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Aklilu A, Woldemariam M, Manilal A, Koira G, Alahmadi RM, Raman G, Idhayadhulla A, Yihune M. Aerobic vaginitis, bacterial vaginosis, and vaginal candidiasis among women of reproductive age in Arba Minch, southern Ethiopia. Sci Rep 2024; 14:9813. [PMID: 38684716 PMCID: PMC11059176 DOI: 10.1038/s41598-024-58654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Reproductive tract infections (RTIs) are a persistent public health threat worldwide, particularly among women in low-income countries of Africa, including Ethiopia, where drug resistance is also a growing problem. It is crucial to address this problem to ensure women's health and well-being. A cross-sectional study was carried out among a cohort of 398 women of reproductive age who sought medical attention at the Gynecology Department of the Arba Minch General Hospital, southern Ethiopia, from January to June 2020. They were chosen through systematic random sampling, and a pre-tested structured questionnaire was used to collect the data. The collection of vaginal and/or cervical swabs were done to diagnose bacterial vaginosis (BV) and aerobic vaginitis (AV) using Nugent and AV score analyses, respectively. The swabs were subjected to standard microbiological culture techniques to detect the isolates causing AV and vaginal candidiasis (VC). The susceptibility profiles of the causative agents of AV were checked by the Kirby-Bauer disc diffusion technique. Descriptive and inferential statistical analyses were also done. Aerobic vaginitis was the predominantly diagnosed RTI (n = 122, 30.7%), followed by BV (n = 117, 29.4%) and VC (n = 111, 27.9%). The prominent bacteria of AV were Escherichia coli (n = 36, 34.2%) and Klebsiella pneumoniae (n = 30, 28.5%). The overall rate of multidrug-resistant (MDR) bacteria was 65.71% (n = 69). History of abortion (p = 0.01; AOR = 4.0, 95% CI = 2.1, 7.7) and the habit of using vaginal pH-altering contraceptives (p = 0.01; AOR = 4.7, 95% CI = 2.5, 8.8) have the greatest odds of RTI. The high prevalence of RTIs in our study warrants an urgent intervention to minimize the associated morbidities and complications. The overall rate of MDR bacterial isolates necessitates the implementation of an effective surveillance program in the study setting.
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Affiliation(s)
- Addis Aklilu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Melat Woldemariam
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Getahun Koira
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Reham M Alahmadi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Gurusamy Raman
- Department of Life Sciences, Yeungnam University, Gyeongsan, Gyeongbuk-do, South Korea
| | - Akbar Idhayadhulla
- Research Department of Chemistry, Nehru Memorial College (Affiliated to Bharathidasan University), Puthanampatti, Tiruchirappalli District, Tamil Nadu, 621007, India
| | - Manaye Yihune
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Kareem Raheem Z, Abdulhamid Said L. Incidence of symptomatic aerobic vaginitis among some Iraqi women in Baghdad city. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aerobic vaginitis (AV) is a newly adopted type of vaginal infection caused by aerobic bacteria; it was defined by Donders in 2002 and diagnosed according to Donder's criteria. AV is associated with increased vaginal pH, decreased vaginal microbiota and overgrowth of facultative anaerobic or aerobic bacteria, including Gram-positive cocci and Gram-negative bacilli. Because knowledge of the aerobic bacterial types causing AV is very important and only limited studies are available in Iraq about this type of vaginal infection, this study aimed to report the prevalence of AV in symptomatic women in Baghdad City, investigate the aerobic bacterial types associated and to evaluate the most critical symptoms and risk factors associated with AV. One hundred fifteen high vaginal swabs (HVSs) and 115 vaginal swabs (VSs) were collected from women of age 18-50 years attending some hospitals and private clinics in Baghdad City under the supervision of a competent gynecologist. Vaginal swabs were prepared for direct wet mount preparation to test under the microscope and Gram staining for AV identification according to Donders Criteria. High vaginal swabs were cultured on different culture media; the primary diagnosis of obtained colonies was based on phenotypic characteristics, conventional biochemical tests and Gram staining. The diagnosis was confirmed using Gram-positive (GP) and Gram-negative (GN) identification cards of the VITEK 2 System. Statistical analysis was carried out using (SPSS v 20) and p-value ≤ 0.05 at 95% CI was considered statistically significant. Out of the 115 swabs, only 89 (77.3%) swabs showed bacterial growth. Ninety-five bacterial isolates were obtained, including (65.2%) Gram-positive and (34.7%) Gram-negative bacteria. G+ve bacterial isolates included: (46.3%) Staphylococcus spp., (6.3%) Kocuria spp., (6.3%) Enterococcus spp., (5.2%) Micrococcus luteus and (1.0%) of Streptococcus agalactiae. G-ve bacterial isolates included (15.7%) Escherichia coli, (11.2%) Klebsiella pneumoniae, (3.2%) Pseudomonas aeruginosa (3.2%) Pseudomonas aeruginosa, (2.1%) Acinetobacter baumannii and (2.1%) Proteus mirabilis. More than half (58.4%) of patients showed severe AV. Mixed bacterial infections were reported in 6 (6.7%) cases only. Vaginal pH ranged between (5.5- 6.5). The most frequent(100%) testified symptoms were abnormal vaginal discharge and itching, or irritation, the less frequent symptoms (51.6%) was vaginal dyspareunia, and the most significant symptoms in associated with different bacterial types and age groups were foul smelling and burning (p= 0.001, 0.008, 0.0001). Among the risk factors, age was significantly associated with most bacterial types obtained with p values (0.05 and 0.02). Staphylococcus spp. and E.coli were the predominant bacterial types in AV patients in the current study, and the lower rate of bacteria was Streptococcus agalactiae (1.0%). A high prevalence of AV was reported; therefore, regular screening and proper diagnosis of AV using microscopic examinations, culturing of swabs and determining vaginal pH using specific vaginal pH test strips should be stimulated to develop AV management.
Keywords: High vaginal swabs, Vaginal swabs, Aerobic vaginitis, aerobic G+ve and G-ve bacteria, Risk factors, Iraq.
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Tumuhamye J, Sommerfelt H, Tumwine JK, Mukunya D, Ndeezi G, Namugga O, Bwanga F, Steinsland H, Nankabirwa V. Umbilical Cord Stump Infections in Central Uganda: Incidence, Bacteriological Profile, and Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16055. [PMID: 36498131 PMCID: PMC9735496 DOI: 10.3390/ijerph192316055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Umbilical cord stump infection (omphalitis) is a risk factor for neonatal sepsis and death. We assessed the incidence of omphalitis, described the bacteriological and antibiotic-resistance profile of potentially pathogenic bacteria isolated from the umbilical cord stump of omphalitis cases, and evaluated whether bacteria present in the birth canal during birth predicted omphalitis. We enrolled 769 neonates at birth at three primary healthcare facilities and followed them for 28 days with scheduled visits on days 3, 7, 14, and 28. Cox regression models were used to estimate the rates of omphalitis associated with potential risk factors. Sixty-five (8.5%) neonates developed omphalitis, with an estimated incidence of 0.095 cases per 28 child-days (95% CI 0.073, 0.12). Potentially pathogenic bacteria were isolated from the cord stump area of 41 (63.1%) of the 65 neonates with omphalitis, and the most commonly isolated species were Escherichia coli (n = 18), Klebsiella pneumoniae (n = 10), Citrobacter freundii (n = 5), and Enterobacter spp. (n = 4). The Enterobacteriaceace isolates were resistant to gentamicin (10.5%, 4/38), ampicillin (86.8%, 33/38), and ceftriaxone (13.2%, 5/38). Delayed initiation of breastfeeding was associated with an increased risk of omphalitis (aHR 3.1; 95% CI 1.3, 7.3); however, vaginal colonization with potentially pathogenic bacteria did not predict omphalitis.
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Affiliation(s)
- Josephine Tumuhamye
- Centre for Intervention Science for Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Halvor Sommerfelt
- Centre for Intervention Science for Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
- Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, 0430 Oslo, Norway
| | - James K. Tumwine
- Department of Paediatric and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
- School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 236, Uganda
| | - Grace Ndeezi
- Department of Paediatric and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Olive Namugga
- Centre for Intervention Science for Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Freddie Bwanga
- Department of Immunology and Molecular Biology, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Hans Steinsland
- Centre for Intervention Science for Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
- Department of Biomedicine, University of Bergen, 5020 Bergen, Norway
| | - Victoria Nankabirwa
- Centre for Intervention Science for Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
- Department of Epidemiology, Biostatics School of Public Health, Makerere University, Kampala P.O. Box 7062, Uganda
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Frequency and Molecular Characterization of Staphylococcus aureus from Placenta of Mothers with Term and Preterm Deliveries. Life (Basel) 2022; 12:life12020257. [PMID: 35207545 PMCID: PMC8879889 DOI: 10.3390/life12020257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023] Open
Abstract
Globally, prematurity is the leading cause of neonatal mortality (babies in the first four weeks of life) and now the second leading cause of mortality after pneumonia in children under age five. The neonatal gut microbial colonization is crucial in the human life cycle. Placental microbiota transmits from the gut microbiota plays a significant role in association with kinship. Simultaneously, this transition is being made from mother to infant. This comparative study explored the diversity of microbiota associated with term and preterm neonates by evaluating the placental samples. The study found that 16/68 (23.5%) full-term placental samples were positive for S. aureus; on the other hand, 4/16 (25%) preterm placental samples confirmed culture growth for S. aureus. Antimicrobial susceptibility patterns showed that Staphylococcusaureus (S. aureus) isolates from both types of samples were resistant to Ofloxacin, Trimethoprim-sulfamethoxazole, Oxacillin, and Cefoxitin. However, Methicillin-Resistant Staphylococcus aureus (MRSA) detection was 43.75% in full-term and 75% in preterm placental samples. Moreover, two isolates were positive for both mecA and PVL virulent genes, and the rest were positive only for the mecA gene. Interestingly few isolates lacked both characteristic MRSA genes, mecA and PVL. Notably, resistances were more inclined towards preterm samples for antimicrobial susceptibility and MRSA screening. It may be concluded that there is a significant presence of S. aureus in the placenta of mothers with term and preterm deliveries which might be responsible for preterm deliveries. Therefore, judicious use of antibiotics during pregnancies may help prevent preterm births.
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Birhane Fiseha S, Mulatu Jara G, Azerefegn Woldetsadik E, Belayneh Bekele F, Mohammed Ali M. Colonization Rate of Potential Neonatal Disease-Causing Bacteria, Associated Factors, and Antimicrobial Susceptibility Profile Among Pregnant Women Attending Government Hospitals in Hawassa, Ethiopia. Infect Drug Resist 2021; 14:3159-3168. [PMID: 34429615 PMCID: PMC8374838 DOI: 10.2147/idr.s326200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Vaginal colonization with some species of bacteria during the last term of pregnancy can affect the health of fetuses and newborns resulting in high morbidity and mortality among newborns. Objective The aim of this study was to determine the colonization rate of potential neonatal disease-causing bacteria, factors associated with colonization rate, and the antimicrobial susceptibility profile of bacteria among pregnant women. Methods Institution-based cross-sectional study was conducted on pregnant women from October 13 to December 28, 2020, at government hospitals located in Hawassa, Ethiopia. Background data were captured using a structured questionnaire. Vaginal swabs were collected to isolate bacteria using the standard method. Antimicrobial susceptibility test was performed using the modified Kirby–Bauer disc diffusion method. Data were analyzed using SPSS. Factors that could predict vaginal colonization with potential neonatal disease-causing bacteria were determined using logistic regression. Results Overall bacterial colonization rate among pregnant women was 271 (98.9%) 95 CI (97.4‒100.1). The prevalence of potential neonatal disease-causing bacteria was 95 (34.7%) 95 CI (28.8‒40.1). The proportion of potential neonatal disease-causing bacteria were as follows: Escherichia coli (n=82, 29.9%), Acinetobacter species (n=9, 3.3%), Staphylococcus aureus (n=7. 2.6%), and Klebsiella pneumoniae (n=4, 1.5%). Pregnant women with a gestational age of 38‒40 weeks were 1.9 times (AOR= 1.9, 95% CI= 1.0–3.4, p=0.04) were more likely to be colonized by potential neonatal disease-causing bacteria. All E. coli, Klebsiella species, and Acinetobacter species were susceptible to gentamicin and imipenem. All S. aureus were susceptible to penicillin, tetracycline, clindamycin, and erythromycin. Conclusion High proportion of pregnant women in this study were colonized with potential neonatal disease-causing bacteria. E. coli was the predominant bacteria. Most bacteria isolated in this study were susceptible to antimicrobial agents tested. Gestational age was significantly associated with the colonization rate of potential neonatal disease-causing bacteria.
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Affiliation(s)
| | - Getamesay Mulatu Jara
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Fanuel Belayneh Bekele
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Elliyas S, Gaind R, Kanwal SK, Singh S, Arya S. Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study. Cureus 2021; 13:e13943. [PMID: 33880281 PMCID: PMC8051276 DOI: 10.7759/cureus.13943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective The aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk Indian women in active labor and its association with early-onset neonatal sepsis (EONS) and puerperal sepsis. Methods The study was conducted prospectively from October 2018 to March 2020 in a tertiary hospital in New Delhi, India. Low-risk pregnant women (N=920) in active labor with intact membranes were recruited. High vaginal swabs were collected, cultured by standard methods to detect aerobic bacteria. The primary outcomes were the development of puerperal sepsis and EONS. Results In a total of 920 low-risk subjects, vaginal colonization was found in 484 (52.6%), coagulase-negative Staphylococcus being the predominant colonizer (13.2%) followed by Escherichia coli (8.9%). Multigravida women were at 1.4 times higher risk of colonization than primigravida (odds ratio [OR] 1.399; 95% CI 1.064, 1.84). Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination (OR 0.34; 95% CI 0.241, 0.481). The incidence of colonization increased with progressive vaginal examinations (p<0.001). None of the colonized women and their neonates developed puerperal sepsis or EONS, respectively. Conclusion Vaginal colonization of aerobic bacteria in active labor is not associated with an increased risk of puerperal sepsis or EONS.
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Affiliation(s)
- Sabeena Elliyas
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sandeep Kumar Kanwal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sarita Singh
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Tumuhamye J, Steinsland H, Bwanga F, Tumwine JK, Ndeezi G, Mukunya D, Namugga O, Kasede AN, Sommerfelt H, Nankabirwa V. Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors. Antimicrob Resist Infect Control 2021; 10:37. [PMID: 33597029 PMCID: PMC7887551 DOI: 10.1186/s13756-021-00897-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/21/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND According to WHO ( CISMAC. Centre for Intervention Science in Maternal and Child health), the antimicrobial resistant bacteria considered to be clinically most important for human health and earmarked for surveillance include extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant bacteria, methicillin-resistant (MRSA) and, macrolide-lincosamide-streptogramin B -resistant vancomycin-resistant (VRSA) Staphylococcus aureus and vancomycin-resistant Enterococcus (VRE). If these bacteria are carried in the female genital tract, they may be transmitted to the neonate causing local or systemic neonatal infections that can be difficult to treat with conventionally available antimicrobials. In order to develop effective treatment strategies, there is need for updated information about the prevalence of colonization with important antimicrobial-resistant pathogens. OBJECTIVE We sought to estimate the prevalence of vaginal colonization with potentially pathogenic and clinically important AMR bacteria among women in labour in Uganda and to identify factors associated with colonization. METHODS We conducted a cross-sectional study among HIV-1 and HIV-2 negative women in labour at three primary health care facilities in Uganda. Drug susceptibility testing was done using the disk diffusion method on bacterial isolates cultured from vaginal swabs. We calculated the prevalence of colonization with potentially pathogenic and clinically important AMR bacteria, in addition to multidrug-resistant (MDR) bacteria, defined as bacteria resistant to antibiotics from ≥ 3 antibiotic classes. RESULTS We found that 57 of the 1472 enrolled women (3.9% prevalence; 95% Confidence interval [CI] 3.0%, 5.1%) were colonized with ESBL-producing Enterobacteriaceace, 27 (1.8%; 95% CI 1.2%, 2.6%) were colonized with carbapenem-resistant Enterobacteriaceae, and 85 (5.8%; 95% CI 4.6%, 7.1%) were colonized with MRSA. The prevalence of colonization with MDR bacteria was high (750/1472; 50.9%; 95% CI 48.4%, 53.5%). Women who were ≥ 30 years of age had higher odds of being colonized with MDR bacteria compared to women aged 20-24 years (OR 1.6; 95% CI 1.1, 2.2). CONCLUSION Most of the women included in our study were vaginally colonized with potentially pathogenic MDR and other clinically important AMR bacteria. The high prevalence of colonization with these bacteria is likely to further increase the incidence of difficult-to-treat neonatal sepsis.
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Affiliation(s)
- Josephine Tumuhamye
- Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Hans Steinsland
- Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Freddie Bwanga
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatric and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatric and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Olive Namugga
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Agnes Napyo Kasede
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Paediatric and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Public Health, Busitema University, Busitema, Uganda
| | - Halvor Sommerfelt
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Victoria Nankabirwa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Epidemiology and Biostatistics School of Public Health, Makerere University, Kampala, Uganda
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