Factors associated with caretakers' knowledge, attitude, and practices in the management of pneumonia for children aged five years and below in rural Uganda.

BACKGROUND: Efforts aimed at reducing morbidity and mortality associated with pneumonia in children aged five years and below largely depend on caretakers. This study aimed to assess the factors associated with knowledge, attitudes, and practices of caretakers regarding pneumonia. METHODS: This was a cross-sectional study carried out within Iganga and Mayuge health and demographic surveillance site (IMHDSS) cohort in Eastern Uganda. Caretakers of children under the age of five years were assessed for knowledge, attitudes, and practices using a set of indicators. The caretaker characteristics as determinants for knowledge, attitude, and practices in relation to pneumonia management were assessed for association. Logistic regression was used to assess the factors associated with caretaker knowledge, attitudes and practices. RESULTS: A total of 649 caretakers of children five years and below of age were interviewed. Caretakers knew pneumonia as one of the childhood diseases, but were less knowledgeable about its transmission, signs and symptoms, risk factors and treatment. Overall, 28% had good knowledge, 36% had moderate knowledge and 35% had poor knowledge. The caretaker attitude was good for more than a half of the respondents (57%), while majority reported good practices (74.1%). Older age (OR = 1.63, 95% CI (1.05-2.51)), Tertiary education (OR = 4.92, 95% CI (2.5-9.65)), being married (OR = 1.82, 95% CI (1.05-3.15)) were associated with having good knowledge. Age above 35 years (aOR = 1.48, 95% CI (1.03-2.11)), and main source of livelihood were associated with good attitude and lastly being female (OR = 2.3, 95% CI (1.23-4.37)), being a Muslim (aOR = 0.5, 95% CI (0.35-0.75)), and being a farmer (OR = 0.5, 95% CI (0.33-0.85)) were associated with being a good caretaker practice. CONCLUSIONS: The caretakers of children five years and below, have relatively adequate knowledge about the signs and symptoms of pneumonia, risk factors and treatment measures. Higher education, being married, and being a salary earner were associated with better knowledge about pneumonia, while being female, being a Muslim, and being a peasant farmer were associated with good practice. Targeted interventions to equip caretakers with relevant and adequate skills and knowledge for lower-income and less educated caretakers, considering cultural and religious beliefs about childhood pneumonia identification and management are required.

Burden of tuberculosis disease among adolescents in a rural cohort in Eastern Uganda.

BACKGROUND: The world health organization (WHO) declared tuberculosis (TB) a global emergency, mainly affecting people in sub-Saharan Africa. However there is little data about the burden of TB among adolescents. We estimated the prevalence and incidence of TB and assessed factors associated with TB among adolescents aged 12-18 years in a rural population in Uganda in order to prepare the site for phase III clinical trials with novel TB vaccines among adolescents. METHODS: In a prospective cohort study, we recruited 5000 adolescents and followed them actively, every 6 months, for 1-2 years. Participants suspected of having TB were those who had any of; TB signs and symptoms, history of TB contact or a positive tuberculin skin test (TST) of ≥10 mm. Laboratory investigations included sputum smear microscopy and culture. RESULTS: Of the 5000 participants, eight culture confirmed cases of TB were found at baseline: a prevalence of 160/100,000 (95% confidence interval (CI), 69-315). There were 13 incident TB cases detected in an average of 1.1 person years: an incidence of 235/100,000 person years (95% CI, 125-402). None of the confirmed TB cases were HIV infected. Predictors for prevalent TB disease were: a history of TB contact and a cough ≥ 2 weeks at baseline and being out of school, while the only predictor for incident TB was a positive TST during follow-up. CONCLUSION: The TB incidence among adolescents in this rural part of Uganda seemed too low for a phase III TB vaccine trial. However, the study site demonstrated capability to handle a large number of participants with minimal loss to follow-up and its suitability for future clinical trials. Improved contact tracing in TB program activities is likely to increase TB case detection among adolescents. Future studies should explore possible pockets of higher TB incidence in urban areas and among out of school youth.

Prevalence and risk factors of latent Tuberculosis among adolescents in rural Eastern Uganda.

BACKGROUND: Latent Tuberculosis treatment is a key tuberculosis control intervention. Adolescents are a high risk group that is not routinely treated in low income countries. Knowledge of latent Tuberculosis (TB) burden among adolescents may influence policy. OBJECTIVES: We determined the prevalence and risk factors of latent TB infection among adolescents in rural Uganda. METHODS: We analyzed baseline data from a study that assessed the prevalence and incidence of Tuberculosis disease among adolescents. We extracted socio-demographics, medical assessment information, and tuberculin skin test results and estimated prevalence ratios (PR) of latent TB infection risk factors by binomial regression. RESULTS: The prevalence of latent TB was 16.1%, 95% CI (15.1 - 17.2). Significant risk factors were: a BCG scar, APR 1.29 (95% CI 1.12 - 1.48); male gender, APR 1.37 (95% CI 1.21 - 1.56); age 17 -18 years, APR 1.46 (95% CI 1.24 - 1.71) and 15-16 years, APR 1.25 (95% CI 1.07 - 1.46) compared to 12-14 years; being out of school, APR 1.31 (95% CI 1.05 - 1.62); and a known history of household TB contact in last 2 years, APR 1.91 (95% CI 1.55 - 2.35). CONCLUSION: Targeted routine latent TB treatment among adolescents out of school may be crucial for TB disease control in low income countries.

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda.

The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P < 0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.