International journal for research in health sciences and nursing, Nov 1, 2021
Globally,neonatal deaths continues to be a challenge especially to to attainment of sustainable d... 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.
Abortion in Uganda [1] like in other African countries such as Nigeria [2] is legal only when per... 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...
Individual nutrient and nutrient mean differences, standard deviation, and upper and lower limits... 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 wei... 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)
Sickle cell anemia (SCA) is common in sub‐Saharan Africa where approximately 1% of births are aff... 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.
Background: Children presenting to hospital with recent or current Plasmodium falciparum malaria ... 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 ill... 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 ... 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
In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe ... 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...
Background Children presenting to hospital with recent or current Plasmodium falciparum malaria a... 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...
Background Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of mater... 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-...
Background: Contraception is a worthwhile and cost effective investment that has potential to spu... 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...
Journal of Advances in Medicine and Medical Research, 2019
Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are ... 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 ...
International journal for research in health sciences and nursing, Nov 1, 2021
Globally,neonatal deaths continues to be a challenge especially to to attainment of sustainable d... 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&#39;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.
Abortion in Uganda [1] like in other African countries such as Nigeria [2] is legal only when per... 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...
Individual nutrient and nutrient mean differences, standard deviation, and upper and lower limits... 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 wei... 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)
Sickle cell anemia (SCA) is common in sub‐Saharan Africa where approximately 1% of births are aff... 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.
Background: Children presenting to hospital with recent or current Plasmodium falciparum malaria ... 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 ill... 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 ... 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
In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe ... 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...
Background Children presenting to hospital with recent or current Plasmodium falciparum malaria a... 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...
Background Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of mater... 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-...
Background: Contraception is a worthwhile and cost effective investment that has potential to spu... 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...
Journal of Advances in Medicine and Medical Research, 2019
Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are ... 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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