Publications

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case–Control Study

We studied associations between delayed care seeking, demographic, socioeconomic, and geographic factors and likelihood of severe malaria in Ugandan children. The study was based at Jinja Hospital, Uganda. We enrolled 325 severe malaria cases and 325 uncomplicated malaria controls matched by age and residence. Patient details, an itinerary of events in response to illness, household information, and location of participants’ residences were captured. Conditional logistic regression was used to determine risk factors for severe malaria and delayed care seeking. Delayed care seeking (≥ 24 hours after fever onset; odds ratio [OR] 5.50; 95% confidence interval [CI] 2.70, 11.1), seeking care at a drug shop as the initial response to illness (OR 3.62; 95% CI 1.86, 7.03), and increasing distance from place of residence to the nearest health center (OR 1.45; 95% CI 1.17, 1.79) were independent risk factors for severe malaria. On subgroup analysis, delayed care seeking was a significant risk factor in children with severe malaria attributable to severe anemia (OR 15.6; 95% CI 3.02, 80.6), but not unconsciousness (OR 1.13; 95% CI 0.30, 4.28). Seeking care at a drug shop (OR 2.84; 95% CI 1.12, 7.21) and increasing distance to the nearest health center (OR 1.18; 95% CI 1.01, 1.37) were independent risk factors for delayed care seeking. Delayed care seeking and seeking care at a drug shop were risk factors for severe malaria. Seeking care at a drug shop was also a predictor of delayed care seeking. The role of drug shops in contributing to delayed care and risk of severe malaria requires further study.

© The American Society of Tropical Medicine and Hygiene
Received : 22 Jan 2017  Accepted : 03 Jul 2017

Arthur Mpimbaza1, Grace Ndeezi2, Anne Katahoire1, Philip J. Rosenthal3, Charles Karamagi2,4

HPV vaccination strategies targeting hard-to-reach populations: Out-of-school girls in LMICs

Highlights
• High HPV vaccination coverage is critical for preventing cervical cancer worldwide.
• School-based programs effectively deliver vaccines to adolescents attending school.
• We propose ways to ensure out-of-school girls have equitable access to HPV vaccines.
• Important to quantify out-of-school girls and research barriers to HPV vaccination.
• To increase uptake, consider targeted communication, outreach, and integrated programs.

Keywords
HPV; Human papillomavirus vaccine; Cervical cancer; Implementation; Vaccine uptake; Vaccination programs; Adolescents; School-based programs; LMICs; Africa

Kimberly Bonnera, Cecily Banurab, Nicole E. Bastaa

Schistosoma mansoni-Associated Morbidity among Preschool-Aged Children along the Shores of Lake Victoria in Uganda

Abstract: Schistosoma mansoni causes morbidity in human beings, with the highest prevalence in rural sub-Saharan Africa. Prolonged S. mansoni infection with egg deposition in intestinal blood vessels leads to liver and spleen enlargement, and thus chronic morbidity.

The objective of this study was to assess whether preschool-aged children develop severe S. mansoni-related morbidity. Parasitological, clinical, and ultrasonographic examinations were carried out in 916 preschool-aged children in five schistosomiasis-endemic districts (Bugiri, Buikwe, Jinja, Mayuge, and Namayingo) along the Lake Victoria shoreline in east-central Uganda.

Anaemia and anthropometry measurements were also taken. Using the Kato-Katz technique on one stool sample collected on three consecutive days, 74.9% (686/916) were found infected with S. mansoni; the majority were lightly infected (57.9%), while 22.7% and 19.4% were moderately and heavily infected, respectively. The overall geometric mean intensity (GMI) of infected children was 294.2 eggs per gram faeces. Mayuge and Jinja districts had the highest (51.2%) and lowest (2.2%) number of infected children, respectively. Hookworm infection was found in 7.8% (71/916) of the children. Both liver and spleen were significantly more enlarged in the infected children than in the uninfected children (p < 0.0005), as measured by ultrasonography.

Physical palpation of the spleen was more often detected in the uninfected children. A significantly (p < 0.0005) higher proportion of S. mansoni-positive children were anaemic (359/686; 52.3%) compared to the children who had no eggs in their stool samples (81/230; 35.2%). Schistosoma mansoni infection did not have any severe effect on the nutrition status of preschool-aged children. Neither infected nor uninfected children were found to be underweight or stunted. Liver fibrosis with distinct Symmer’s ‘pipe stems’ was found in a few heavily-infected children (0.3%). In a linear multivariable regression analysis, age of the child, anaemia, liver fibrosis, and size of the left liver lobe were associated with S. mansoni intensity of infection (adjusted R2 = 0.11; p < 0.0005). Our results demonstrate that S. mansoni-related morbidity does develop in children less than six years of age, and that older children (37–60 months) are at higher risk (regression coefficient 0.33; p <0.0005) compared to younger ones (12–36 months).

We recommend that preschool-aged children be included in the target population for schistosomiasis mass treatment so as to prevent the childhood chronic form of schistosomiasis. Keywords: Schistosoma mansoni; morbidity; preschool-aged children; Lake Victoria shoreline; Uganda

Allen Nalugwa 1,*, Fred Nuwaha 2 , Edridah Muheki Tukahebwa 3 and Annette Olsen 4

Investigating unlicensed retail drug vendors’ preparedness and knowledge about malaria: An exploratory study in rural Uganda

Background: Despite major efforts to increase the uptake of preventive measures and timely use of the first lineantimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors’ (1) training related to malaria case management
for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options.
Methods: A qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. Results: About half of the 75 vendors interviewed had received some sort of formal training on malaria at a postsecondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a
clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two- fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government’s first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection.Conclusion: Findings from this study confirm significant gaps in unlicensed vendors’ knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet.

Eric Liowa , Rosemin Kassama,⁎ , Richard Sekiwungab

Disclosure of HIV test results by women to their partners following antenatal HIV testing: a population-based cross-sectional survey among slum dwellers in Kampala Uganda.

Batte A, Katahoire A, Chimoyi A, Ajambo S, Tibingana B, Banura C.. BMC Public Health 2015, Jan 31;15(1):63

Assets and challenges facing caregivers when managing malaria in young children in rural Uganda

Rosemin Kassam1*, John Collins2 and Richard Sekiwunga3

COMMUNICATION IN THE CONTEXT OF FAMILY CAREGIVING: AN EXPLORATORY STUDY OF UGANDAN CHILDREN ON ANTIRETROVIRAL THERAPY

P. Kajubi, Anne R. Katahoire, David Kyaddondo and Susan R. Whyte

Spaces for talking: Communication patterns of Children on Antiretroviral Therapy in Uganda

Phoebe Kajubia,⁎, Stine Baggerb, Anne R. Katahoirea, David Kyaddondoa, Susan R. Whyte