Anemia and interleukin-10, tumor necrosis factor alpha, and erythropoietin levels among children with acute, uncomplicated Plasmodium falciparum malaria.

Anemia is an important complication of malaria, and its pathogenesis is not well understood. To gain insight into potential age-related relationships between tumor necrosis factor alpha (TNF-alpha), interleukin 10 (IL-10), erythropoietin, and anemia during acute malaria, 273 children of ages 12 to 120 months presenting with acute, uncomplicated malaria in Kampala, Uganda, were monitored at enrollment and 3 and 7 days later. Younger children had higher geometric mean erythropoietin, TNF-alpha, and alpha(1)-acid glycoprotein (AGP) concentrations than older children. Univariate regression analysis revealed that age, log(10) erythropoietin levels, IL-10/TNF-alpha ratio, and AGP levels were each significantly associated with hemoglobin levels at baseline. Hemoglobin concentrations were inversely correlated with the log(10) erythropoietin level at all three visits. For the older age groups, higher levels of TNF-alpha were significantly associated with higher IL-10 levels at all three visits, but this relationship was significant only at baseline for younger children. These data suggest that younger children do not maintain IL-10 production in response to the inflammatory process, and this mechanism may contribute to the more severe anemia found in younger children. Acute malaria is an illness whose incidence and severity are largely age dependent. Further studies are needed to understand the relationships between age-related immune responses to malaria and their role in the pathogenesis of malarial anemia.

Antioxidant status and acute malaria in children in Kampala, Uganda.

Although antioxidant status has been implicated in the pathogenesis of malaria, these factors need further characterization. A longitudinal study was conducted involving 273 children 1-10 years of age with acute, uncomplicated malaria in Kampala, Uganda. Plasma vitamin A, carotenoids, and vitamin E were measured at enrollment and on day 7. Malaria parasitemia was measured at enrollment, on day 3, and on day 7. Malaria parasitemia had completely cleared in 57.1% and 85.3% of children by day 3 and day 7, respectively. Plasma vitamin A, alpha-carotene, beta-carotene, lycopene, lutein/zeaxanthin, and vitamin E were depressed at enrollment and increased by day 7. Multivariate analyses showed that higher plasma lycopene concentrations at enrollment were associated with clearance of parasitemia between enrollment and day 3 (odds ratio = 1.46, 95% confidence interval = 1.07-2.06, per 0.10 micromol/L of lycopene). This study suggests that children with acute malaria have depressed plasma concentrations of antioxidants, and that higher plasma lycopene is associated with more rapid clearance of malaria parasitemia.

Birth trauma among liveborn infants in Mulago Hospital, Uganda.

In this retrospective review, data is presented of birth trauma seen among 4288 live born infants admitted to the special care unit of a large hospital over a three year period. Hypoxaemic brain injury resulting from birth asphyxia was by far the commonest form of birth trauma in this sample and it was the main cause of death, in many infants. All infants diagnosed as having sustained intracranial haemorrhage died while none of the other types of birth injuries were associated with any deaths. The need is emphasised to handle "high risk" deliveries with extra care while at the same time seeking solutions to the risk factors as well as lifting the overall standard of living of women in the community.

A 12-month lactation clinic experience in Uganda.

A review of case histories of mother-infant pairs who attended a lactation clinic between January and December, 1989 is presented. The results show that the majority of mothers consulting the clinic perceive their lactation problems as 'insufficient breast milk production'. Factors which might have contributed to early lactation failure include: delayed initiation of breast feeding, use of prelacteal feeds, infrequent breast feeds by day and night, and early supplementation. The latter was especially common in this clinic sample: 69.6 per cent of infants were on regular supplementation by 4 months of age. The need is stressed for research into such breast feeding failures, revitalize community-based breast feeding support, as well as assessing the knowledge, attitude, and practices of health workers concerning breast feeding.

Observations on kangaroo baby care.

PIP: The author's visit to "kangaroo care" programs in Guatemala and Colombia has led Uganda's University of Kampala to consider the introduction of this innovation in its neonatal special care unit. Such programs, which place premature infants in direct contact with their mother's skin during breastfeeding, represents a simple, inexpensive strategy for infant survival in developing countries and eliminates the need for mechanical incubators. Research conducted at the Hospital Universitario de Valle in Cali, Colombia, found that falls in the infant's body temperature. In the Latin American programs, premature infants are entered into the breastfeeding program immediately after delivery.^ieng

Morbidity and mortality in the Special Care Baby Unit of New Mulago Hospital, Kampala.

The morbidity and mortality of admissions to the Special Care Baby Unit at New Mulago Hospital, Kampala are described for 1598 infants seen during the 12-month period of 1989. The overall neonatal mortality rate on the Unit was 18.0%, which has shown only slight improvement during the period 1984-1989. The major causes of death were, in descending order of frequency: birth asphyxia, respiratory distress syndrome, aspiration syndromes, very low birthweight, infection, anaemia and congenital malformations. Birth asphyxia was the most common cause of death in infants weighing over 2500 g while respiratory distress syndrome predominated among deaths below 2500 g. Birth injuries and transient tachypnoea of the newborn were also common reasons for admission. Difficulties of caring for infants requiring special care in a developing country are emphasized. These include inadequate equipment and supplies, poor investigative facilities and scarcity of well trained personnel. The situation is further aggravated by low morale among health workers due to poor working conditions.

A 12-month lactation clinic experience in Uganda

A review of case histories of mother-infant pairs who attended a lactation clinic between January and December; 1989 is presented. The results show that the majority of mothers consulting the clinic perceive their lactation problems as 'insufficient breast milk production'. Factors which might have contributed to early lactation failure include: delayed initiation of breast feeding; use of prelacteal feeds; infrequent breast feeds by day and night; and early supplementation. The latter was especially common in this clinic sample: 69.6 per cent of infants were on regular supplementation by 4 months of age. The need is stressed for research into such breast feeding failures; revitalize community-based breast feeding support; as well as assessing the knowledge; attitude; and practices of health workers concerning breast feeding

Silence: The Concern of Parents; Teachers and HIV Councillors about Sex Education in an AIDS Impacted Area in SW Uganda

"Objectives: To a) Describe the traditional system of knowledge acquisition i.e. timing; how; by whom b) identify and explain gaps and problems in sex education. c) Outline community identified problems. Traditional mechanisms that provided youth with information regarding sexuality and marital expectations are no longer adhered to as they once were. In the absence of effective alternatives; this can be Lethal. Methods: This research was conducted in a trading and is part of a larger project intended to assess and counter disease impacts. Open ended interviews and focus groups were conducted with parents; teachers and HIV counsellors. Results: Family integrity was maintained if the paternal auntie (ssenga) ensured that a young girls was a virgin on her wedding night. As a safeguard the aunt was to provide information about sexuality; privately; secretly at the onset of sexual maturation. Much less emphasis was placed on the young boys sexuality. Migration due land pressure and urbanization; familial conflict and high death rates attributed to AIDS; contribute to the silence. Many parents and teachers do not feel capable in providing youth with this information. Mothers did and still do feel reticent about addressing such intimate issues. ""I get embarrassed to talk about sexual matters to my daughter ... some sex words in our language are too heavy to utter ... how do I mention a penis or vagina before my son or daughter?"" Parents and teachers assume that the other is delivering sex education. Potential solutions forwarded have included training a specialist within schools and parent teacher meetings aimed at addressing these issues. Conclusions: Both parents and teachers; as care takers; acknowledge that their own silence is highly problematic and that this must change. This change is behavioural in itself. They have offered solutions of their own to counter disease impact in their families and community."

The Use of Prelacteal Feeds in Uganda:Implications for Diarrhoeal Disease Control in Infancy

For a long time; clinical observation has indicated that many Ugandan Mothers offer artificial feeds to their newly delivered infants in the immediate post partum period; contrary to the recommendation by the World Health organisation. In an attempt to further document the use of these prelacteal feeds survey of 488 mothers was carried out at Mulago and Mbarara University teaching hospitals. Results show that 25.2 percent of mothers in this sample gave prelacteal feeds to their infants; confirming an earlier observation in the Uganda Breastfeeding Situation Analysis of 1991 that either there was no milk flow yet or that the babies were crying too much. The dangers associated with the use of prelacteal feeds are discussed. In conclusion; it is recommended that measures be taken to discourage this harmful practice among mothers delivering in our health facilities. The need is expressed to try and document the extent of prelacteal usage among mothers who deliver outside the formal health sector

"Cycles of Risks; The Harsh Realities of ""Married"" Adolescent Girls in an AIDS Impacted area in Rural SW Uganda."

"Objectives: To a)Profile the lives of ""married"" adolescent girls and the decisions made which may have placed them vulnerable to HIV infection b) Explore attitudes and perceptions of young girls toward the disease. pervasive in rural Rakai is the assumption that young girls are prey for older men. Although it is assumed that they are free from infection; their risk realities are far more complicated. Methods: This ethnographic study used both in depth; open ended interviews and focus groups with ""married"" girls less than 19. Results: The study site is a trading centre with high prevalence of HIV and extensive history of prostitution. This rural centre offers the young girl opportunity for employment (access to cash) as house or bar girls; and asylum from abusive situations stemming from stepmother scenarios and witchcraft in the village. Support is inevitably associated with men; either in marriage or multiple relationships. Fatalism encourages the ease with which a young girl will enter into successive relationships which constitute ""cycles"" of risk. Given the nature of the relationship; and the economic inflexibility of the partner; testing and condom negotiation are not acceptable alternatives. Conclusions: The profiles of young attached girls indicate the harsh realities many will experience in adolescent life. The voices and choices of young girls are vivid testimonials to the potential for transmission and the necessity of targeting interventions for adolescent girls."

"""We are Dying and Getting Finished; Who Will We Leave These Ones For?"" Women's Concerns about Childbearing in Rural Rakai; SW Uganda."

Objectives: To a) Establish the parameters of reproductive choice amongst women who are at high risk for HIV infection. b) Discuss the impact ofthese parameters on issues concerning perinatal transmission. Methods: Research wasdone in amixed ethinicity trading centre in AIDS affected SW Uganda. This ethnographic study used both in-depth; open ended interviews and focus groups with women who believe they are infected or have been tested HIV positive. Results: Regardless of' marriage form' birth control including condom use is perceived to be non negotiable. 'They only use them with those women from out' 'Men want to be associated with many numbers of children... want to leave someone behind' 'Did you come here just to eat?' Women do exercise reproductive choice; either in refusal or without husbands' knowledge (pills; injections; traditional methods). The consquences of refusal to either have sex or produce children are very restrictive; they lead to separation(leaving women economically vulnerable) or the men will go out and find another woman. Little change occurs in relationships where positive sero-status of one or both partners is a real possibility. Evidence suggests that certainty of sero-status gives the impetus to make hard decisions;reproductively. Uncertainty leads to both confusion and fatalism. REgardless of access to cash; sick babies are neglected(immunization; breast feeding; treatment) by both parents. ''This one is slimming anyway''. Mothers experience both the stigma and associated burdens of caring for the sick child. In addition they often decide not to treat themselves. Birth of healthy babies indicate that parents are negative. Conclusion: The voices of women are a testimony to the constraints they expirience sexually and reproductively. They do have a 'choice'. However ;the repercussions of this choice; particularly in high risk environments become restrictive and burdensome