Determinants of acute diarrhoea in children aged 0 – 5 years in Uganda

Background: Diarrhoea disease remains one of the leading causes of morbidity and mortality in sub-Saharan Africa. Using a large national dataset, this study determines it’s prevalence and identifies some of the determinants in one of these countries, Uganda.Objective: To establish the prevalence and determinants of acute diarrhoea in children aged 0 – 5 years in Uganda.Design: Cross-sectional study using the 2000/2001 Uganda Demographic and Health Survey (UDHS) dataset.Subjects: Information was derived from the women’s questionnaire done on sampled mothers aged 15 – 49 years and with living children aged 0 – 5 years.Results: Overall prevalence of diarrhoea in children aged 0 – 5 years was 23.8%. The Northern and Eastern regions of the country had the highest prevalence of diarrhoea in children (29.3% and 26.9% respectively). Independent determinants of diarrhoea were: age-group below two years, Northern and Eastern regions of residence, and children with history of fever in the two weeks preceding survey. Mother attaining secondaryor higher level of education, covered well or borehole as source of drinking water, and duration of breastfeeding less than six months, were found protective factors.Conclusion: According to results of the UDHS 2000/2001, every two weeks, one in four children in Uganda is affected by diarrhoea. Factors associated with increased diarrhoea include: age-group one to two years, children living in Eastern and Northern parts of the country, and children who had fever within those two weeks. Factors associated with reduced diarrhoea incidence include: mother’s education level higher than primary school, covered well or borehole as family source of drinking water, and duration ofbreastfeeding less than six months

Development and Implementation of Patient Management Information System of Kampala International University Teaching Hospital(KIU-TH), Bushenyi District, Uganda

The study evaluatedthe effectiveness of the existing/current patient management information system (EPMIS) design of KIU-TH and the effectiveness of the proposed patient management information system design of KIU-TH in Bushenyi District, Uganda. To test the null hypothesis of there is no significant difference between the existing/current PMIS design and the proposed PMIS design of KIU-TH in Bushenyi District, Uganda. This study employed quasi-experimental designs, descriptive survey, and comparative analysis design approach. The data were analyzed using means and t-test.The findings revealed that the existing PMIS was fairly satisfactory with an overall mean of (2.84). On the other hand, the findings revealed that the proposed patient management information (PPMIS) was effective with an overall mean of (3.22). In addition,the findings also revealed that there was significant difference between the existing PMIS and the proposed PMIS (t=-5.069, sig. =0.000).It was concluded that Orlando’s nursing process theory by Orlando (1972) is a suitable guideline for designing a user friendly patient management information system.Based on the findings of this study, it is recommended that the KIU-TH management implement the proposed PMIS in order to improve on the quality of patient service delivery at the KIU teaching hospital.[1] *Malinga Ramadhan B, College of Higher Degrees and Research, Kampala International University. E-mail: [email protected] **Dr. Ssenyonga T.,College of Higher Degrees and Research, Kampala International University. E-mail: [email protected] **Dr. Novembrieta R. Sumil, College of Higher Degrees and Research, Kampala International University. E-mail: [email protected]  

Anaplasmosis in Uganda. III. Parasitological and serological evidence of Anaplasma infection in Ugandan goats

Randomly selected goat sera from north-western, central, and south-western regions of Uganda were analyzed parasitologically and serologically for evidence of anaplasmosis. Prevalence rates of 3,2 % by parasitemia, 4,8 % by card-agglutination test, and 12,9 % by DOT-ELISA combined with western blotting were established. Parasitologically positive samples were consistently serologically positive. Positive samples were all from either the north-western or south-western regions of the country. Goats in these regions graze with cattle and are presumable exposed to the same tick species. There was no evidence of clinical caprine anaplasmosis, whereas bovine anaplasmosis cases are very common. Rhipicephalus evertsi was frequently observed on goats which cograze with cattle.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Erysipelothrix rhusiopathiae infection in pigs, pork and raw pork handlers in Kamuli District, Eastern Uganda

Erysipelothrix rhusiopathiae is a zoonotic ubiquitous gram-positive bacterium, which causes erysipelas in swine, mammals, birds and erysipeloid in humans. People in contact with animals, animal products or animal wastes are at greatest risk. From June 2013 to December 2015, a multidisciplinary risk assessment was conducted to identify the risks associated with E. rhusiopathiae along the pig value chain in Kamuli District, Eastern Uganda. Quantitative and qualitative methods of data collection were employed. Serum from 460 pigs and 100 fresh pork samples and human EDTA blood was gathered from 302 raw pork handlers (butchers, abattoir workers and housewives), for microbiology cultures and serology. Six focus group discussions were conducted with 26 butchers/abattoir workers and with 26 housewives. Three key informant interviews were conducted with a health assistant, veterinary officer and a nursing officer. Overall, 308/460 (67%) of the pig sera carried antibodies against E. rhusiopathiae. Forty-five percent (45/100, 45%) of the fresh pork samples were contaminated with E. rhusiopathiae and 30/302 (9.9%) of the raw pork handlers were positive for infection with E. rhusiopathiae. The mean age of the raw pork handlers was 38 years, 21/30 (70%) of men were infected compared to 9/30(30%) of the women. The main risk factor for the infection was the type of raw pork handler. Of the abattoir workers 14/38 (47%) were positive, 9/59 (30%) of the butchers and 7/205 (23.3%) of the housewives were infected with E.rhusiopathiae. This is the first ever report of E. rhusiopathiae in pigs and humans in Uganda and East Africa. Previously, the acute form of swine erysipelas may have been confused for other diseases in pigs reported in Uganda which are characterized acute symptoms such as sudden death (for example, African swine fever). We recommend increasing awareness of the disease among animal and human practitioners as treatment is easy and available and vaccination is possible. However, the disease is still unknown to local veterinarians, clinical doctors, meat inspectors, butchers and laboratory personnel. Proper hygiene, regular pork inspection, use of protective wear among people working/ in contact with animals should be promoted. The study was conducted under the Safe Food, Fair Food project led by the International Livestock Research Institute and carried out with the financial support of the Federal Ministry for Economic Cooperation and Development, Germany, and the CGIAR Research Program on Agriculture for Nutrition and Health, led by the International Food Policy Research Institute

Tobacco Smoking and Associated Factors among People Living with HIV in Uganda

Introduction The prevalence of smoking among people living with HIV (PLWH) in Uganda is high. Aims and Methods We assessed the smoking patterns, behaviors, and associated factors among PLWH in Uganda through a cross-sectional survey. Descriptive statistics were used to describe smoking patterns and behaviors. Logistic regression was used to identify factors associated with current smoking status. Results We recruited 777 participants between October and November 2019: 387 (49.8%) current smokers and 390 (50.2%) nonsmokers. 60.9% were males, and the mean age was 40.5 (SD 10.7) years. In multivariate logistic regression, the following increased the odds of being a current smoker: being male (odds ratio [OR] 6.60 [95% confidence interval, CI = 4.34–10.04]), having at least two smokers among five closest friends (OR 3.97 [95% CI = 2.08–7.59]), living in smoking-permitted households (OR 5.83 [95% CI = 3.32–10.23]), alcohol use (OR 3.96 [95% CI = 2.34–6.71]), a higher perceived stress score (OR 2.23 [95% CI = 1.50–3.34]), and higher health-related quality of life (OR 5.25 [95% CI = 1.18–23.35]). Among smokers, the mean Fagerström Test for Nicotine Dependence score was 3.0 (SD 1.9), and 52.5% were making plans to quit. Self-efficacy to resist smoking and knowledge of the impact of smoking on PLWH’s health were low. Conclusions Being male, having at least two smokers among five closest friends, living in smoking-permitted households, alcohol use, higher perceived stress scores, and higher health-related quality of life were associated with being a current smoker. Smokers had low to moderate nicotine dependence, high willingness to quit, and low self-efficacy. Implications Future behavioral smoking cessation interventions for PLWH should address co-consumption with alcohol and comorbid mental health conditions that are common among PLWH such as stress. In addition, they should take into account the lack of knowledge among this population of the impact of smoking on their health, and low self-efficacy. Given the relatively low levels of nicotine dependency and high levels of willingness to quit in our sample, smoking cessation interventions, if offered, are likely to support this population in achieving long-term smoking abstinence

Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study

The original publication is available at http://www.biomedcentral.comAbstract Background: The principles and practice of Family Medicine that arose in developed Western countries have been imported and adopted in African countries without adequate consideration of their relevance and appropriateness to the African context. In this study we attempted to elicit a priori principles of generalist medical practice from the experience of long-serving medical officers in a variety of African counties, through which we explored emergent principles of Family Medicine in our own context. Methods A descriptive study design was utilized, using qualitative methods. 16 respondents who were clinically active medical practitioners, working as generalists in the public services or non-profit sector for at least 5 years, and who had had no previous formal training or involvement in academic Family Medicine, were purposively selected in 8 different countries in southern, western and east Africa, and interviewed. Results The respondents highlighted a number of key issues with respect to the external environment within which they work, their collective roles, activities and behaviours, as well as the personal values and beliefs that motivate their behaviour. The context is characterized by resource constraints, high workload, traditional health beliefs, and the difficulty of referring patients to the next level of care. Generalist clinicians in sub-Saharan Africa need to be competent across a wide range of clinical disciplines and procedural skills at the level of the district hospital and clinic, in both chronic and emergency care. They need to understand the patient's perspective and context, empowering the patient and building an effective doctor-patient relationship. They are also managers, focused on coordinating and improving the quality of clinical care through teamwork, training and mentoring other health workers in the generalist setting, while being life-long learners themselves. However, their role in the community, was found to be more aspirational than real. Conclusions The study derived a set of principles for the practice of generalist doctors in sub-Saharan Africa based on the reported activities and approaches of the respondents. Patient-centred care using a biopsychosocial approach remains as a common core principle despite wide variations in context. Procedural and hospital care demands a higher level of skills particularly in rural areas, and a community orientation is desirable, but not widely practiced. The results have implications for the postgraduate training of family physicians in sub-Saharan Africa, and highlight questions regarding the realization of community-orientated primary care.Publishers' Versio

Effect of dolutegravir on folate, vitamin B12 and mean corpuscular volume levels among children and adolescents with HIV: a sub‐study of the ODYSSEY randomized controlled trial

INTRODUCTION: Dolutegravir-based antiretroviral therapy (ART) is the preferred antiretroviral treatment for children and adolescents living with HIV. A large surveillance study in Botswana previously raised concerns about an association between pre-conception dolutegravir and neural tube defects. Before these concerns were subsequently resolved, we set up a sub-study to look at the effect of dolutegravir on levels of folate and vitamin B12 in children and adolescents within the randomized ODYSSEY trial, as folate and vitamin B12 are known to play a crucial role in neural tube development. METHODS: We conducted the sub-study among Ugandan ODYSSEY participants and compared folate and vitamin B12 between children randomized to dolutegravir-based ART (DTG) and non-dolutegravir-based standard-of-care treatment (SOC). Plasma folate was measured at enrolment and week 4 on stored samples; in addition, plasma and red blood cell (RBC) folate and vitamin B12 were assayed at week ≥96 in prospectively collected samples. RBC mean corpuscular volume (MCV) was measured 24-weekly in all ODYSSEY participants. Samples analysed in the sub-study were collected between September 2016 and October 2020. RESULTS: A total of 229 children aged ≥6 years were included in the sub-study with median age at trial enrolment of 12.3 (interquartile range [IQR] 9.0, 14.7) years, and CD4 count of 501 (IQR 228, 695); 112 (49%) children were male. Most participants (225/229, 98%) had plasma folate results at enrolment and 214 (93%) children had results available for RBC folate, vitamin B12 and plasma folate at week ≥96. MCV results were analysed on 679 children aged ≥6 years enrolled in ODYSSEY. At week 4, mean plasma folate was significantly higher in the dolutegravir arm than in SOC (difference [DTG-SOC] 1.6 ng/ml, 95% CI 0.8, 2.3; p<0.001), and this difference persisted to week ≥96 (2.7 ng/ml, 95% CI 1.7, 3.7; p<0.001). Mean RBC folate at ≥96 weeks was also higher in the DTG arm (difference 73 ng/ml, 95% CI 3, 143; p = 0.041). There was no difference in the treatment arms for vitamin B12 levels at ≥96 weeks or change in MCV through trial follow-up. CONCLUSIONS: Plasma and RBC folate levels were higher in children and adolescents receiving dolutegravir-based ART than on other ART regimens. Further studies are needed to clarify the mechanisms of these interactions and the clinical implications of increased blood folate levels

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

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