-
[show abstract]
[hide abstract]
ABSTRACT: Calprotectin is a calcium- and zinc-binding protein and a marker in faeces of gastrointestinal inflammation. Reference values have been established in children older than 4 years. The aim of the present study was to determine the concentration of faecal calprotectin (FC) in human immunodeficiency virus (HIV)-infected, highly active antiretroviral therapy-naïve Ugandan children and compare it with the reference value.
We tested 193 HIV-infected children ages 0 to 12 years in a hospital-based survey for FC. A standardised interview with sociodemographic information and medical history was used to assess risk factors. A cluster of differentiation 4 (CD4) cell percentage was prevalent in all of the children.
The median FC concentrations decreased with increasing age, as in healthy children. The median concentration was 208 mg/kg in infants 0 to 1 year, 171 mg/kg among toddlers 1 to 4 years, and 62 mg/kg for children 4 to 12 years. Children with advanced disease and a low CD4 cell percentage had significantly higher FC concentrations than those with a high CD4 cell percentage. Children older than 4 years with diarrhoea had significantly higher FC concentrations compared with those without diarrhoea.
HIV-infected children older than 4 years had a median FC concentration above the reference value, and gut inflammation in the children with elevated values is likely. Children with more advanced disease had increased FC concentrations regardless of age.
Journal of pediatric gastroenterology and nutrition 11/2011; 54(6):785-90. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Improved case management of paediatric pneumonia is recognised as a key strategy for pneumonia control. Since symptoms of pneumonia and malaria often overlap, there are concerns that children with pneumonia are treated with antimalarial drugs. There is a need to describe how children with severe pneumonia have been managed prior to their arrival at hospital, including possible risks of developing more severe disease.
A case-series study of 140 children, aged 2-59 months, with severe radiologically verified pneumonia at Mulago Hospital, Kampala was undertaken. Caretakers were interviewed about initial symptoms, treatment given and care sought. Using WHO definitions, children were clinically classified as having severe or very severe pneumonia.
The children had been ill for a median of 7 days before arrival at hospital, 90/140 (64%) had received treatment at home, and 72/140 (51%) had seen another health-care provider prior to presentation at hospital. Altogether, 32/140 (23%) children had reportedly received antibiotics only prior to admission, 18/140 (13%) had received anti-malarials only and 35/140 (25%) had received both. Being classified as very severe pneumonia was more common among children who had received anti-malarials only (OR 5.5, 1.8-16.4).
Although the majority of caretakers were able to recognise the key symptoms of pneumonia, they did not respond with any immediate care-giving action. Since progression from first recognition of pneumonia symptoms to severe disease is rapid, management guidelines regarding timing of care-seeking need to be clearly defined. The reason why children who sought health facility care failed to improve should be investigated. Meanwhile, there is a need to increase caretakers' and health workers' awareness of the urgency to act promptly when key pneumonia symptoms are observed.
Annals of Tropical Paediatrics International Child Health 12/2009; 29(4):281-9. · 0.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The management of sickle cell disease (SCD) has remained insurmountable in developing countries such as Uganda, because most communities are not aware of it.
To determine knowledge gaps, attitudes and beliefs of the communities about sickle cell disease in Eastern and Western Uganda.
Cross sectional descriptive study.
The districts of Sironko and Mbale in Eastern Uganda and Mbarara and Ntungamo in Western Uganda.
Households, students and health workers.
Household respondents from Eastern Uganda were more aware of SCD than those from Western (p < 0.001), with the majority reporting that they had seen more people with SCD in their communities than those from the West (p < 0.001). Fewer (< 1.9%) believed SCD was due to witch craft. Eight per cent of household respondents in Eastern believed it was a curse from God compared to 2% in the West. Less than 18% of the household respondents knew they could have children with SCD and (< 52%) of health workers knew SCD screening methods. Fewer (< 14%) of the health workers had participated in screening. Less than 20% of the respondents knew their sickle cell status.
Respondents from Eastern Uganda were more aware of SCD than those from Western. Minority of the respondents knew their SCD status and few health staff knew how to screen it. There is need to sensitise communities and policy makers about prevention, screening and treatment of SCD.
East African medical journal 09/2009; 86(9):442-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Pneumonia is a major cause of morbidity and mortality in the 'under-5s' and in Uganda accounts for 10-30% of childhood deaths. Antibiotic resistance is increasing.
To describe the bacterial aetiology, antimicrobial sensitivity and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital, Uganda.
A total of 157 children aged 2-59 months with symptoms of severe pneumonia according to WHO guidelines were recruited over a 4-month period in 2005/2006. Blood and induced sputum were obtained for culture, and chest radiographs were undertaken. Children were clinically classified as having severe or very severe pneumonia and were followed up for a maximum of 7 days.
Bacteraemia was detected in 15.9% of patients with Staphylococcus aureus (36%) and Streptococcus pneumoniae (28%) were the organisms most commonly isolated. Bacteria were isolated from sputum in half of the children, the commonest organisms being Streptococcus pneumoniae (45.9%), Haemophilus influenzae (23.5%) and Klebsiella species (22.4%). Staphylococcus aureus had only 33.3% sensitivity to chloramphenicol and H. influenzae isolates were completely resistant. S. pneumoniae was sensitive to chloramphenicol in 87.4% of cases. The case fatality rate was 15.5%. Independent predictors of death were very severe pneumonia (OR 12.9, CI 2.5-65.8), hypoxaemia (SaO(2) <92%, OR 4.9, CI 1.2-19.5) and severe malnutrition (OR 16.5, CI 4.2-65.5).
S. aureus, S. pneumoniae and H. influenzae are common bacterial causes of severe pneumonia. Chloramphenicol, the current first-line antibiotic for treating severe pneumonia in Ugandan children, is useful in pneumonia caused by S. pneumoniae but other common bacteria show resistance. The presence of severe malnutrition, hypoxaemia and very severe pneumonia increase the risk of death and should be considered in case management protocols.
Annals of Tropical Paediatrics International Child Health 01/2009; 28(4):253-60. · 0.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this article is to assess constraints on educational opportunities of orphans cared for within the extended family system in Lira district, northern Uganda. The data were collected through: review of school census records; ethnographic fieldwork; in-depth interviews with 21 community leaders, 45 heads of households caring for orphans and 35 orphans. Focus group discussions were held with men and women caring for orphans, community leaders and orphans. A household survey was conducted in 402 households caring for orphans. We found that very poor widows living on less than half a dollar per day head 48% of the households caring for orphans. The elderly heads of households were 3 times more likely to have all the children in their household in schools than the younger ones. Furthermore, the widowed and single heads of households were more likely to have all orphans in school than the married, and households that received external support offered better educational opportunities. Poverty, as indicated by lack of food while at school and heavy involvement of orphans in domestic labour, were identified as major constraints on orphans' schooling. There is an urgent need to support orphans' education in northern Uganda beyond the current Universal Primary Education efforts. The most vulnerable households need to be targeted, and the communities need to be sensitized to child labour, school meals and sex abuse.
AIDS Care 04/2007; 19(3):361-8. · 1.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To establish dietary and socio-economic factors and their association with the nutritional status of pre-school children in a poor suburb of Kampala city, Uganda.
A cross-sectional study.
Three nursery schools in a low income suburb of Kampala city, Uganda.
A sub-sample of forty one randomly selected pre-school children (three to six years of age) from a larger intervention study, participated in the present investigation.
The results reveal high levels of chronic malnutrition (stunting and underweight) among the children. Almost half (46.3%) and one third (29.3%) of the children had height-for-age and weight-for-age centiles, respectively, below the 20th centile. The father's educational status was significantly (p = 0.017) associated with the children's nutritional status with all the children whose fathers had tertiary education and above having better weight-for-age centiles (above the 50th). Economic status too was significantly (p = 0.026) associated with the nutritional status of the children with children from the upper and mid-upper socio-economic classes having better weight-for-age centiles than children from the lower socio-economic status. Analysis of the diet showed a significant association between the nutrition status of the children and some of the foods consumed. Children who were above the 50th weight-for-age centiles consumed significantly more bread (p = 0.008) and light-green-leafy vegetables (p = 0.020) than those who had lower weight-for-age centiles. Children who were above their 50th height-for-age centiles consumed significantly (p = 0.049) more soybeans than children who had lower height-for-age centiles.
Socio-economic as well as dietary factors were found to be inextricably linked and have been shown to be significantly associated with the nutritional status in this group of suburban pre-school children in Kampala city, Uganda.
East African medical journal 11/2006; 83(10):565-74.
-
[show abstract]
[hide abstract]
ABSTRACT: Birth asphyxia contributes significantly to perinatal morbidity and mortality especially in resource poor countries. Although the Apgar score has been in use for over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome have not been established in many sub-Saharan countries including Uganda.
To determine the prevalence of low Apgar score and establish immediate outcome and possible risk factors for poor outcome in babies with low Apgar score.
Labour wards, operating theatres and special baby care unit, Mulago Teaching and referral Hospital, Uganda.
Babies delivered in Mulago Hospital between September and October 1999. Those with low Apgar scores, together with an equal number of babies with normal scores matched for sex as controls, were followed up for 48 hours.
Clinical features, anthropometry, gestational age, oxygen saturation, blood glucose and autopsy of babies who died.
Clinical improvement, death, complications such as HIE, RDS, aspiration pneumonia, hypoglycaemia, hypothermia, hypotension and hypoxaemia.
The prevalence of low Apgar score at one and five minutes was 8.4% and 2.8% respectively. Adverse outcome was seen in 57.3% of cases: death in 12.1% and clinical complications in 45.2%. HIE occurred in 21.8%, hypoxaemia in 12.9%, hypoglycaemia in 16.9% and aspiration pneumonia in 4.8%. Maternal factors significantly associated with low Apgar scores included primiparity, abnormal delivery, age and medical diseases during pregnancy, while birth injuries and cord accidents were the baby factors. Poor outcome was associated with birth injury, hypothermia, hypoglycaemia, hypotension, aspiration pneumonia, hypoxaemia and severe birth asphyxia.
Even though the prevalence of low Apgar was only 8.4%, adverse outcomes associated with it were observed in more than half the patients. Therefore there is need to carefully evaluate and monitor babies with low Apgar scores immediately after birth.
East African medical journal 02/2003; 80(1):22-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To establish the magnitude and risk factors for malnutrition in Kasese district at the Uganda-Congo border.
Cross sectional nutrition survey.
Thirty clusters were selected. The height, weight, and mid upper arm circumference of at least 31 children per cluster were measured. Data on food frequency, prevalence of cough, fever and diarrhoea was also collected.
Half of the 932 children (49.8%) were stunted, and 21.9% were severely stunted. While 17.4% of the children were under weight, 1.29% were wasted and 3.7% had MUAC <12.5 cm. Risk factors for stunting included not consuming milk, fathers' low formal education, having no immunisation card, and not breast feeding among 12-23 months old. Risk factors for underweight included fathers' and mothers' low education level, consumption of legumes, and fever or diarrhoea two weeks before the survey. For wasting the risk factors were consumption of vegetables, legumes or starchy foods. Those not consuming high-energy or animal foods including milk were likely to be severely wasted as were those not breast feeding in the 12-23 months age group. Fever or a diarrhoea episode two weeks preceding the survey and living in a female-headed household, were also risk factors for severe wasting.
Attention to education, poverty alleviation, appropriate feeding practices, prevention and treatment of infections might assist in combating malnutrition in this district.
East African medical journal 08/2002; 79(8):427-34.
-
[show abstract]
[hide abstract]
ABSTRACT: Despite concerted support to vaccination programmes, coverage remains low. While health service reasons for this are known, there is little information on caretaker constraints to vaccination in Africa.
To establish the prevalence of missed vaccination opportunities and caretaker constraints to childhood vaccinations.
Cross-sectional descriptive study.
Caretakers of 408 children aged 12-23 months were interviewed.
Kiyeyi, a rural area in Eastern Uganda.
Complete vaccination coverage by card was 26.7% while by history and card it was 44.6%. Of the 215 eligible children who sought treatment in a health facility where vaccination could be offered, 59.6% missed an opportunity to be vaccinated while 24.4% of the children missed an opportunity during routine vaccination sessions. Reasons for non-completion of vaccination included caretaker 'not bothered', being busy, or ill and fear of rude health workers. While most caretakers were aware of vaccination and its benefits, none knew the immunisation schedule. The major caretaker constraints were low level of formal education, fear of vaccine side effects, and perceived contraindications to vaccinations.
Promotion of formal education for girls and educating mothers and health workers on the timing of vaccinations, their side effects and management might contribute to higher vaccination coverage.
East African medical journal 08/2002; 79(7):347-54.
-
[show abstract]
[hide abstract]
ABSTRACT: Despite Uganda's recent economic success, malnutrition is still an important public health problem and little information is available on socio-economic risk factors for severe protein energy malnutrition.
To determine socio-economic risk factors for severe protein energy malnutrition among children aged 0-60 months.
A case control study.
Mulago Referral and Teaching Hospital, Kampala, Uganda.
Sixty six severely malnourished children (age 0-60 months) were matched, for age and sex, with 66 well nourished controls, and socio-economic, demographic, health facility utilisation and feeding practices were compared between the two groups.
Severe protein energy malnutrition was associated with young age of the caretaker (p = 0.005), living in a mud walled house (OR 2.44, CI 1.13-5.32), lack of breast feeding (OR 3.22, CI 1.31-8.02), failure to complete immunisation (OR 3.68, CI 1.53-9.011), no land ownership (OR 4.62, CI 2.09-10.3), and no ownership of livestock (OR 13.65, CI 3.60-60.84), by the caretaker. The level of formal education of the caretaker was not associated with severe malnutrition.
There seems to be a strong association between severe malnutrition and some indicators of poverty, lack of breastfeeding, and failure to complete immunisation. Programmes aimed at poverty alleviation, promotion of breastfeeding and immunisation, will go a long way in preventing malnutrition.
East African medical journal 10/2000; 77(9):471-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Despite ample food supplies, the incidence of childhood underweight and stunting remains high in Uganda. Many factors contribute to this situation, but the role of low zinc intakes has not been adequately explored.
Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight, height, and midupper arm circumference (MUAC).
The study was randomized, double-blind, placebo-controlled, parallel, and 8 mo long, and incorporated 6 mo of zinc supplementation. Children (n = 153) aged 55.8 +/- 11.2 mo from 3 randomly selected nursery schools of medium, low, and very low socioeconomic status in a suburb of Kampala took part. The intervention comprised 10 mg Zn (as ZnSO4) or placebo daily in freshly prepared fruit juice, Monday to Friday inclusive.
Zinc supplementation increased MUAC by the end of the study (P = 0.029) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo (P = 0.019 and P = 0.038, respectively). There was no effect on weight gain of the children from the other schools. Zinc supplementation had no influence on height. Infection rates (of which 82% were recorded as malaria) were lower in the zinc-supplemented group than in control subjects (P = 0.063).
Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries. The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status, but may become so as nutritional status improves.
American Journal of Clinical Nutrition 01/1999; 68(6):1261-6. · 6.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <30 months of age in a central Ugandan community, whose main dietary staples are banana (matoki) and maize.
The study was a cross-sectional survey using stratified multistage random sampling to select households with a child <30 months of age in rural and semi-urban environments. A questionnaire was administered to mothers of 261 infants and toddlers in their home setting. Their health status was assessed by clinical examination and anthropometric measurements (mid-upper arm circumference [MUAC], weight, and supine length).
A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23. 8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lack of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cow's milk consumption, low intake of energy from fat, and less well educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had been immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, there was a high prevalence of infection in the week preceding the survey interview, including diarrhea (23.0%), malaria (32.3%), or cough/influenza (72.8%).
This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.
PEDIATRICS 11/1998; 102(4):E45. · 4.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite efforts to improve prenatal and perinatal health care in developing countries, child-birth remains hazardous for both mother and child. Several measures have been initiated to try to improve maternal and perinatal morbidity and mortality. One such measure is the establishment of maternity waiting shelters at hospitals where mothers can wait so that, when they go into labour or develop antenatal complications, they can transfer to the hospital wards for management and safe delivery. From May 1987 to April 1989, we evaluated pregnancy outcome among 280 women using such a shelter in a remote rural district in Zimbabwe. Perinatal mortality was higher (29.8 per 1000) among 773 non-waiting mothers than among the waiting mothers (25.0 per 1000), although this was not statistically significant (p > 0.05). However, there were significantly more low birthweight babies (11.4%) among the non-waiting mothers than among the waiting mothers (4.3%) (p < 0.01). Fetal deaths were more common than early neonatal deaths, suggesting that maternal factors accounted for most of the perinatal deaths. Poor pregnancy outcome was associated more with primigravidae and grand multigravidae than with those who had had one to four pregnancies. We conclude that maternity waiting shelters can contribute to preventing low birthweight and, to a lesser extent, improve perinatal outcome. There is a need to strengthen health care referral systems and to increase efforts to improve other determinants of perinatal and maternal morbidity and mortality.
Annals of Tropical Paediatrics International Child Health 04/1996; 16(1):55-9. · 0.90 Impact Factor
-
J K Tumwine
[show abstract]
[hide abstract]
ABSTRACT: Despite the rarity of lung abscess in children, 24 patients were treated at Harare Central Hospital during the 10 year period (1979 to 1988). The bacteriology and clinical findings of the 24 patients are presented. Bacteria were isolated from 18 patients. The most frequent isolates were Staphylococcus aureus, group A beta haemolytic streptococci, and Pseudomonas aeroginosa. Most of the abscesses followed measles, empyema or an episode of aspiration. The patients were managed with bronchoscopy, physiotherapy, and appropriate antibiotics, and had a mortality of 25%. Efforts at controlling measles as well as early and appropriate management of empyema are likely to reduce the number of lung abscesses in children.
East African medical journal 11/1992; 69(10):547-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Health teams in a rural district in Zimbabwe have been implementing child survival programmes since 1984. A prospective study of the causes of morbidity and mortality in under-five children was done. Community based surveys assessing nutrition status, immunisation coverage and knowledge and use of sugar and salt solution for diarrhoea were carried out. Malnutrition, acute respiratory infections and diarrhoea accounted for 69.7 pc of the 902 under-fives admissions while 33 (67.4 pc) of the hospital deaths were under-fives. The mortality pattern parallelled that of morbidity. Malnutrition was more common in the dry communal areas and on the commercial estates. Full immunisation coverage rates in the 12-23-month-olds increased from 44.3 pc in 1984 to 70 pc in 1989; and up to 69 pc of the mothers correctly prepared and used sugar and salt solution for diarrhoea management. Although there appears to have been little impact on malnutrition, respiratory infections and diarrhoea, the study shows that a lot can be achieved even in a remote rural district given political will, community involvement, and dedicated staff. The maintenance of the current momentum and the introduction of further socio-economic reforms is a big challenge facing the health teams, community members and politicians.
The Central African journal of medicine 02/1992; 38(1):30-6.
-
J K Tumwine
[show abstract]
[hide abstract]
ABSTRACT: In the rural district of Chimanimani in Zimbabwe, the Expanded Programme on Immunisation (EPI) which started in January 1982 has achieved measles coverage of between 50 and 80% in the 12-23 months age group, from 1984 to 1988, through 65 outreach centres, and 15 static health centres serving 93985 people in 119 villages. Facility based data as well as community based surveys have failed to show serious measles transmission in children under nine months of age, a common observation in high population density urban areas in Africa. Instead there has been a reduction in measles incidence and age distribution of measles has shifted to older children. The lowest measles incidence rate of 0.8 per 100 children occurred in the 0-5 months age group and the highest incidence rate of 4.0 per 100 children in the 48-59 months of age group. Only 7.9% of measles cases occurred in children under nine months of age. The high vaccination coverage rates were made possible by the post-independence government commitment, community involvement and dedicated staff. Our observations support the current one-dose 9 months minimum age measles vaccination policy for the low density rural areas in the developing countries.
East African medical journal 10/1991; 68(9):694-701.
-
[show abstract]
[hide abstract]
ABSTRACT: Although several cases of reactions to bee venom including acute renal failure have been reported, the literature from Africa is scanty and that concerning children virtually non-existent. We report a child who was stung by over 1,000 bees and developed acute renal failure and extensive scalp necrosis. The pathogenesis of these complications is discussed and the importance of their public awareness stressed.
The Central African journal of medicine 09/1990; 36(8):202-4.
-
J K Tumwine
[show abstract]
[hide abstract]
ABSTRACT: A mini outbreak of measles in Chimanimani District in Zimbabwe where the measles immunisation coverage is about 79% is reported. Although many of the cases occurred in susceptible non-immunised children of the vaPostori (Apostolic) religious sects, a large number was in teenagers and adults. The importance of health education in increasing community participation in immunisation is emphasised. There is need to chart out a strategy to deal with a projected pool of persons susceptible to measles as our coverage rates continue to increase.
East African medical journal 09/1989; 66(8):531-4.
-
[show abstract]
[hide abstract]
ABSTRACT: There is a dearth of literature on tropical ulcers in the rural areas in the tropics and subtropics. Results of a study of 1680 tropical ulcer patients attending an out patient department of a clinic in a rural district in Zimbabwe over a 14 months period are presented. The ulcers were more common during the wet humid months with 63 percent of the ulcers falling in the 5-14 year age group. There was a male predominance over the female with a ratio of 1.4:1. Culture and sensitivity results of isolates from 8 patients are discussed and the need for further studies on the possible causative organism(s) stressed. Implications of such outbreaks on the already over-burdened health care system are stressed; and the need for the intensification of health education in the prevention of this disease highlighted.
The Central African journal of medicine 07/1989; 35(6):413-6.
-
J K Tumwine
East African medical journal 06/1983; 60(5):319-22.
