Publications

Autoantibody levels are associated with acute kidney injury, anemia and post-discharge morbidity and mortality in Ugandan children with severe malaria.

Rivera-Correa, J., Conroy, A. L., Opoka, R. O., Batte, A., Namazzi, R., Ouma, B. Rodriguez, A. (2019). Scientific reports, 9(1), 14940.

Associations between erythrocyte polymorphisms and risks of uncomplicated and severe malaria in Ugandan children: A case control study

Abstract
Background
Evidence for association between sickle cell and alpha thalassemia trait and severe malaria is compelling. However, for these polymorphisms associations with uncomplicated malaria, and for G6PD deficiency associations with uncomplicated and severe malaria, findings have been inconsistent. We studied samples from a three-arm case-control study with the objective of determining associations between common host erythrocyte polymorphisms and both uncomplicated and severe malaria, including different severe malaria phenotypes.

Method
We assessed hemoglobin abnormalities, α-thalassemia, and G6PD deficiency by molecular methods in 325 children with severe malaria age-matched to 325 children with uncomplicated malaria and 325 healthy community controls. Conditional logistic regression was used to measure associations between specified genotypes and malaria outcomes.

Results
No tested polymorphisms offered significant protection against uncomplicated malaria. α-thalassemia homozygotes (_α/_α) had increased risk of uncomplicated malaria (OR 2.40; 95%CI 1.15, 5.03, p = 0.020). HbAS and α-thalassemia heterozygous (_α/αα) genotypes protected against severe malaria compared to uncomplicated malaria (HbAS OR 0.46; 0.23, 0.95, p = 0.036; _α/αα OR 0.51; 0.24, 0.77; p = 0.001) or community (HbAS OR 0.23; 0.11, 0.50; p<0.001; _α/αα; OR 0.49; 0.32, 0.76; p = 0.002) controls. The α-thalassemia homozygous (_α/_α) genotype protected against severe malaria when compared to uncomplicated malaria controls (OR 0.34; 95%CI 0.156, 0.73, p = 0.005), but not community controls (OR 1.03; 0.46, 2.27, p = 0.935). Stratifying by the severe malaria phenotype, compared to community controls, the protective effect of HbAS was limited to children with severe anemia (OR 0.17; 95%CI 0.04, 0.65; p = 0.009) and that of _α/αα to those with altered consciousness (OR 0.24; 0.09, 0.59; p = 0.002). A negative epistatic effect was seen between HbAS and _α/αα; protection compared to uncomplicated malaria controls was not seen in individuals with both polymorphisms (OR 0.45; 0.11, 1.84; p = 0.269). G6PD deficiency was not protective against severe malaria.

Conclusion
Associations were complex, with HbAS principally protective against severe anemia, _α/αα against altered consciousness, and negative epistasis between the two polymorphisms.

Arthur MpimbazaID1 *, Andrew WalakiraID2 , Grace Ndeezi3 , Anne Katahoire1 , Charles Karamagi3,4, Samuel L. Nsobya2 , Stephen Tukwasibwe2 , Victor AsuaID2 , Philip J. Rosenthal5

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

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

Background
Substantial concern exists about the high risk of sexually transmitted HIV to adolescent
girls and young women (AGYW, ages 15–24) in Eastern and Southern Africa. Yet limited
research has been conducted with AGYW’s male sexual partners regarding their perspectives
on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order
to inform the DREAMS Partnership and similar HIV prevention programs in Uganda.
Methods
We conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in
three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues
identified as potential transmission areas, and via female partners enrolled in DREAMS.
Analyses focused on men’s current and recent partnerships and HIV service use.
Results
Most respondents (80%) were married and 28 years old on average. Men saw partner concurrency
as pervasive, and half described their own current multiple partners. Having married
in their early 20s, over time most men continued to seek out AGYW as new partners,
regardless of their own age. Relationships were highly fluid, with casual short-term partnerships
becoming more formalized, and more formalized partnerships characterized by periods
of separation and outside partnerships. Nearly all men reported recent HIV testing and
described testing at distinct relationship points (e.g., when deciding to continue a relationship/get
married, or when reuniting with a partner after a separation). Testing often stemmed
from distrust of partner behavior, and an HIV-negative status served to validate respondents’
current relationship practices.

Ann Gottert1 *, Julie Pulerwitz1 , Godfrey Siu2 , Anne Katahoire2 , Jerry Okal3 , Florence Ayebare2 , Nrupa Jani1 , Pamela Keilig1 , Sanyukta Mathur1

Effects of a School-Based Intervention on Frequency and Quality of Adolescent-Parent/Caregiver Sexuality Communication: Results from a Randomized-Controlled Trial in Uganda

Abstract
In a cluster-randomized trial conducted in 22 government secondary schools in Uganda, effects of a school-based intervention aimed at improving aspects of parent/caregiver-adolescent communication on sexuality were examined. The intervention comprised classroom-based education sessions, take home assignments for students to discuss with parents/caregivers and parenting workshops. Baseline and post intervention questionnaires were completed by students and by parents/caregivers. Effect estimates were significant for both students and parents/caregivers on sexuality communication frequency and quality, and for positive and negative attitudes towards sex-related communication, all in the desired direction with effect sizes ranging from 0.17 to 0.38. Effects on four sum scores related to general parenting proved significant only for parents'/caregivers' legitimacy with regard to rule setting (parents'/caregivers' reports only). These results suggest that in Uganda, using schools as gateways, parent/caregiver-adolescent communication can be improved through modification of existing school curricula, training teachers in learner-centered approaches and through mobilization and training of parents/caregivers.

KEYWORDS:
Adolescents; Africa; Parents; Sexuality communication; Uganda

Katahoire AR1, Banura C2, Muhwezi WW3, Bastien S4,5, Wubs A6, Klepp KI7, Aarø LE6,8.

“I am not that sick ”The use of Assistive Mobility Technologies among the Elderly

Abstract
The use of mobility assistive technologies in different contexts seem to give a great promise to potentially improve mobility, functionality, social interaction as well as performance of daily activities for the elderly. Unused wheelchairs and abandoned crutches however were a common scene in the homes of the elderly people during this study. This paper presents stories of three elderly people from a bigger study on aging and the use of assistive technologies, drawing attention to the need for proper understanding and appreciation of the context before assistive technologies are assigned especially in old age.

 https://openaccesspub.org/jarh/article/616

Namaganda Rehema Bavuma 1 *, Dr. David Kyaddondo (PhD)1 , Dr. Steven Kiwuwa (PhD)1 , Dr. Isaac Kajja (PhD) 1

Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study

This study investigated unlicensed drug outlets’ practices for the management of malaria in the rural district of Butaleja, Uganda. A
qualitative design using semi structured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using
thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education,
but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While
most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy
(ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria
treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over
a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing
gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed
vendors to improve the management of childhood malaria.

Eric Liow ,1 Rosemin Kassam ,1 and Richard Sekiwunga2

Incidence, patterns and risk factors for injuries among Ugandan children

ABSTRACT
There is limited epidemiological data on childhood injuries in developing countries. This study assessed the incidence, patterns and risk factors for injuries among children aged 0–5 years in Wakiso District, Uganda. To determine differences, chi-square and Wilcoxon rank sum tests were used. Risk factors were assessed using Poisson regression. Overall, information from 359 children of mean age 32 months (SD: 18.4) was collected. Annual incidence of injuries was 69.8 per 1000 children/year (95% CI 58.8–80.8). One fatal injury due to burns was reported. Incidence of injuries was less associated with being female (IRR: 0.56, 95% CI 0.34–0.90) and increasing age of the caretaker (IRR: 0.96, 95% CI 0.92–0.99). The high incidence of childhood injuries necessitates the need for interventions to reduce injuries among children.

Anthony Batte, Godfrey E. Siu, Brenda Tibingana, Anne Chimoyi, Lucy Chimoyi, Nino Paichadze & Kennedy Otwombe