1
|
Nannsen AØ, Kristensen K, Johansen LB, Iken MK, Madsen M, Pilgaard KA, Grabowski D, Hangaard S, Schou AJ, Andersen A. Management of Diabetes during School Hours: A Cross-Sectional Questionnaire Study in Denmark. Healthcare (Basel) 2023; 11:healthcare11020251. [PMID: 36673619 PMCID: PMC9859616 DOI: 10.3390/healthcare11020251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30-35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel's perspective. All primary schools in Denmark were invited to participate in the study (n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.
Collapse
Affiliation(s)
- Anne Østergaard Nannsen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Correspondence:
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Lise Bro Johansen
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | | | - Mette Madsen
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Kasper Ascanius Pilgaard
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
- Department of Pediatrics, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Stine Hangaard
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
| | - Anders Jørgen Schou
- Steno Diabetes Center Odense (SDCO), 5000 Odense, Denmark
- Pediatric Research Unit, Odense University Hospital, 5000 Odense, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
| |
Collapse
|
2
|
To become an expert within a week: Children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education - A qualitative interview study. J Pediatr Nurs 2022; 67:e24-e30. [PMID: 36307293 DOI: 10.1016/j.pedn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education during hospitalisation. DESIGN AND METHODS A qualitative interpretive design was applied. Semi-structured interviews with 15 children and their parent(s) were conducted. Data were analysed via thematic analysis. RESULTS The analysis revealed three themes: To be diagnosed with diabetes turns one's world upside down; It is positive to meet friendly and helpful healthcare professionals; and Diabetes education is overwhelming but required. CONCLUSIONS To be hospitalised and receive a diabetes diagnosis is overwhelming. The family must learn, in a short time, the basic skills to manage the condition. While learning, the child may fluctuate between being active and passive. In this vulnerable situation, it is positive to meet helpful healthcare professionals. Children find the motivation to learn, as they want to self-manage and be independent. All necessary education is given, but often the families would like to be more actively involved in the teaching. Sometimes, the teaching is also very compressed. PRACTICE IMPLICATIONS It is important to be aware of the vulnerable situation of the family and to adjust education to the fluctuations of the child. Teaching should be simplified and broken down stepwise, using pictures, artefacts, etc., to support the learning. More involvement may make education even more engaging and interesting. It has to be considered whether the education can be compressed into too short a time, making it difficult to transfer to the everyday lives of the families.
Collapse
|
3
|
Kang HS, Park HR, Kim CJ, Singh-Carlson S. Experiences of Using Wearable Continuous Glucose Monitors in Adults With Diabetes: A Qualitative Descriptive Study. Sci Diabetes Self Manag Care 2022; 48:362-371. [PMID: 35916341 DOI: 10.1177/26350106221116899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to understand the experiences of adults with diabetes wearing a continuous glucose monitor (CGM). METHODS This qualitative, descriptive study included 19 adults with type 1 diabetes or type 2 diabetes, who had used the FreeStyle Libre CGM for at least 4 weeks, from an outpatient clinic at a university-affiliated hospital in Korea. Data were collected through in-depth interviews and analyzed using an inductive content analysis approach. RESULTS The content analysis revealed 3 major themes-navigating glucose level fluctuations, reframing diabetes self-care and improving quality of life, and device improvement and service quality. Participants reported that CGMs offered convenient glucose level monitoring, allowed early response to rapid glucose changes, and facilitated effective patient-clinician communication. Participants expressed concerns about the financial burden and limited services, recommending improvements for devices, consumer services, and health insurance coverage. CONCLUSIONS Study findings indicated that using wearable CGMs could improve self-care and quality of life in adults with diabetes. Using CGMs could improve patients' understanding of how diabetes self-care management affects real-time glucose levels. Health care providers could support patients' self-care by using device data. Improvements in quality, services, and insurance coverage could increase user satisfaction and promote self-care.
Collapse
Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Hyang Rang Park
- Department of Nursing, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Chun-Ja Kim
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, South Korea
| | | |
Collapse
|
4
|
Hart RI, Kimbell B, Rankin D, Allen JM, Boughton CK, Campbell F, de Beaufort C, Fröhlich‐Reiterer E, Ware J, Hofer SE, Kapellen TM, Rami‐Merhar B, Thankamony A, Hovorka R, Lawton J. Parents' experiences of using remote monitoring technology to manage type 1 diabetes in very young children during a clinical trial: Qualitative study. Diabet Med 2022; 39:e14828. [PMID: 35274356 PMCID: PMC9311187 DOI: 10.1111/dme.14828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
AIMS To explore parents' experiences of using remote monitoring technology when caring for a very young child with type 1 diabetes during a clinical trial. METHODS Interviews were conducted with parents of 30 children (aged 1-7 years) participating in a trial (the KidsAP02 study) comparing hybrid closed-loop insulin delivery with sensor-augmented pump therapy. In both arms, parents had access to remote monitoring technology. Data analysis focused on identification of descriptive themes. RESULTS Remote monitoring technology gave parents improved access to data which helped them pre-empt and manage glucose excursions. Parents observed how, when children were in their own care, they could be more absent while present, as their attention could shift to non-diabetes-related activities. Conversely, when children were others' care, remote monitoring enabled parents to be present while absent, by facilitating oversight and collaboration with caregivers. Parents described how remote monitoring made them feel more confident allowing others to care for their children. Parents' confidence increased when using a hybrid closed-loop system, as less work was required to keep glucose in range. Benefits to children were also highlighted, including being able to play and sleep uninterrupted and attend parties and sleepovers without their parents. While most parents welcomed the increased sense of control remote monitoring offered, some noted downsides, such as lack of respite from caregiving responsibilities. CONCLUSIONS Remote monitoring can offer manifold benefits to both parents and very young children with type 1 diabetes. Some parents, however, may profit from opportunities to take 'time out'.
Collapse
Affiliation(s)
- Ruth I. Hart
- Usher InstituteUniversity of EdinburghEdinburghUK
| | | | - David Rankin
- Usher InstituteUniversity of EdinburghEdinburghUK
| | - Janet M. Allen
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | - Fiona Campbell
- Department of Paediatric DiabetesLeeds Children's HospitalLeedsUK
| | - Carine de Beaufort
- Department of Pediatric Diabetes and EndocrinologyClinique PédiatriqueCentre HospitalierLuxembourg CityLuxembourg
- Department of Pediatric EndocrinologyUZ‐VUB Free University BrusselsBrusselsBelgium
| | | | - Julia Ware
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Sabine E. Hofer
- Department of Pediatrics IMedical University of InnsbruckInnsbruckAustria
| | - Thomas M. Kapellen
- Hospital for Children and AdolescentsUniversity of LeipzigLeipzigGermany
- Hospital for Children and Adolescents am Nicolausholz Bad KösenBad KösenGermany
| | - Birgit Rami‐Merhar
- Department of Pediatric and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Ajay Thankamony
- Department of PaediatricsUniversity of CambridgeCambridgeUK
- Children’s ServicesCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Julia Lawton
- Usher InstituteUniversity of EdinburghEdinburghUK
| | | |
Collapse
|
5
|
Crocket H, Elbashy MM, Kavanagh T, Styles S, Galland B, Haszard JJ, Wiltshire E, Jefferies C, de Bock MI, Tomlinson P, Jones S, Wheeler BJ. Parental experiences of short term supported use of a do-it-yourself continuous glucose monitor (DIYrtCGM): A qualitative study. Diabet Med 2022; 39:e14731. [PMID: 34687240 DOI: 10.1111/dme.14731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022]
Abstract
AIMS To investigate the experiences of parents caring for young children with type 1 diabetes type 1 diabetes using a do-it-yourself continuous glucose monitor (DIYrtCGM) in a supported setting. METHODS Exit interviews were conducted with parents from 11 families at the end of the MiaoMiao study: a randomised cross-over trial focusing on parental fear of hypoglycaemia. Technical support was provided to participants while using DIYrtCGM during the trial. A convenience sampling approach was used to recruit parents. An in-depth, semi-structured interview approach was used. Thematic analysis was used to identify key themes and subthemes. RESULTS Parents identified that remote monitoring enabled proactive management and that overall alarms/glucose alerts were useful. Some parents reported reductions in anxiety, increased independence for their child, and improvements in the child-parent relationship. However, parents also reported regular signal loss with DIYrtCGM, along with complicated apps and challenges troubleshooting technical problems. Despite this, nine of the 11 families continued to use the system after the end of the trial. CONCLUSIONS Do-it-yourself continuous glucose monitoring (CGM) was on balance beneficial for the parents interviewed. However, while access to CGM shifted the burden of care experienced by parents, burden did not significantly reduce for all parents, as the improved glycaemic control that they achieved was accompanied with the responsibility for continually monitoring their child's data. Supported use of do-it-yourself CGM may be an achievable, cost-effective option for parents caring for children with type 1 diabetes in countries without funded access to CGM.
Collapse
Affiliation(s)
- Hamish Crocket
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Mona M Elbashy
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tom Kavanagh
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Sara Styles
- Department of Human Nutrition, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Paediatrics and Child Health, Capital and Coast District Health Board, Wellington, New Zealand
| | - Craig Jefferies
- Paediatric Endocrinology, Starship Children's Health, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
- Department of Paediatrics, Canterbury District Health Board, Christchurch, New Zealand
| | - Paul Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
| | - Shirley Jones
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
6
|
Tong H, Qiu F, Fan L. Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study. BMJ Open 2022; 12:e048763. [PMID: 35017233 PMCID: PMC8753393 DOI: 10.1136/bmjopen-2021-048763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The mental state of parental caregivers affects outcomes in children with type 1 diabetes mellitus (T1DM). This study aimed to qualitatively examine perception of common challenges among parental caregivers of children with T1DM. SETTING Semistructured interviews 45-60 min long were conducted with parental caregivers of children with T1DM. Interview recordings were transcribed and coded in NVivo V.11.0 to observe emergent themes. PARTICIPANTS Eligible T1DM caregiving parents (parent(s) and/or legal guardian(s)) were identified from caregivers attending visits with children hospitalised or assessed in the Pediatric Neuroendocrinology Department of Shengjing Hospital, China Medical University in Shenyang from January 2018 to June 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Not applicable. RESULTS A total of 20 T1DM caregiving parents were interviewed, aged 30-53 years, including 7 fathers and 13 mothers, with their children whose mean age was 10.6±2.45 years. Content analysis revealed 5 major themes with 13 subthemes, including persistent psychological stress (catastrophic emotions, emotional distress and altered self-efficacy), family function change (altered family life patterns and changes in parental role/function), challenges in daily management (technical challenges, emotional regulation, parent-child conflict and transition of care autonomy from parent to child), financial burden (cost burden of treatment and altered family economics), and lack of social support (social activity limitations and insufficient support system). CONCLUSIONS The period of emotional disturbance during initial diagnosis, psychological stresses of long-term caregiving, and conflict emerging from transition from parental to child responsibility all can cause psychological response detrimental to parental caregivers and children with T1DM. This work provides compelling evidence for the role of assessment and intervention in parental caregivers' psychological and emotional well-being in diabetes care, as well as for the necessity of improved social and school support for children with T1DM in China.
Collapse
Affiliation(s)
- Huijuan Tong
- School of Nursing, Shenyang Medical College, Shenyang, China
| | - Feng Qiu
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
7
|
Kimbell B, Lawton J, Boughton C, Hovorka R, Rankin D. Parents' experiences of caring for a young child with type 1 diabetes: a systematic review and synthesis of qualitative evidence. BMC Pediatr 2021; 21:160. [PMID: 33814007 PMCID: PMC8019496 DOI: 10.1186/s12887-021-02569-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS To synthesise the qualitative evidence on parents' experiences of caring for a child aged ≤8 years with type 1 diabetes to identify: the challenges they encounter; their views about support received; ways in which support could be improved; and, directions for future research. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO and Web of Science databases to identify qualitative studies reporting parents' views and experiences of caring for a child with type 1 diabetes aged ≤8 years. Key analytical themes were identified using thematic synthesis. RESULTS Fourteen studies were included. The synthesis resulted in the generation of two overarching themes. Monopolisation of life describes the all-encompassing impact diabetes could have on parents due to the constant worry they experienced and the perceived need for vigilance. It describes how parents' caring responsibilities could affect their wellbeing, relationships and finances, and how a lack of trusted sources of childcare and a desire to enable a 'normal' childhood constrained personal choices and activities. However, use of diabetes technologies could lessen some of these burdens. Experiences of professional and informal support describes how encounters with healthcare professionals, while generally perceived as helpful, could lead to frustration and anxiety, and how connecting with other parents caring for a child with type 1 diabetes provided valued emotional and practical support. CONCLUSIONS This synthesis outlines the challenges parents encounter, their views about support received and ways in which support might be improved. It also highlights significant limitations in the current literature and points to important areas for future research, including how sociodemographic factors and use of newer diabetes technologies influence parents' diabetes management practices and experiences. PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128710.
Collapse
Affiliation(s)
- B Kimbell
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - J Lawton
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Boughton
- Wellcome Trust - MRC Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - R Hovorka
- Wellcome Trust - MRC Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - D Rankin
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Ndahura NB, Munga J, Kimiywe J, Mupere E. Caregivers' Nutrition Knowledge and Dietary Intake of Type 1 Diabetic Children Aged 3-14 Years in Uganda. Diabetes Metab Syndr Obes 2021; 14:127-137. [PMID: 33469330 PMCID: PMC7813451 DOI: 10.2147/dmso.s285979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aimed to assess the association between caregiver's level of type 1 diabetes (T1D) nutrition knowledge with children's dietary diversity score (DDS), mean intake of macronutrients, nutrient adequacy ratios (NARs) and mean adequacy ratio (MAR). RESEARCH DESIGN AND METHODS A cross-sectional analytical study design was used. The study was conducted at 6 diabetes clinics in Uganda among 59 caregivers and 61 children. T1D nutrition knowledge survey (NKS) was used to assess the caregiver's nutrition knowledge, and the 24-hour dietary recall and dietary diversity score (DDS) questionnaires were used to collect data on the child's dietary intake. RESULTS Majority (93.2%) of the caregivers had low T1D nutrition knowledge. Carbohydrate counting was the least performed nutrition knowledge domain. The children's mean DDS, calorie intake and MAR were 5.7 ± 1.6, 666.7 ± 639.8 kcal and 0.7 ± 0.3, respectively. The mean NARs of carbohydrate, protein, and fat were 0.9 ± 0.3, 0.9 ± 0.4, 0.5 ± 0.5, respectively. There was a significant association between DDS with NARs of carbohydrate, protein, fat, vitamins A, B2, B3, B5, B12, folic acid, zinc and MAR. No formal education was significantly associated with a lower mean NKS score among caregivers (p = 0.039). Caregivers' T1D nutrition knowledge, age and family size explained 14% of variation in the child's dietary diversity (p = 0.041). CONCLUSION Despite poor nutrition knowledge among caregivers especially on carbohydrate counting, dietary diversity among children with T1D remained favorable. Excess carbohydrate intake was observed with inadequate intake of proteins, fats and micronutrients (vitamin A, B vitamins and calcium). Caregivers with low education were more likely to register poor nutrition knowledge; therefore, there is need to develop and tailor nutrition education programmes to enhance comprehensive learning among caregivers for improved outcomes.
Collapse
Affiliation(s)
- Nicholas Bari Ndahura
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
- Correspondence: Nicholas Bari Ndahura Department of Human Nutrition and Home Economics, P.O Box 1 Kyambogo, Kampala, UgandaTel +256772636271 Email
| | - Judith Munga
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| |
Collapse
|