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1.
BMC Res Notes ; 15(1): 338, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36316786

RESUMO

OBJECTIVE: Esophageal cancer is a common malignancy globally. Most patients in sub-Saharan Africa present at advanced stage not amenable to curative therapy. Stenting provides palliation for these patients. In Uganda, many endoscopy units can perform diagnostic endoscopy but only a handful routinely perform endoscopic interventions like stenting. We describe esophageal cancer patients who underwent esophageal stenting intending to highlight its importance in a resource-limited setting. Endoscopy reports were reviewed for patients who underwent evaluation for esophageal cancer at Lubaga Hospital from December 2014 to March 2022. RESULTS: 315 records of patients with esophageal cancer were reviewed. Male to female ratio was 2:1. 188(60%) patients were 60 years and above. 268 (85%) esophageal lesions were described as fungating, friable or polypoid. 249 (79%) tumors were in mid or distal esophagus. 66% esophageal lesions caused severe luminal obstruction not traversable by the scope. 164 (52%) patients did not opt for stenting due to personal and other reasons. Stenting wasn't successful in 7 out of the 148 patients who underwent either primary or tandem stenting. Despite 207 (66%) of patients with advanced esophageal cancer presenting with endoscopically non-traversable tumors, endoscopic stenting was still possible with a technical success rate of 95.3%.


Assuntos
Neoplasias Esofágicas , Humanos , Masculino , Feminino , Uganda , Estudos Retrospectivos , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Stents , Endoscopia Gastrointestinal , Hospitais
2.
PLoS One ; 17(11): e0275905, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36318523

RESUMO

BACKGROUND: Group antenatal care (G-ANC), an alternative to focused ANC (F-ANC), involves grouping mothers by gestational and maternal age. In high-income countries, G-ANC has been associated with improved utilization of health care services like Prevention of Mother to Child Transmission (PMTCT) of HIV services. Some low-resource countries with poor utilization of health care services have piloted G-ANC. However, there is limited evidence of its efficiency. We, therefore, compared G-ANC versus F-ANC with regards to optimal utilization of PMTCT of HIV services and assessed associated factors thereof among adolescent mothers in eastern Uganda. We defined optimal utilization of PMTCT of HIV services as the adolescent being up to date with HIV counseling and testing. If found HIV negative, subsequent timely re-testing. If found HIV positive, initiation of antiretroviral therapy (ART) under option B plus for the mother. While for the infant, it entailed safe delivery, testing, feeding, and appropriate HIV chemotherapy. METHODS: From February to April 2020, we conducted a cross-sectional study among 528 adolescent mothers in four sites in eastern Uganda. We assessed the optimal utilization of PMTCT of HIV services among adolescent mothers that had attended G-ANC versus F-ANC at the post-natal care or immunization clinics. We also assessed the factors associated with optimal utilization of PMTCT of HIV services among these mothers. RESULTS: Optimal utilization of PMTCT was higher among those in G-ANC than in F-ANC (74.7% vs 41.2, p-0.0162). There was a statistically significant association between having attended G-ANC and optimal utilization of PMTCT [PR = 1.080, 95%CI (1.067-1.093)]. Other factors independently associated with optimal utilization were; having a partner that tested for HIV [PR = 1.075, 95%CI (1.048-1.103)], trimester of first ANC visit: second trimester [PR = 0.929, 95%CI (0.902-0.957)] and third trimester [PR = 0.725, 95%CI (0.616-0.853)], and the health facility attended: Bugembe HCIV [PR = 1.126, 95%CI (1.113-1.139)] and Jinja regional referral hospital [PR = 0.851, 95%CI (0.841-0.861]. CONCLUSIONS: Adolescent mothers under G-ANC had significantly higher optimal utilization of PMTCT of HIV services compared to those under F-ANC. We recommend that the Ministry of Health considers widely implementing G-ANC, especially for adolescent mothers.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Lactente , Feminino , Adolescente , Gravidez , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Cuidado Pré-Natal , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Transversais , Uganda , Infecções por HIV/tratamento farmacológico
3.
Afr Health Sci ; 22(Spec Issue): 22-33, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321115

RESUMO

Background: Over 90% of new paediatric HIV infections are acquired through mother to child transmission. Prevention of mother to child HIV transmission (PMTCT) research in sub-Saharan Africa informed WHO guidelines which enabled implementation of PMTCT programs globally. Objectives: To describe Makerere University-Johns Hopkins University (MU-JHU) perinatal HIV prevention research and implementation of the Mulago National Referral Hospital (MNRH) PMTCT program. Methods: Perinatal HIV prevention studies conducted at MU-JHU between 1997-2016 were summarized. Program aggregated data was extracted and analyzed using STATA 15. Results: In 1999, the HIVNET 012 study demonstrated that single-dose nevirapine (sdNVP) to the mother at onset of labor and to her newborn, reduced MTCT by nearly 50%. In 2016, the PROMISE study documented the safety and efficacy of ART during pregnancy and breastfeeding period. Program implementation at MNRH started in 2000. Uptake of HIV testing increased from 70% to 99% from 2006 onwards. sd NVP was the initial ARV regimen but by 2012, MOH recommended Option B+(triple therapy). MTCT rates reduced from 16.9% in 2001 to 2.3% in 2020. Conclusion: Perinatal HIV prevention clinical trials conducted at MU-JHU provided evidence to inform WHO PMTCT guidelines. MNRH program evaluation demonstrated the significant decline in MTCT rates over the last two decades.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Complicações Infecciosas na Gravidez , Humanos , Gravidez , Criança , Recém-Nascido , Feminino , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Infecções por HIV/tratamento farmacológico , Mães , Uganda , Nevirapina , Encaminhamento e Consulta , Hospitais , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico
4.
Afr Health Sci ; 22(Spec Issue): 93-107, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321113

RESUMO

Introduction: There is a rise in alcohol and other drug (AOD) abuse in the country but details of the practice are scanty. This paper provides characteristics of clients in the rehabilitation centres, their AOD related practices before and early months of COVID-19, and correlates of repeat treatment. Methods: The study was conducted in 10 rehabilitation centres in Kampala Metropolitan area. Characterization of AOD clients involved descriptive analysis while comparison of AOD related practices pre-and during COVID-19 lockdown was carried out using interrupted time series analysis. Modified Poisson regression model was used to analyse the repeat treatment. Results: The clients were mostly male (85%), single (57%) and had attained secondary education (84%). Nearly a third of them (29%) were unemployed while 68% were aged between 15-34 years. The commonest substances used were alcohol (52%), cannabis (19%), cocaine (13%) and opioids (8%). The commonest sources of substances were street dealers (52%) and friends (37%). COVID-19 did not change the pattern of AOD use except for Opioids. Repeat treatment was associated with being male, seeking care in private facilities, being casual labourer/self-employed. Conclusion: Intervention programs should target the educated, the unemployed, young men, their friends, street drug dealers and AOD hotspots.


Assuntos
Alcoolismo , COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Masculino , Humanos , Adolescente , Adulto Jovem , Adulto , Feminino , Uganda , Controle de Doenças Transmissíveis , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Centros de Reabilitação , Analgésicos Opioides
5.
Afr Health Sci ; 22(Spec Issue): 114-123, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321116

RESUMO

Introduction: Repatriation is a fundamental and often preferred solution to the refugee crisis around the world. This study explored the process of repatriation of the South Sudanese refugees from the West Nile districts in Uganda. Methods: This was a retrospective analysis of the process of repatriation of refugees in three west Nile refugee districts of Adjumani, Arua, and Moyo, Uganda. Both qualitative and qualitative data were collected. Results: The findings showed that several stakeholders were involved in the repatriation exercise including the government at central and district levels, United Nations agencies and non-governmental organizations, and refugee communities. The key steps undertaken during repatriation include information and education campaigns to promote returns focussing on security and socio-economic conditions in South Sudan and the facilitation of confidence-building visits in the areas of origin. During the repatriation exercise, key interventions provided included health care screening and treatment, and the provision of reintegration support services including the provision of food security items and cash allowances. Conclusions: The findings highlight the fundamental steps followed during a well-planned, structured, and effective repatriation of South Sudanese refugees from Uganda. Understanding repatriation requires an appreciation of how it is implemented to support offering an effective, durable, and lasting solution to refugees to promote their health and welfare.


Assuntos
Deportação , Refugiados , Humanos , Estudos Retrospectivos , Uganda , Sudão/etnologia
6.
Afr Health Sci ; 22(Spec Issue): 11-21, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321114

RESUMO

Introduction: Observational studies provide important evidence supporting the feasibility and effectiveness of health interventions. The 20-year-old Infectious Diseases Institute (IDI) established to respond to infectious diseases, specifically HIV/AIDS, invested in the set-up of longitudinal cohorts. In this paper we discuss the results of these cohorts and their impact on the response to the HIV pandemic in Uganda. Methods: IDI invested in experienced system developers, clinic and laboratory capacity to create the infrastructure to host longitudinal cohorts. Several cohorts were created, including patients initiated and followed up on ART, specialized cohorts (e.g. TB co-infection) and long-term cohorts with patients on ART for over 10 years and aged 60 and above. These cohorts function as platforms for sub-studies, attracting collaborators and students. Results: Data from the IDI cohorts contributed evidence to ART programs on when to start, which drugs to use, how to best monitor and which models of care to implement. Sub-studies contributed to management of opportunistic infections, understanding immunological response and the emerging complications of non-communicable diseases. Conclusion: Cohorts provide a platform for clinical care, training, and research to inform strategic responses and put Makerere University at the center of the response to the HIV pandemic in the region.


Assuntos
Síndrome de Imunodeficiência Adquirida , Coinfecção , Doenças Transmissíveis , Infecções por HIV , Humanos , Adulto Jovem , Adulto , Infecções por HIV/complicações , Instituições de Assistência Ambulatorial , Uganda
7.
Afr Health Sci ; 22(Spec Issue): 42-50, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321125

RESUMO

Longitudinal population-based cohort studies can provide critical insights on temporal, spatial and sociodemographic changes in health status and health determinants that are not obtained by other study designs. However, establishing and maintaining such a cohort study can be challenging and expensive. Here, we describe the role of Makerere University in the development and conduct of such a cohort. We chronicle the first academia-led reports of HIV in East Africa; how this led to initiation of the Rakai Community Cohort Study in 1988, the first and oldest HIV cohort in sub-Saharan Africa; its impact on HIV prevention, care and treatment; how the cohort has been maintained; and opportunities, challenges, and future directions including non-communicable diseases.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Humanos , Estudos de Coortes , Infecções por HIV/prevenção & controle , Uganda
8.
Afr Health Sci ; 22(Spec Issue): 80-84, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321120

RESUMO

Background: Outbreaks are occurring at increasing frequency and they require multisectoral and multi-stakeholder involvement for optimal response. The Global Health Security Agenda is a framework that governments and other stakeholders can use to strengthen countries' capacities to prevent, detect and respond to outbreaks but there are few examples of academic programs using this approach. Methods: This is a narrative review of contributions of Makerere University through the Global Health Security Program at the Infectious Diseases Institute (IDI). Information was sourced from peer-reviewed publications and grey literature highlighting work done between 2017 - 2021. Results: Aligned to GHSA, IDI made contributions to strengthen national and subnational capacities for biosafety and biosecurity, sample collection and transportation, electronic disease surveillance, infection prevention and control, case management prior to COVID-19 that were subsequently used to support response efforts for COVID-19 in Uganda. Conclusion: The IDI Global Health Security program provides a model that can be used by institutions to deliberately develop capacities relevant to outbreak preparedness and response.


Assuntos
COVID-19 , Doenças Transmissíveis , Humanos , Saúde Global , Uganda/epidemiologia , Universidades , Surtos de Doenças/prevenção & controle , Doenças Transmissíveis/epidemiologia
9.
Afr Health Sci ; 22(Spec Issue): 68-70, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321124

RESUMO

Background: Makerere University College of Health Sciences has been collaborating with the Uganda Heart Institute to build capacity for research, training and clinical care in cardiovascular medicine for the last 34 years to appropriately respond to rising societal needs for advanced cardiovascular care which was lacking before this period. Aim: To describe the major milestones in the MakCHS-UHI cardiovascular training collaboration and chart way for future collaborations. Method: This short communication highlights some of the salient features and important milestones in the collaboration journey of the two institutions. Conclusion: Clinical centres of excellence in specialised fields of health care, such as the Uganda Heart Institute for Cardiology, provide a conducive academic environment for MakCHS clinical scientists to provide high quality evidence-based care to meet societal needs.


Assuntos
Doenças Cardiovasculares , Medicina , Humanos , Universidades , Uganda , Atenção à Saúde
10.
Afr Health Sci ; 22(Spec Issue): 51-56, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321121

RESUMO

Background: Collaborative research between institutions may not yield results to transform communities. Many research collaborations come to the end of their life time without achieving their originally set goals and with a dearth of community transformation to show for it. Objective: To delineate and highlight the achievements of the Uganda (Makerere University)-Case Western Reserve University Research Collaboration. Methods: We retrospectively compiled and reviewed the data on research, training and policy impact achievements of the Uganda (Makerere University)-Case Western Reserve University Research Collaboration over a period of 30 years of its existence. Results: Over the last 35 years, the Uganda (Makerere University)-Case Western Reserve University Research Collaboration trained a total of 104 Ugandans with Masters, PhDs and other varied graduate training programs. More than 70 large tuberculosis/TB+HIV studies were conducted with more than 360 manuscripts published including landmark local and global TB/HIV policy impact publications. Conclusion: The Uganda (Makerere University)-Case Western Reserve University Research Collaboration has in the past 35 years built the capacity of Ugandan and international students through conducting landmark research, training and mentoring and contributed to TB HIV management policy changes in Uganda.


Assuntos
Infecções por HIV , Estudantes , Humanos , Universidades , Uganda , Estudos Retrospectivos
11.
Afr Health Sci ; 22(Spec Issue): 85-92, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321123

RESUMO

Introduction: Keeping HIV-infected adults away from the health care system during the COVID-19 travel restrictions, presents a challenge to HIV treatment adherence. Methods: This study focused on the initial two phases where Phase 1 designed a Makerere College of Health Sciences (MakCHS) Unstructured Supplementary Service Data (USSD)-based application; and Phase 2 piloted patient enrolment onto the application and determined the feasibility of remote follow-up of patients receiving long-term antiretroviral therapy (ART). Results: A off/online user application, MakCHS Health app, was developed. Overall, 112 patients [(66(59%) female] receiving ART at Mulago ISS clinic, Kampala, were enrolled onto the MakCHS Health app. Up to 89 (80%) utilized the app to access medical help. Patients' medical queries included needs for drug refills, missed taking HIV medication, medical illnesses, access to COVID-19 vaccination and other personal needs that required clinicians' attention. Conclusion: Piloting a MakCHS Health application for patient follow-up was feasible and well-received by HIV treatment providers and patients receiving ART. We recommend scale up of the application to enroll all patients receiving long-term treatment for HIV/AIDS, and subsequently expand to. other HIV treatment programs in similar settings.


Assuntos
COVID-19 , Telefone Celular , Infecções por HIV , Adulto , Humanos , Feminino , Masculino , Vacinas contra COVID-19 , Pandemias , Uganda , Infecções por HIV/tratamento farmacológico
12.
Afr Health Sci ; 22(Spec Issue): 124-132, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321128

RESUMO

Background: The elderly have an increased risk of developing visual impairment (VI). Due to the increase in life expectancy of individuals in Sub-Saharan Africa, the population of the elderly is projected to increase. It is thus postulated that the prevalence of VI will increase which is currently unknown in Uganda. Objective: To determine the prevalence and risk factors for VI among the elderly at Mulago National Referral Hospital eye clinic in Uganda. Methods: This was a cross-sectional study carried out in 2020 with consecutive enrolment of patients aged 60 years and above. Obtaining history was followed by systemic and ocular examination. Statistical analysis was performed to determine the prevalence and factors associated with VI. Results: Of 346 elderly participants examined, 174 (50.3%) were males and median age was 67 (IQR 63-74). Prevalence of VI was 32.1%. Cataract was the leading cause of blindness 54.1%, followed by refractive error (21.6%), glaucoma (11.7%), and corneal opacities (5.4%). Age (adjusted Prevalence Ratio (aPR): 1.05, 95% CI (1.02, 1.06)), history of diabetes mellitus (aPR 1.46, 95%CI (1.04, 2.05)), history of hypertension (aPR 1.46, 95%CI (1.10, 1.93)), having completed primary level of education (aPR 0.74, 95%CI (0.55, 0.98)) and secondary level of education (aPR 0.47, 95%CI (0.30,0.73)), presence of a cataract at examination (aPR: 2.28, 95%CI (1.66, 3.13)) were statistically significantly associated with VI. Conclusion: In Mulago hospital, the prevalence of VI among the elderly is high with majority of the causes being correctable. We recommend that efforts towards early case identification of causes of VI among the elderly should be a priority.


Assuntos
Catarata , Baixa Visão , Idoso , Masculino , Humanos , Feminino , Estudos Transversais , Prevalência , Uganda/epidemiologia , Acuidade Visual , Baixa Visão/etiologia , Cegueira/etiologia , Fatores de Risco , Encaminhamento e Consulta , Hospitais
13.
Afr Health Sci ; 22(Spec Issue): 34-41, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321118

RESUMO

Introduction: Infectious diseases and neglected tropical diseases continue to be a major challenge in resource limited settings, causing significant morbidity and mortality. Although vaccines are a key biomedical prevention tool, resource limited settings often lack the infrastructure, regulatory frameworks, and skilled human resource to conduct vaccine clinical trials. To address this gap, the Makerere University Walter Reed Project (MUWRP) was established and has contributed to vaccine research in Uganda and globally. Methods: This was achieved through training a strong vaccine clinical trial workforce; development of requisite clinical trial infrastructure for research activities and management of investigational products; conducting phase I-III vaccine trials and contribution to national ethical and regulatory frameworks that protect participants. Results: As of 2022, MUWRP had successfully conducted and completed five phase I/II HIV vaccine clinical trials, five for Ebola and Marburg, while one phase I/II Schistosomiasis and one phase III COVTD-19 vaccine clinical trial are ongoing. Discussion: The completed vaccine trials provided critical scientific knowledge on the safety and immunogenicity of investigational products which informed the design of better vaccines for diseases of global health importance. Conclusion: Academia, through establishment of appropriate partnerships can contribute to the identification of solutions to complex public health challenges.


Assuntos
Pesquisa Biomédica , Vacinas , Humanos , Uganda , Universidades , Ensaios Clínicos como Assunto
14.
Glob Health Sci Pract ; 10(3)2022 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-36332065

RESUMO

INTRODUCTION: During the 2018-2020 Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, risk communication and community engagement (RCCE) were prioritized in geographic areas in Uganda considered at high risk of introduction of EVD. To inform EVD preparedness in Uganda, we evaluated community perceptions and prevention practices related to EVD in 6 districts in Uganda. METHODS: In March 2020, we conducted a population-based survey in 6 purposively selected districts in Uganda using multistage cluster sampling. We examined differences between districts classified as high- versus low risk for EVD in terms of their message exposure from RCCE; risk perception; and EVD knowledge, attitudes, and prevention practices. RESULTS: A total of 3,485 respondents were interviewed (91% response rate). EVD message exposure was more common in the high- versus low-risk districts. EVD risk perceptions were low overall but greater in the high- versus low-risk districts. Comprehensive knowledge was significantly greater in the high- versus low-risk districts (adjusted prevalence ratio [aPR] 1.61, 95% confidence interval [CI]=1.35, 1.93). Respondents' engagement in all 3 EVD prevention practices (frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding burials involving contact with a corpse) was very low (4%). However, respondents with comprehensive knowledge were more likely to engage in all 3 EVD prevention practices compared to respondents without comprehensive knowledge (aPR 1.87, 95% CI=1.08, 3.25). CONCLUSION: Our findings suggest that while RCCE efforts as part of EVD outbreak preparedness may have contributed to higher EVD knowledge in the targeted high-risk districts, uptake of prevention behaviors was similarly low across districts. In a non-outbreak setting, implementing targeted RCCE strategies may not be sufficient to motivate people to adopt protective behaviors in the absence of a high threshold of perceived threat such as in an active outbreak.


Assuntos
Ebolavirus , Doença pelo Vírus Ebola , Humanos , Ebolavirus/fisiologia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Uganda/epidemiologia , Surtos de Doenças/prevenção & controle
15.
Glob Health Sci Pract ; 10(3)2022 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-36332068

RESUMO

INTRODUCTION: We introduce the iDARE methodology and present the results of iDARE implementation in Uganda, Kenya, and Tanzania during the coronavirus disease (COVID-19) pandemic. IDARE METHODOLOGY: iDARE drives locally led solutions that address barriers to achieving improved health outcomes. WI-HER supported the governments of Uganda, Kenya, and Tanzania, to design and implement solutions to improve (1) HIV health outcomes, (2) gender-based violence identification and response, and (3) mass drug administration coverage, respectively. RESULTS: In Uganda, the iDARE team at Nagongera Health Center IV increased viral load suppression (VLS) among actively enrolled men in care from 65% to 95% and increased VLS among actively enrolled children in care from 60% to 96% in 12 months. In 11 months, the Mulanda Health Center IV iDARE team increased VLS among actively enrolled men in care from 85% to 93% and actively enrolled children in care from 73% to 96%. In Kenya, 8 facility iDARE teams improved identification, management, and response for gender-based violence survivors by a monthly average of 642% in 10 months. Additionally, the identification, management, and response for male survivors of gender-based violence increased from an average of 8 to 188 men per month and from an average of 81 to 364 women per month. In Tanzania, the government applied iDARE to improve mass drug administration (MDA) access and uptake among school-age children. Eighteen percent of the children (equal male and female) had missed or refused treatment during school-based MDA. After 1 month of application of iDARE, the 4 schools achieved 99% MDA uptake among registered children (enrolled and nonenrolled). DISCUSSION: Due to the various lockdowns, restrictions, and safety implications during the COVID-19 pandemic, iDARE was used to rapidly adjust from planned in-person to sometimes virtual engagements. Despite these challenges, iDARE demonstrated improvements in Uganda, Kenya, and Tanzania.


Assuntos
COVID-19 , Pandemias , Criança , Feminino , Masculino , Humanos , Quênia/epidemiologia , COVID-19/epidemiologia , Uganda/epidemiologia , Tanzânia/epidemiologia , Controle de Doenças Transmissíveis , Avaliação de Resultados em Cuidados de Saúde
16.
Antimicrob Resist Infect Control ; 11(1): 142, 2022 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-36372895

RESUMO

BACKGROUND: Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda. METHODS: A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software. RESULTS: Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin. CONCLUSIONS: Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.


Assuntos
Raiva , Infecções Estafilocócicas , Animais , Humanos , Cães , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana , Estudos Transversais , Raiva/tratamento farmacológico , Raiva/epidemiologia , Metronidazol , Uganda/epidemiologia , Bactérias Gram-Positivas , Oxacilina , Bactérias , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
17.
PLoS One ; 17(11): e0276182, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36367869

RESUMO

BACKGROUND: Vitamin D deficiency affects 7-86% of infants globally and results in recurrent infections, impaired growth and nutritional rickets. Low-birth-weight infants in Uganda are at risk of vitamin D deficiency due to limited sunlight exposure and dependence on breastmilk. We aimed to determine the prevalence and factors associated with vitamin D deficiency among low-birth-weight infants aged 6 weeks to 6 months at Mulago national referral hospital in Uganda. METHODS: We conducted a cross-sectional study at Mulago Hospital between September 2016 and March 2017. We enrolled infants born with low birth weight between six weeks and six months whose mothers were available and willing to provide informed consent. Upon obtaining informed consent, we administered a structured questionnaire and performed a physical examination on the participants. Blood was drawn for calcium, phosphorus and vitamin D estimation. We measured serum 25 hydroxy vitamin D (25(OH)D) using the electrochemiluminescence method. Vitamin D deficiency and insufficiency were defined as (25(OH)D) < 20ng/ml and from 20ng/ml to <30 ng/ml respectively. To determine factors associated with vitamin D deficiency, we fit multivariable logistic regression models with exposure factors determined a priori. Data were analysed using Stata version 14. RESULTS: We enrolled 297 participants, 49.2% (167/297) of whom were males. The median infant age was nine weeks (interquartile range 7-13). All infants had less than one hour of sunlight exposure and over 90.6% (269/297) had received multivitamin supplements containing vitamin D. The prevalence of vitamin D deficiency was 12.1% (36/297): 95% CI (8.9%-16.4%). The prevalence of vitamin D insufficiency was 19.9% (59/297): 95% CI (15.7%-24.8%). Boys had higher odds of vitamin D deficiency compared to girls [adjusted odds ratio 2.8: 95% CI 1.3-6.1]. CONCLUSION: Vitamin D deficiency was 12.1% among low-birth-weight infants in Uganda although almost all of them had received multivitamin supplements containing vitamin D. We recommend that more studies are done in low-birth-weight infants to assess the risk factors for vitamin D in these population in Uganda.


Assuntos
Deficiência de Vitamina D , Lactente , Recém-Nascido , Masculino , Feminino , Humanos , Estudos Transversais , Uganda/epidemiologia , Vitamina D , Recém-Nascido de Baixo Peso , Vitaminas
19.
PLoS One ; 17(11): e0277226, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36355810

RESUMO

BACKGROUND: Female sex workers (FSWs) in Uganda are at high risk of HIV infection. Scaling up oral pre-exposure prophylaxis (PrEP) will reduce HIV incidence if high levels of adherence are maintained. This study evaluates PrEP adherence using clinic-based pill counts and self-reported measures, and factors associated with protective levels of adherence. METHODS: Participants were sex workers who had been taking PrEP for at least 5 months and were attending routine follow-up visits for PrEP care in fishing communities and along the Trans-African Highway. Participants who had a pill count showing at least 85% use since their last clinic visit and those who reported taking their PrEP every day in the last 5 months were categorised as having 'protective adherence'. Spearman's correlation and weighted kappa assessed the relationship between pill count and self-reported measures. Bivariate and multivariate logistic regression was used to determine factors associated with protective adherence as measured by pill count. RESULTS: We recruited 524 FSWs, with a median age of 29 years (IQR 23-35). Participants were recruited from fishing communities and Trans-African Highway towns (n = 297, 56.7%, and n = 227, 43.0%). Nearly three quarters (n = 372, 71.0%) of women were estimated to have protective adherence based on pill count (i.e., a pill count of >85%) and 50.4% by self-report in last 3 months. There was a strong positive association between self-reported measures and pill count measures (rest = 0.6453, 95% CI = 0.5924-0.6927) and a moderate agreement between self-reported measures and pill count measures, κ = 0.544 (95%CI = 0.4869-0.6011, p < 0.001). Factors associated with protective adherence included being aged 35 years or older (aOR = 2.40, 95% CI = 1.17-4.86), living in a fishing community (aOR = 1.45, 95% CI = 0.62-3.38), and having an STI in last 3 months (aOR = 1.64, 95% CI = 1.07-2.49). CONCLUSION: Our findings indicate that PrEP-experienced FSWs attending clinical follow-up visits reported high protective levels of oral pre-exposure prophylaxis, as measured by both pill count and self-reported measures, and a moderate agreement between pill count and self-reported measures.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Profissionais do Sexo , Feminino , Humanos , Adulto Jovem , Adulto , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Autorrelato , Tenofovir/uso terapêutico , Uganda/epidemiologia , Adesão à Medicação
20.
Glob Health Action ; 15(1): 2141312, 2022 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36369730

RESUMO

BACKGROUND: Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored. OBJECTIVE: To assess the effect of community health worker (CHW) involvement on utilisation of antenatal services during pregnancy in resource-constrained rural settings in Uganda. METHODS: We conducted a quasi-experimental evaluation study among mothers from Eastern Uganda. We used Difference in Differences (DiD) analysis to assess the effect of CHW intervention on ANC attendance. Components of the intervention included community dialogues and empowering CHWs to educate pregnant women about using maternal health services. The primary endpoints were early initiation of ANC and completion of at least 4 ANC visits. RESULTS: Overall, the intervention significantly improved attendance of ≥ 4 ANC visits (DiD = 5.5%). The increase was significant in both intervention and comparison areas (46.2-64.4% vs. 54.1-66.8%, respectively), with slightly greater gains in the intervention area. Other elements that predicted ≥4 ANC attendance besides the intervention were post-primary education (PR1.14, 95%CI 1.02-1.30), higher wealth quintile (PR1.17, 95%CI 1.06-1.30), and early initiation of ANC (PR1.58, 95%CI 1.49-1.68). The intervention did not significantly improve early initiation of ANC (DiD =-1.3%). Instead, early initiation of ANC was associated with higher husband education (PR1.19,95%CI 1.02-1.39), larger household size (PR = 0.81, 95%CI 0.70-0.95), and higher wealth index (PR1.19,95%CI 1.03-1.37). CONCLUSIONS: The CHW intervention improved attendance of at least 4 ANC visits but not early initiation of ANC. There is need to promote CHW-led health education to increase attendance at 4+ ANC visits, but other approaches to promote early initiation are urgently required.


Assuntos
Serviços de Saúde Materna , Cuidado Pré-Natal , Feminino , Gravidez , Humanos , Uganda , Gestantes , Período Pós-Parto
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