarding social-economic factors, an overwhelming (95%) had received advice from family members, most (90%) purchased prescribed drugs, and most (72.5%) relied on traditional methods due to healthcare costs.  Conclusion. The majority of the participants were not knowledgeable about neonatal care; experienced stress, and a significant number did not exclusively breastfeed babies after discharge.  Recommendation. The Ministry of Health should strengthen maternal health education programs, especially on neonatal care practices, by integrating structured neonatal care modules into antenatal and postnatal services

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Makerere University Maize Image Dataset

The dataset was created to provide an open and accessible maize dataset with well-labeled, sufficiently curated, and prepared maize crop imagery that will be used by data scientists, researchers, the wider machine learning community, and social entrepreneurs within Sub-saharan Africa and worldwide for various machine learning experiments so as to build solutions towards infield maize crop disease diagnosis and spatial analysis. The image dataset was collected across three different classes: Healthy, Maize Streak Virus (MSV), and Maize Leaf Blight (MLB)

Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda

Introduction: The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We describe the curriculum development and rollout using a cascade model. Methods: In June 2021, the World Health Organisation (WHO) Hospital Emergency Unit Assessment Tool (HEAT) was used to assess emergency units and document existing capacity gaps in regional referral hospitals and general hospitals. The WHO Basic Emergency Care curriculum was modified to a training curriculum for emergency care principles for COVID-19 management. Training of trainers was conducted across 14 health regions in July and August 2021. The trainers trained cascaded the training through facility-based training during continuous professional development sessions. Results: Using the HEAT, 115 health facilities (14 regional and 101 general hospitals) were assessed. Only 31.3% (36/115) of the health facilities had a formal triage system. 53.5% (54/101) of general hospitals lacked non-rotating staff in the emergency unit. Some 511 healthcare workers from 205 facilities were trained as trainers, of whom 51.8% were nurses. The trainers trained cascaded the training to 3,550 healthcare workers. There was a significant difference between the overall median pre-test (71%) and median post-test (86.8%) scores of trainers trained (p<0.001). Conclusion: There was a general lack of emergency unit protocols and a shortage of fixed staff at the emergency units. The cascade model facilitated the dissemination of emergency care knowledge to seven times more healthcare workers than the trainers trained. This demonstrates the efficiency of this approach in knowledge dissemination and its ability to be replicated in other low resource settings