Globally,neonatal deaths continues to be a challenge especially to to attainment of sustainable development goal 3 .About 4 million neonatal deaths per year,with 99% of the deaths occurring in low and middle resource countries,75% of... more
Globally,neonatal deaths continues to be a challenge especially to to attainment of sustainable development goal 3 .About 4 million neonatal deaths per year,with 99% of the deaths occurring in low and middle resource countries,75% of these occurring in the first week of life.Prematurity remains an indirect leading cause of mortality and morbidity.Uganda's progress on the improvement of perinatal morbidity and mortality has largely stagnated at 27 deaths per 1,000 live births from the year 2006. One of the cost-effective readily available interventions that would curtail perinatal mortality is kangaroo mother care(KMC)-a low tech four decades old intervention.However challenges about its implementation persist on in Uganda despite intensified implementation and roll-out startegies in 2010.This study,the first of its kind to the best of our knowledge in eastern Uganda sought to find the facilitators and barriers of KMC. Materials and methods:This was a qualitative study using in-depth interviews(IDI) carried out at a tertiary university teaching hospital.Twenty IDIs were carried out among mothers/caretakers using the phenomena theory.After each IDI, each transcript was analyzed by two researchers working independently using NVIVO software version 11 plus (QSR International, Burlington, Massachusetts) and themes and subthemes developed. Results:Majority of mothers/caretakers, were adolescents and young adults and primiparous at 55%.The major facilitators to KMC were supportive staff that facilitated positive attitude ,ability to substitute provider and family support. The major barriers were lack of family support,lack of male involvement,maternal stress and poor health and multiple gender roles, infrastructural challenges,and misconceptions associated with preterm births such as early sexual intercourse and lack of herbal medicine use. Conclusion:More facility leadership involvement and engagement of mothers during antenatal,community and promotion of male involvement in sexual and reproductive health matters will improve uptake of KMC.This can be spearheadded by sexual and reproductive health, and neonatal and child health care service providers.
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Abortion in Uganda [1] like in other African countries such as Nigeria [2] is legal only when performed to save a woman’s life. Therefore Uganda’s law does not mean that abortion is legal but is rather restrictive [1, 3]. Every woman has... more
Abortion in Uganda [1] like in other African countries such as Nigeria [2] is legal only when performed to save a woman’s life. Therefore Uganda’s law does not mean that abortion is legal but is rather restrictive [1, 3]. Every woman has the recognized human right to decide freely and responsibly without coercion and violence the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health [4]. Access to legal and safe abortion, as a tenet of safe motherhood is critical for the realization of these rights [5]. Uganda has one of the high total fertility rate (TFR) of 5.4 , and 38 percent of women age 15-49 do not want any more children or are sterilized while Uganda’s Contraceptive prevalence rate is only 39%, with the teenagers and the least privileged of the society less likely to access family planning services [6]. Worth noting too, is that despite the progress in allevi...
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Individual nutrient and nutrient mean differences, standard deviation, and upper and lower limits of agreement (LOA) comparing WFR and combined DR1 and DR1; Supplementary table summarising Bland-Altman analysis results for all nutrients.... more
Individual nutrient and nutrient mean differences, standard deviation, and upper and lower limits of agreement (LOA) comparing WFR and combined DR1 and DR1; Supplementary table summarising Bland-Altman analysis results for all nutrients. Results presented in absolute and percentage values. (DOCX 16Â kb)
Dataset for validation of triple pass 24-h dietary recall in Ugandan children by simultaneous weighed food assessment; Associated dataset in Excel format to enable validation of results and statistical interpretation. Gender has been... more
Dataset for validation of triple pass 24-h dietary recall in Ugandan children by simultaneous weighed food assessment; Associated dataset in Excel format to enable validation of results and statistical interpretation. Gender has been removed to limit indirect identifiable information, but can be made available on request. (XLSX 26Â kb)
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Sickle cell anemia (SCA) is common in sub‐Saharan Africa where approximately 1% of births are affected. Severe anemia is a common cause for hospital admission within the region yet few studies have investigated the contribution made by... more
Sickle cell anemia (SCA) is common in sub‐Saharan Africa where approximately 1% of births are affected. Severe anemia is a common cause for hospital admission within the region yet few studies have investigated the contribution made by SCA. The Transfusion and Treatment of severe anemia in African Children Trial (ISRCTN84086586) investigated various treatment strategies in 3983 children admitted with severe anemia (hemoglobin < 6.0 g/dl) based on two severity strata to four hospitals in Africa (three Uganda and one Malawi). Children with known‐SCA were excluded from the uncomplicated stratum and capped at 25% in the complicated stratum. All participants were genotyped for SCA at trial completion. SCA was rare in Malawi (six patients overall), so here we focus on the participants recruited in Uganda. We present baseline characteristics by SCA status and propose an algorithm for identifying children with unknown‐SCA. Overall, 430 (12%) and 608 (17%) of the 3483 Ugandan participants had known‐ or unknown‐SCA, respectively. Children with SCA were less likely to be malaria‐positive and more likely to have an affected sibling, have gross splenomegaly, or to have received a previous blood transfusion. Most outcomes, including mortality and readmission, were better in children with either known or unknown‐SCA than non‐SCA children. A simple algorithm based on seven admission criteria detected 73% of all children with unknown‐SCA with a number needed to test to identify one new SCA case of only two. Our proposed algorithm offers an efficient and cost‐effective approach to identifying children with unknown‐SCA among all children admitted with severe anemia to African hospitals where screening is not widely available.
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Background: Children presenting to hospital with recent or current Plasmodium falciparum malaria are at increased the risk of invasive bacterial disease, largely enteric gram-negative organisms (ENGO), which is associated with increased... more
Background: Children presenting to hospital with recent or current Plasmodium falciparum malaria are at increased the risk of invasive bacterial disease, largely enteric gram-negative organisms (ENGO), which is associated with increased mortality and recurrent morbidity. Although incompletely understood, the most likely source of EGNO is the bowel. We hypothesised that as a result of impaired gut-barrier function endotoxin (lipopolysaccharide), present in the cell-wall of EGNO and in substantial quantities in the gut, is translocated into the bloodstream, and contributes to the pathophysiology of children with severe malaria. Methods: We conducted a prospective study in 257 children presenting with malaria to two hospitals in Kenya and Uganda. We analysed the clinical presentation, endotoxin and cytokine concentration. Results: Endotoxaemia (endotoxin activity ≥0.4 EAA Units) was observed in 71 (27.6%) children but its presence was independent of both disease severity and outcome. E...
Background: Early rapid fluid resuscitation (boluses) in African children with severe febrile illnesses increases the 48-hour mortality by 3.3 % compared with controls (no bolus). We explored the effect of boluses on 48-hour all-cause... more
Background: Early rapid fluid resuscitation (boluses) in African children with severe febrile illnesses increases the 48-hour mortality by 3.3 % compared with controls (no bolus). We explored the effect of boluses on 48-hour all-cause mortality by clinical presentation at enrolment, hemodynamic changes over the first hour, and on different modes of death, according to terminal clinical events. We hypothesize that boluses may cause excess deaths from neurological or respiratory events relating to fluid overload. Methods: Pre-defined presentation syndromes (PS; severe acidosis or severe shock, respiratory, neurological) and predominant terminal clinical events (cardiovascular collapse, respiratory, neurological) were described by randomized arm (bolus versus control) in 3,141 severely ill febrile children with shock enrolled in the Fluid Expansion as Supportive Therapy (FEAST) trial. Landmark analyses were used to compare early mortality in treatment groups, conditional on changes in ...
Background. In the Fluid Expansion as a Supportive Treatment (FEAST) trial, an unexpectedly high proportion of participants from eastern Uganda presented with blackwater fever (BWF). Methods. We describe the prevalence and outcome of BWF... more
Background. In the Fluid Expansion as a Supportive Treatment (FEAST) trial, an unexpectedly high proportion of participants from eastern Uganda presented with blackwater fever (BWF). Methods. We describe the prevalence and outcome of BWF among trial participants and compare the prevalence of 3 malaria-protective red blood cell polymorphisms in BWF cases vs both trial (non-BWF) and population controls. Results. ) and 9 of 282 (3.4%) receiving 2 or 3 transfusions, respectively. By day 28, 39 of 318 (12.3%) BWF cases and 154 of 1554 (9.9%) non-BWF controls had died (P = .21), and 7 of 255 (3.0%) vs 13/1212 (1%), respectively, had severe anemia (P = .036). We found no association with G6PD deficiency. The prevalence of both the sickle cell trait (10/218 [4.6%]) and homozygous α
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In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To... more
In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10 %), 6-month mortality and relapse (6 %). A definitive trial to establish best transfusion and treatment strategies to prevent both early and delayed mortality and relapse is warranted. TRACT is a multicentre randomised controlled trial of 3954 children aged 2 months to 12 years admitted to hospital with severe anaemia (haemoglobin < 6 g/dl). Children will be enrolled over 2 years in 4 centres in Uganda and Malawi and followed for 6 months. The trial will simultaneously evaluate (in a factorial trial with a 3 x...
Research Interests: Biomarkers, General Internal Medicine, Malawi, Humans, Child, and 15 moreInfant, Anemia, Dietary Supplements, Health Status, Clinical Sciences, Infant Mortality, Age Factors, Blood Transfusion, Anthelmintics, Child mortality, Hospital Mortality, Clinical Protocols, Hemoglobins, Child preschool, and Cardiovascular medicine and haematology
Background Children presenting to hospital with recent or current Plasmodium falciparum malaria are at increased the risk of invasive bacterial disease, largely enteric gram-negative organisms (ENGO), which is associated with increased... more
Background Children presenting to hospital with recent or current Plasmodium falciparum malaria are at increased the risk of invasive bacterial disease, largely enteric gram-negative organisms (ENGO), which is associated with increased mortality and recurrent morbidity. Although incompletely understood, the most likely source of EGNO is the bowel. We hypothesised that as a result of impaired gut-barrier function endotoxin (lipopolysaccharide), present in the cell-wall of EGNO and in substantial quantities in the gut, is translocated into the bloodstream, and contributes to the pathophysiology of children with severe malaria. Methods We conducted a prospective study in 257 children presenting with malaria to two hospitals in Kenya and Uganda. We analysed the clinical presentation, endotoxin and cytokine concentration. Results Endotoxaemia (endotoxin activity ≥0.4 EAA Units) was observed in 71 (27.6%) children but its presence was independent of both disease severity and outcome. Endo...
Research Interests: Microbiology, Immunology, Nonparametric Statistics, Medical Microbiology, Biology, and 15 moreMalaria, Cytokines, Kenya, Medicine, Lipopolysaccharide, Prospective studies, Humans, Infant, Clinical Sciences, Cytokine, ENDOTOXEMIA, Plasmodium falciparum, Endotoxins, Child preschool, and Malaria Falciparum
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Background Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum... more
Background Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant (MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic antibiotics. This study aimed at determining the bacterial species diversity and susceptibility patterns of indwelling urinary catheters from postpartum mothers attending Mbale Regional Referral Hospital (MRRH). Methods A cross-sectional study employing quantitative and qualitative was carried out in MRRH among postpartum mothers with urinary catheters and their care-takers. The purposive non-random sampling strategy was used to collect data using an interviewer-administered questionnaire for the quantitative data collection and in-...
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Background: Contraception is a worthwhile and cost effective investment that has potential to spur national development. It is important in averting significant maternal and childhood morbidity and mortality. No wonder countries with low... more
Background: Contraception is a worthwhile and cost effective investment that has potential to spur national development. It is important in averting significant maternal and childhood morbidity and mortality. No wonder countries with low contraceptive prevalence rates (CPR) have poor maternal and childhood health indicators. Consequently, during the 2012 London conference Uganda set a target of improving modern CPR (mCPR) to 50% by 2020. We report how eastern Uganda is faring on this commitment and identify the factors associated with contraceptive uptake. Methods: Using a cross-sectional study design, we recruited 418 sexually active women aged 15-49 years who had come to nurse their sick ones in a tertiary hospital. We used systematic sampling to recruit participants. Data was collected using an interviewer administered pretested questionnaire, analyzed using STAT version 19. Results: Of the 418 women respondents, 15.6% were teens while 50% were aged 20-29 years. Significantly, 64...
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Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and... more
Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and antimicrobial susceptibility patterns among pregnant women attending antenatal in a District Hospital in Eastern Uganda. Materials and Methods: A descriptive cross sectional study was conducted in which pregnant mothers who had come for routine antenatal care were counseled and their consents obtained before taking off urine samples for laboratory diagnosis. For those samples found to have pus cells, culture and sensitivity test was done to identify the organisms and determine susceptibility to particular antibiotics and antifungal agents. Results: Gram negative isolates were more sensitive to meropenem (100%), and ciprofloxacin (93.8%) but less sensitive to trimethoprim/sulphurmethoxazole (20%), Ceftazidime (7%), and Cefepime (6%). Gram positive isolates ...
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Background: The history and importance of breastfeeding is emphasized from anthropology of nutrition studies albeit with challenges. Furthermore exclusive breastfeeding (EBF) is a known economically effective intervention that can help... more
Background: The history and importance of breastfeeding is emphasized from anthropology of nutrition studies albeit with challenges. Furthermore exclusive breastfeeding (EBF) is a known economically effective intervention that can help reduce maternal and childhood morbidity and mortality. Moreover the global prevalence of EBF have remained low with Uganda averaging 42.6%.Subsequently in 2012, the World Health Assembly endorsed a Comprehensive maternal, infant and young child nutrition implementation plan with six specific global nutrition targets, one of which was to increase the rate of EBF in the first 6 months to at least 50% by 2025.This study aimed at tracking whether eastern Uganda had met the set target and what factors would be influencing EBF. Methods: We carried out a mixed methods cross sectional study in Manafwa district, eastern Uganda. We employed both qualitative and quantitative data collection tools. We based on the concepts of habitus and dispositions to explore t...
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Background: Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five... more
Background: Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five and the elderly, although any age group can be affected. This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated from mother-baby pairs in Ngora district after the rollout of the pneumococcal vaccine. We hypothesized that high carriage of Streptococcus pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contracting pneumonia. Methods: Consecutive sampling was used to select 152 mother-baby pairs from community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity testing using the Kirby-Bauer’s agar disc diffusion method. Results: This study found that there was a low p...
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Introduction Adolescence is a period of transition from childhood to adulthood and is thus a critical in ones’ development characterized by opportunities and risks. By 2016, 16% of the World’s population was of adolescents with 82%... more
Introduction Adolescence is a period of transition from childhood to adulthood and is thus a critical in ones’ development characterized by opportunities and risks. By 2016, 16% of the World’s population was of adolescents with 82% residing in developing countries. About 12million births are due to 15-19 year olds. Sub-Saharan Africa particularly East Africa has high adolescent pregnancy rates with ranges as high as 35.8% in Eastern Uganda. Of Uganda’s maternal mortality ratio of 336/100.000 live births, 17.1% were attributable to adolescents aged 15-19 years. Whereas research is awash with contributing factors to such pregnancies, little is known about their lived experiences during early motherhood. We therefore set to study the lived experiences of adolescent mothers attending our hospital. Methods A phenomenological study design was used in which adolescent mothers that were attending Young child clinic were identified from the register and simple random sampling used to select ...
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Background Few recent descriptions of severe childhood malaria have been published from high-transmission regions. In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the... more
Background Few recent descriptions of severe childhood malaria have been published from high-transmission regions. In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the entomological inoculation rate exceeds 100 infective bites per year. Methods A prospective descriptive study was conducted to determine the prevalence, clinical spectrum and outcome of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital in Eastern Uganda. All children aged 2 months–12 years who presented on Mondays to Fridays between 8.00 am and 5.00 pm from 5th May 2011 until 30th April 2012 were screened for parasitaemia. Clinical and laboratory data were then collected from all P. falciparum positive children with features of WHO-defined severe malaria by use of a standardized proforma. Results A total of 10 208 children were screened of which 6582 (64%) had a positive blood film. Of these children, 662 (10%) had clinical features o...
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Background: Antenatal care, one of the pillars of safe motherhood, is a proven a concept aimed at reducing maternal and neonatal morbidity and mortality. It is a largely a health preventive and promotive activity. In order to foster its... more
Background: Antenatal care, one of the pillars of safe motherhood, is a proven a concept aimed at reducing maternal and neonatal morbidity and mortality. It is a largely a health preventive and promotive activity. In order to foster its utilization and the desired benefits, the males who are largely key decision makers especially in patriarchal societies have to be involved. This concept of male involvement (MI) is essential in curtailing the gender inequality and improves the family livelihood. Although different strategies have been employed to woe males into ANC clinics, their involvement is largely lacking in Uganda. This study reports level of males’ involvement, their knowledge and attitudes of ANC and influencing factors . Methods: This was a cross sectional community descriptive study that employed quantitative and qualitative methods. Our qualitative data study was based on the phenomenological design and rooted into the Grounded theory. For quantitative study, 135 adult ma...
Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention,... more
Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 ...
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Objective: This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated in the mother-baby pairs in Ngora district after the roll out of the pneumococcal vaccine. We... more
Objective: This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated in the mother-baby pairs in Ngora district after the roll out of the pneumococcal vaccine. We hypothesized that high carriage of S. pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contacting pneumoniae. Results: Consecutive sampling technique was used to select 152 mother-baby pairs from the community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity using the Kirby-Bauer’s agar disc diffusion method. This study found that there was a low prevalence of pneumococcal carriage in the mother-baby pair in Ngora district. We also observed high rates microbial resistance to Penicillin which is the first-line management of pneumonia in Uganda. The relationship between pneumococcal carriage and immunization status suggest that Pneumococ...
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Background: Severe anaemia in children requiring hospital admission is a major public health problem in malaria-endemic Africa. Affordable methods for the assessment of haemoglobin have not been validated against gold standard measures... more
Background: Severe anaemia in children requiring hospital admission is a major public health problem in malaria-endemic Africa. Affordable methods for the assessment of haemoglobin have not been validated against gold standard measures for identifying those with severe anaemia requiring a blood transfusion, despite this resource being in short supply. Methods: We conducted a prospective descriptive study of hospitalized children aged 2 months – 12 years at Mbale and Soroti Regional Referral Hospitals, assessed to have pallor at triage by a nurse and two clinicians. Haemoglobin levels were measured using the HemoCue® Hb 301 system (gold standard); the Haemoglobin Colour Scale; calorimetric and Sahli’s methods. We report clinical assessments of the degree of pallor, clinicians’ intention to transfuse, inter-observer agreement, limits of agreement using the Bland-Altman method, and the sensitivity and specificity of each method in comparison to HemoCue® Results: We recruited 322 childr...
Data on the performance and utility of rapid serological tests in infants to determine HIV exposure are unclear and in some instances contradictory. This study sought to understand the performance of rapid serological tests in high HIV... more
Data on the performance and utility of rapid serological tests in infants to determine HIV exposure are unclear and in some instances contradictory. This study sought to understand the performance of rapid serological tests in high HIV burden, high Option B+ coverage settings to be used as an HIV exposure screening tool. A total of 3600 infants up to 24 months of age at 4 regional hospitals in Uganda were systematically enrolled and tested simultaneously using both HIV rapid serological and nucleic acid-based tests. Only 58 of the 94 HIV-positive infants who received both rapid serological and nucleic acid-based tests were positive with the rapid serological test (sensitivity: 61.7%; 95% confidence interval: 51.1 to 71.5). Using rapid serological tests to screen infants for exposure to HIV and follow-up nucleic acid-based testing would have missed 38.3% (36 of 94) of HIV-positive infants. Finally, several HIV-positive infants who were negative by rapid serological test presented to ...
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Despite notable progress towards PMTCT, only 50% of HIV-exposed infants in sub-Saharan Africa were tested within the first 2 months of life and only 30% of HIV-infected infants are on antiretroviral treatment. This study assessed HIV... more
Despite notable progress towards PMTCT, only 50% of HIV-exposed infants in sub-Saharan Africa were tested within the first 2 months of life and only 30% of HIV-infected infants are on antiretroviral treatment. This study assessed HIV prevalence in infants and children receiving care at various service entry points in primary healthcare facilities in Uganda. A total of 3600 infants up to 24 months of age were systematically enrolled and tested at four regional hospitals across Uganda. Six hundred infants were included and tested from six facility entry points: PMTCT, immunization, inpatient, nutrition, outpatient and community outreach services. The traditional EID entry point, PMTCT, had a prevalence of 3.8%, representing 19.6% of the total HIV-positive infants identified in the study. Fifty percent of the 117 identified HIV-positive infants were found in the nutrition wards, which had a prevalence of 9.8% (p < 0.001 compared to PMTCT). Inpatient wards had a prevalence of 3.5% an...
Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily... more
Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria. A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1. Mbale Regional Referral Hospital. Children 3 months to 12 years old with severe falciparum malaria. Usual care. We enrolled 104 c...
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Research Interests: Biomarkers, Uganda, Hemoglobinopathies, Biological Sciences, Humans, and 15 moreMutation, Female, Male, Infant, Phenotype, Prevalence, Urinalysis, Age Factors, Erythrocytes, Clinical Infectious Diseases, Severity of Illness Index, Child preschool, Symptom assessment, Medical and Health Sciences, and Patient Outcome Assessment
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Research Interests: Mortality, Humans, Child, Shock, Female, and 7 moreResuscitation, Male, Infant, Fever, Fluid Therapy, Child preschool, and Medical and Health Sciences
Plasmodium falciparum malaria is common in African children. Severe disease manifestations include severe malarial anemia (SMA) and cerebral malaria (CM). In vitro studies suggest that splenic sequestration is associated with SMA and... more
Plasmodium falciparum malaria is common in African children. Severe disease manifestations include severe malarial anemia (SMA) and cerebral malaria (CM). In vitro studies suggest that splenic sequestration is associated with SMA and protective against CM. We sought to characterize the relationship between ultrasonographically derived spleen volume (SV), clinical manifestations and outcome. We conducted a prospective observational study of severe malaria and SV in children aged 3 months to 12 years in Eastern Uganda. An SV normogram was generated from 186 healthy controls and adjusted for total body surface area (TBSA). Children with severe P. falciparum malaria were classified according to disease phenotype, and SV z-scores were compared for cases and controls to assess the degree of spleen enlargement. One hundred and four children with severe malaria, median age 19.2 months, were enrolled; 54 were classified as having SMA and 15 with CM. Mortality was 27% in the CM group vs 1.9% in the SMA group. TBSA-adjusted SV z-scores were lower in children with CM compared to SMA (1.98 [95% CI 1.38-2.57] vs 2.73 [95% CI 2.41-3.04]; p=0.028). Mean SV z-scores were lower in children who died (1.20 [95% CI 0.14-2.25]) compared to survivors (2.58 [95% CI 2.35-2.81]); p=0.004. SV is lower in CM compared to SMA. Severe malaria with no increase in SV z-score may be associated with mortality.