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Kakembo N, Grabski DF, Situma M, Ajiko M, Kayima P, Nyeko D, Shikanda A, Okello I, Tumukunde J, Nabukenya M, Ogwang M, Kisa P, Muzira A, Ruzgar N, Fitzgerald TN, Sekabira J, Ozgediz D. Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis. J Surg Res 2023; 286:23-34. [PMID: 36738566 DOI: 10.1016/j.jss.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 12/05/2022] [Accepted: 12/24/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Children's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation. MATERIALS AND METHODS Surgical volume, outcomes, and distribution of pediatric general surgical procedures were analyzed using prospective pediatric surgical databases from four separate regional hospitals in Uganda. The current averted burden of surgical disease through pediatric surgical delivery in Uganda and the unmet surgical need based on estimates from high-income country data was calculated. RESULTS A total of 8514 patients were treated at the four hospitals over a 6-year period corresponding to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000 children per year. The majority of complex congenital anomalies and surgical oncology cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability adjusted life years per year, which resulted in an economic benefit of approximately 23 million USD per year. However, the average case volume performed at the four regional hospitals currently represents 1% of the total projected pediatric surgical need. CONCLUSIONS This investigation is one of the first to demonstrate the distribution of pediatric surgical procedures at a country level through the use of a prospective locally created database. Significant disease burden was averted by local pediatric and adult surgical teams, demonstrating the economic benefit of pediatric surgical care delivery. These findings support several ongoing strategies to increase pediatric surgical access in Uganda.
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Affiliation(s)
- Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Mbarara Hospital, Mbarara, Uganda
| | - Margaret Ajiko
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Peter Kayima
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - David Nyeko
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Anne Shikanda
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Innocent Okello
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Martin Ogwang
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Nensi Ruzgar
- Yale University School of Medicine, New Haven, Connecticut
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - John Sekabira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, California
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Fukuda N, Balikagala B, Ueno T, Anywar DA, Kimura E, Palacpac NMQ, Odongo-Aginya EI, Ogwang M, Horii T, Miida T, Mita T. The impact of sequestration on artemisinin-induced parasite clearance in Plasmodium falciparum malaria in Africa. Clin Infect Dis 2022; 76:1585-1593. [PMID: 36519341 DOI: 10.1093/cid/ciac944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Artemisinin-resistant Plasmodium falciparum is spreading in Southeast Asia and Africa. In vivo susceptibility to artemisinin is studied by looking at the rate of decline of peripheral parasitemia (parasite clearance half-life). However, parasites that are adhered/sequestered to the endothelium and undetectable in the peripheral blood are not considered in the estimation of parasite clearance. Here we evaluated the influence of sequestration on in vivo artemisinin efficacy in Uganda, where artemisinin resistance is spreading.
Methods
We analyzed 133 P. falciparum malaria patients included in an in vivo study on artemisinin efficacy in northern Uganda in 2018 and 2019. The parasite clearance half-life was estimated from peripheral parasitemia after artemisinin monotherapy. P. falciparum histidine-rich protein 2 (PfHRP2) was measured in pre-treatment plasma. The number of sequestered parasites was estimated from PfHRP2 concentration and peripheral parasitemia.
Results
The estimated number of sequestered parasites per plasma volume ranged from 0 to 2,564,000/μL. Inflammation, thrombocytopenia, and dyslipidemia were significantly associated with sequestration independently of peripheral parasitemia. The median parasite clearance half-lives were 1.65 h in patients infected with Pfkelch13 wild-type parasites (N = 104) and 3.95 h in those with A675V artemisinin-resistant mutant (N = 18). In the multivariable model for the wild-type population, 1,000,000/μL of sequestered parasites were estimated to delay parasite clearance by 16.8% (95% CI: 5.1%–28.5%) although it was not clear in the A675V population.
Conclusions
In P. falciparum malaria patients without artemisinin-resistant mutations, intensive sequestration delays parasite clearance after treatment, which may contribute to reduced artemisinin efficacy.
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Affiliation(s)
- Naoyuki Fukuda
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University , Tokyo , Japan
| | - Betty Balikagala
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University , Tokyo , Japan
| | - Tsuyoshi Ueno
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Juntendo University , Tokyo , Japan
| | | | - Eisaku Kimura
- School of Tropical Medicine and Global Health, Nagasaki University , Nagasaki , Japan
| | - Nirianne Marie Q Palacpac
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University , Osaka , Japan
| | | | | | - Toshihiro Horii
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University , Osaka , Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Juntendo University , Tokyo , Japan
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University , Tokyo , Japan
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Mac-Seing M, Ochola E, Ogwang M, Zinszer K, Zarowsky C. Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda. Int J Health Policy Manag 2022; 11:1187-1196. [PMID: 33906334 PMCID: PMC9808201 DOI: 10.34172/ijhpm.2021.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/28/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors' perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. METHODS Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people's organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. RESULTS We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. CONCLUSION This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.
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Affiliation(s)
- Muriel Mac-Seing
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | | | - Martin Ogwang
- Institutional Direction Department, St-Mary’s Hospital, Lacor, Uganda
| | - Kate Zinszer
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | - Christina Zarowsky
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
- School of Public Health, University of Western Cape, Bellville, South Africa
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Balikagala B, Fukuda N, Ikeda M, Katuro OT, Tachibana SI, Yamauchi M, Opio W, Emoto S, Anywar DA, Kimura E, Palacpac NMQ, Odongo-Aginya EI, Ogwang M, Horii T, Mita T. Evidence of Artemisinin-Resistant Malaria in Africa. N Engl J Med 2021; 385:1163-1171. [PMID: 34551228 DOI: 10.1056/nejmoa2101746] [Citation(s) in RCA: 331] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the six Southeast Asian countries that make up the Greater Mekong Subregion, Plasmodium falciparum has developed resistance to derivatives of artemisinin, the main component of first-line treatments for malaria. Clinical resistance to artemisinin monotherapy in other global regions, including Africa, would be problematic. METHODS In this longitudinal study conducted in Northern Uganda, we treated patients who had P. falciparum infection with intravenous artesunate (a water-soluble artemisinin derivative) and estimated the parasite clearance half-life. We evaluated ex vivo susceptibility of the parasite using a ring-stage survival assay and genotyped resistance-related genes. RESULTS From 2017 through 2019, a total of 14 of 240 patients who received intravenous artesunate had evidence of in vivo artemisinin resistance (parasite clearance half-life, >5 hours). Of these 14 patients, 13 were infected with P. falciparum parasites with mutations in the A675V or C469Y allele in the kelch13 gene. Such mutations were associated with prolonged parasite clearance half-lives (geometric mean, 3.95 hours for A675V and 3.30 hours for C469Y, vs. 1.78 hours for wild-type allele; P<0.001 and P = 0.05, respectively). The ring-stage survival assay showed a higher frequency of parasite survival among organisms with the A675V allele than among those with the wild-type allele. The prevalence of parasites with kelch13 mutations increased significantly, from 3.9% in 2015 to 19.8% in 2019, due primarily to the increased frequency of the A675V and C469Y alleles (P<0.001 and P = 0.004, respectively). Single-nucleotide polymorphisms flanking the A675V mutation in Uganda were substantially different from those in Southeast Asia. CONCLUSIONS The independent emergence and local spread of clinically artemisinin-resistant P. falciparum has been identified in Africa. The two kelch13 mutations may be markers for detection of these resistant parasites. (Funded by the Japan Society for the Promotion of Science and others.).
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Affiliation(s)
- Betty Balikagala
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Naoyuki Fukuda
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Mie Ikeda
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Osbert T Katuro
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Shin-Ichiro Tachibana
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Masato Yamauchi
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Walter Opio
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Sakurako Emoto
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Denis A Anywar
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Eisaku Kimura
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Nirianne M Q Palacpac
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Emmanuel I Odongo-Aginya
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Martin Ogwang
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Toshihiro Horii
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
| | - Toshihiro Mita
- From the Department of Tropical Medicine and Parasitology, School of Medicine (B.B., N.F., M.I., S.-I.T., M.Y., S.E., T.M.), and the Atopy Research Center, Graduate School of Medicine (B.B.), Juntendo University, Tokyo, the School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki (E.K.), and the Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Osaka (N.M.Q.P., T.H.) - all in Japan; and Mildmay Uganda, Nazibwa Hill, Kampala (O.T.K.), and St. Mary's Hospital Lacor (W.O., M.O.) and the Faculty of Medicine, Gulu University (D.A.A., E.I.O.-A.), Gulu - all in Uganda
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Belaid L, Atim P, Ochola E, Omara B, Atim E, Ogwang M, Bayo P, Oola J, Okello IW, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health 2021; 18:88. [PMID: 33910570 PMCID: PMC8080315 DOI: 10.1186/s12978-021-01144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda.
Methods Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing.
Results Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.
Conclusions The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women’s capacity to practice child spacing.
Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01144-5. The evidence on what increases birth spacing remains limited. This study explored community views on influences on short birth interval to promote a culturally safe child spacing in Northern Uganda. A participatory research process began by collating perspectives of causes of short birth intervals through fuzzy cognitive mapping. Focus group discussions clarified concepts emerging from the fuzzy cognitive mapping exercise. Fieldworkers administered a household survey to quantify reproductive health outcomes. In deliberative dialogue sessions involving women and their communities, shared and discussed these results and suggested potential actions to promote culturally safe child spacing. Women, men, and youth showed clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice, however, as women feel they are unable to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social resources and are likely to face intra-partner violence. Women were not comfortable with contraceptive methods and reported experiencing side effects. The deliberative dialogues suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.
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Affiliation(s)
- Loubna Belaid
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada.
| | - Pamela Atim
- Department of Public Health, Gulu University, Laroo Division, Gulu Municipality 166, Gulu, Uganda
| | | | - Bruno Omara
- Gulu University, Gulu Municipality 166, Gulu, Uganda
| | | | - Martin Ogwang
- St Mary's Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | - Pontius Bayo
- St Mary's Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | | | | | - Ivan Sarmiento
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Kate Zinszer
- University of Montreal, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Neil Andersson
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Belaid L, Atim P, Atim E, Ochola E, Ogwang M, Bayo P, Oola J, Wonyima Okello I, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action. Fam Med Community Health 2021; 9:fmch-2020-000610. [PMID: 33731319 PMCID: PMC7978070 DOI: 10.1136/fmch-2020-000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda. Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes. Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall. They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign. Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.
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Affiliation(s)
- Loubna Belaid
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada
| | - Pamela Atim
- Public Health, Gulu University, Gulu, Uganda
| | - Eunice Atim
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | | | | | - Janet Oola
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | - Ivan Sarmiento
- Family Medicine, McGill University, Montreal, Québec, Canada
| | | | - Kate Zinszer
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Christina Zarowsky
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Neil Andersson
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada.,Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales, Acapulco, Mexico
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Belaid L, Ochola E, Bayo P, Alii GW, Ogwang M, Greco D, Zarowsky C. Exploring the impact of a community participatory intervention on women's capability: a qualitative study in Gulu Northern Uganda. BMC Womens Health 2021; 21:28. [PMID: 33461541 PMCID: PMC7812725 DOI: 10.1186/s12905-020-01170-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
Background Community participatory interventions mobilizing women of childbearing age are an effective strategy to promote maternal and child health. In 2017, we implemented this strategy in Gulu Northern Uganda. This study explored the perceived impact of this approach on women's capability. Methods We conducted a qualitative study based on three data collection methods: 14 in-depth individual interviews with participating women of childbearing age, five focus group discussions with female facilitators, and document analysis. We used the Sen capability approach as a conceptual framework and undertook a thematic analysis. Results Women adopted safe and healthy behaviors for themselves and their children. They were also able to respond to some of their family's financial needs. They reported a reduction in domestic violence and in mistreatment towards their children. The facilitators perceived improved communication skills, networking, self-confidence, and an increase in their social status. Nevertheless, the women still faced unfreedoms that deprived them of living the life they wanted to lead. These unfreedoms are related to their lack of access to economic opportunities and socio-cultural norms underlying gender inequalities. Conclusion To expand women's freedoms, we need more collective political actions to tackle gender inequalities and need to question the values underlying women's social status.
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Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, Canada.
| | | | - Pontius Bayo
- St. Mary's Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | | | - Martin Ogwang
- St. Mary's Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | - Donato Greco
- International Prevention Research Institute, Allée Claude Debussy, 69130, Écully, Lyon, France
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Fukuda N, Tachibana SI, Ikeda M, Sakurai-Yatsushiro M, Balikagala B, Katuro OT, Yamauchi M, Emoto S, Hashimoto M, Yatsushiro S, Sekihara M, Mori T, Hirai M, Opio W, Obwoya PS, Auma MA, Anywar DA, Kataoka M, Palacpac NMQ, Odongo-Aginya EI, Kimura E, Ogwang M, Horii T, Mita T. Ex vivo susceptibility of Plasmodium falciparum to antimalarial drugs in Northern Uganda. Parasitol Int 2020; 81:102277. [PMID: 33370608 DOI: 10.1016/j.parint.2020.102277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
In Uganda, artemether-lumefantrine was introduced as an artemisinin-based combination therapy (ACT) for malaria in 2006. We have previously reported a moderate decrease in ex vivo efficacy of lumefantrine in Northern Uganda, where we also detected ex vivo artemisinin-resistant Plasmodium falciparum. Therefore, it is necessary to search for candidate partner alternatives for ACT. Here, we investigated ex vivo susceptibility to four ACT partner drugs as well as quinine and chloroquine, in 321 cases between 2013 and 2018. Drug-resistant mutations in pfcrt and pfmdr1 were also determined. Ex vivo susceptibility to amodiaquine, quinine, and chloroquine was well preserved, whereas resistance to mefloquine was found in 45.8%. There were few cases of multi-drug resistance. Reduced sensitivity to mefloquine and lumefantrine was significantly associated with the pfcrt K76 wild-type allele, in contrast to the association between chloroquine resistance and the K76T allele. Pfmdr1 duplication was not detected in any of the cases. Amodiaquine, a widely used partner drug for ACT in African countries, may be the first promising alternative in case lumefantrine resistance emerges. Therapeutic use of mefloquine may not be recommended in this area. This study also emphasizes the need for sustained monitoring of antimalarial susceptibility in Northern Uganda to develop proper treatment strategies.
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Affiliation(s)
- Naoyuki Fukuda
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shin-Ichiro Tachibana
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mie Ikeda
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Miki Sakurai-Yatsushiro
- Department of International Affairs and Tropical Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Betty Balikagala
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Osbert T Katuro
- Mildmay Uganda, Nazibwa Hill, Lweza, P.O. Box 24985, Kampala, Uganda
| | - Masato Yamauchi
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sakurako Emoto
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Muneaki Hashimoto
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa, 761-0301, Japan
| | - Shouki Yatsushiro
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa, 761-0301, Japan
| | - Makoto Sekihara
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Toshiyuki Mori
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Makoto Hirai
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Walter Opio
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Paul S Obwoya
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Mary A Auma
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Denis A Anywar
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Masatoshi Kataoka
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa, 761-0301, Japan
| | - Nirianne M Q Palacpac
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | | | - Eisaku Kimura
- School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki 852-8523, Japan
| | - Martin Ogwang
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Toshihiro Horii
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Balikagala B, Sakurai-Yatsushiro M, Tachibana SI, Ikeda M, Yamauchi M, Katuro OT, Ntege EH, Sekihara M, Fukuda N, Takahashi N, Yatsushiro S, Mori T, Hirai M, Opio W, Obwoya PS, Anywar DA, Auma MA, Palacpac NMQ, Tsuboi T, Odongo-Aginya EI, Kimura E, Ogwang M, Horii T, Mita T. Recovery and stable persistence of chloroquine sensitivity in Plasmodium falciparum parasites after its discontinued use in Northern Uganda. Malar J 2020; 19:76. [PMID: 32070358 PMCID: PMC7026951 DOI: 10.1186/s12936-020-03157-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Usage of chloroquine was discontinued from the treatment of Plasmodium falciparum infection in almost all endemic regions because of global spread of resistant parasites. Since the first report in Malawi, numerous epidemiological studies have demonstrated that the discontinuance led to re-emergence of chloroquine-susceptible P. falciparum, suggesting a possible role in future malaria control. However, most studies were cross-sectional, with few studies looking at the persistence of chloroquine recovery in long term. This study fills the gap by providing, for a period of at least 6 years, proof of persistent re-emergence/stable recovery of susceptible parasite populations using both molecular and phenotypic methods. Methods Ex vivo drug-susceptibility assays to chloroquine (n = 319) and lumefantrine (n = 335) were performed from 2013 to 2018 in Gulu, Northern Uganda, where chloroquine had been removed from the official malaria treatment regimen since 2006. Genotyping of pfcrt and pfmdr1 was also performed. Results Chloroquine resistance (≥ 100 nM) was observed in only 3 (1.3%) samples. Average IC50 values for chloroquine were persistently low throughout the study period (17.4–24.9 nM). Parasites harbouring pfcrt K76 alleles showed significantly lower IC50s to chloroquine than the parasites harbouring K76T alleles (21.4 nM vs. 43.1 nM, p-value = 3.9 × 10−8). Prevalence of K76 alleles gradually increased from 71% in 2013 to 100% in 2018. Conclusion This study found evidence of stable persistence of chloroquine susceptibility with the fixation of pfcrt K76 in Northern Uganda after discontinuation of chloroquine in the region. Accumulation of similar evidence in other endemic areas in Uganda could open channels for possible future re-use of chloroquine as an option for malaria treatment or prevention.
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Affiliation(s)
- Betty Balikagala
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Miki Sakurai-Yatsushiro
- Department of International Affairs and Tropical Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shin-Ichiro Tachibana
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mie Ikeda
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masato Yamauchi
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Osbert T Katuro
- Mildmay Uganda, Nazibwa Hill, Lweza, P.O. Box 24985, Kampala, Uganda
| | - Edward H Ntege
- Division of Malaria Research, Proteo-Science Center, Ehime University, 3 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - Makoto Sekihara
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Naoyuki Fukuda
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Nobuyuki Takahashi
- Department of International Affairs and Tropical Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shouki Yatsushiro
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14 Hayashi-cho, Takamatsu, Kagawa, 761-0395, Japan
| | - Toshiyuki Mori
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Makoto Hirai
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Walter Opio
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Paul S Obwoya
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Denis A Anywar
- Faculty of Science, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Mary A Auma
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Nirianne M Q Palacpac
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takafumi Tsuboi
- Division of Malaria Research, Proteo-Science Center, Ehime University, 3 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | | | - Eisaku Kimura
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Martin Ogwang
- St. Mary's Hospital Lacor, P.O. Box 180, Gulu, Uganda
| | - Toshihiro Horii
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, 3 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Kisa P, Grabski DF, Ozgediz D, Ajiko M, Aspide R, Baird R, Barker G, Birabwa-Male D, Blair G, Cameron B, Cheung M, Cigliano B, Cunningham D, D'Agostino S, Duffy D, Evans F, Fitzgerald TN, Galiwango G, Gerolmini D, Gerolmini M, Kakembo N, Kambugu JB, Lakhoo K, Langer M, Muhumuza MF, Muzira A, Nabukenya MT, Naik-Mathuria B, Nakku D, Nankunda J, Ogwang M, Okello I, Penny N, Reimer E, Sabatini C, Sekabira J, Situma M, Ssenyonga P, Tumukunde J, Villalona G. Unifying Children's Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda. World J Surg 2019; 43:1435-1449. [PMID: 30617561 DOI: 10.1007/s00268-018-04905-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a significant unmet need for children's surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders' meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. METHODS The stakeholders' meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and short-term objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. RESULTS The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. CONCLUSION Collaborations between disciplines, both within LMICs and with international partners, are required to advance children's surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children's surgical capacity. Such a process may prove useful in other LMICs with a wide range of children's surgery stakeholders.
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Affiliation(s)
- Phyllis Kisa
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, USA
| | - Doruk Ozgediz
- Department of Surgery, Yale University School of Medicine, New Haven, USA.
| | | | | | - Robert Baird
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Gillian Barker
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Doreen Birabwa-Male
- Mulago National Referral Hospital, Uganda Ministry of Health, Kampala, Uganda
| | - Geoffrey Blair
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Brian Cameron
- Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Canada
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, USA
| | | | | | | | - Damian Duffy
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Faye Evans
- Department of Anesthesiology, Harvard Medical School, Boston, USA
| | | | | | | | | | - Nasser Kakembo
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | | | - Kokila Lakhoo
- Department of Paediatric Surgery, Oxford University, Oxford, UK
| | - Monica Langer
- Department of Surgery, Northwestern University School of Medicine, Chicago, USA
| | | | - Arlene Muzira
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Mary T Nabukenya
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | | | - Doreen Nakku
- Department of Surgery, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | | | - Innocent Okello
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Norgrove Penny
- Department of Orthopedics, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Eleanor Reimer
- Department of Anesthesiology, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Coleen Sabatini
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, USA
| | - John Sekabira
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | | | - Janat Tumukunde
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Gustavo Villalona
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, USA
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Abstract
BACKGROUND Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system. Whereas efforts have been made to introduce paediatric triage in Uganda such as Emergency Triage Assessment and Treatment Plus (ETAT+), it is not clear if hospitals have local protocols for adult triage being used in each setting. OBJECTIVES To determine the presence of existing hospital triage systems, the cadre of staff undertaking triage and barriers to development/improvement of formal triage systems. METHODOLOGY This was a descriptive cross-sectional study. Acholi sub-region was randomly selected for the study among the three sub-regions in Northern Uganda. The study was conducted in 6 of the 7 hospitals in the region. It was a written self-administered questionnaire. RESULTS Thirty-three participants from 6 hospitals consented and participated in the study. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal hospital-based adult triage protocol in place. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from OPD and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improvement/development of formal triage in all these hospitals. CONCLUSION Formal adult hospital-based triage is widely lacking in Northern Uganda and staff do perform subjective "eyeball" judgments to make triage decisions.
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Affiliation(s)
- Keneth Opiro
- Gulu University Faculty of Medicine, P.O.Box, 166 Gulu Uganda
| | - Lee Wallis
- University of Cape Town Faculty of Health Sciences, Surgery, Division of Emergency Medicine
| | - Martin Ogwang
- St. Mary's hospital Lacor, P. O. Box, 180, Gulu Uganda, Surgery
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12
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Wabinga H, Subramanian S, Nambooze S, Amulen PM, Edwards P, Joseph R, Ogwang M, Okongo F, Parkin DM, Tangka F. Uganda experience-Using cost assessment of an established registry to project resources required to expand cancer registration. Cancer Epidemiol 2016; 45 Suppl 1:S30-S36. [PMID: 27890388 PMCID: PMC5840874 DOI: 10.1016/j.canep.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/26/2016] [Accepted: 11/11/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objectives of this study are (1) to estimate the cost of operating the Kampala Cancer Registry (KCR) and (2) to use cost data from the KCR to project the resource needs and cost of expanding and sustaining cancer registration in Uganda, focusing on the recently established Gulu Cancer Registry (GCR) in rural Northern Uganda. METHODS We used Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) to estimate the KCR's activity-based cost for 2014. We grouped the registry activities into fixed cost, variable core cost, and variable other cost activities. After a comparison KCR and GCR characteristics, we used the cost of the KCR to project the likely ongoing costs for the new GCR. RESULTS The KCR incurred 42% of its expenditures in fixed cost activities, 40% for variable core cost activities, and the remaining 18% for variable other cost activities. The total cost per case registered was 28,201 Ugandan shillings (approximately US $10 in 2014) to collect and report cases using a combination of passive and active cancer data collection approaches. The GCR performs only active data collection, and covers a much larger area, but serves a smaller population compared to the KCR. CONCLUSION After identifying many differences between KCR and GCR that could potentially affect the cost of registration, our best estimate is that the GCR, though newer and in a rural area, should require fewer resources than the KCR to sustain operations as a stand-alone entity. The optimal structure of the GCR needs to be determined in the future.
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Affiliation(s)
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA.
| | | | | | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA
| | - Rachael Joseph
- United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | - D Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, United Kingdom
| | - Florence Tangka
- Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA, USA
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Amato T, Abate F, Piccaluga P, Iacono M, Fallerini C, Renieri A, De Falco G, Ambrosio MR, Mourmouras V, Ogwang M, Calbi V, Rabadan R, Hummel M, Pileri S, Leoncini L, Bellan C. Clonality Analysis of Immunoglobulin Gene Rearrangement by Next-Generation Sequencing in Endemic Burkitt Lymphoma Suggests Antigen Drive Activation of BCR as Opposed to Sporadic Burkitt Lymphoma. Am J Clin Pathol 2016; 145:116-27. [PMID: 26712879 PMCID: PMC4778259 DOI: 10.1093/ajcp/aqv011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: Recent studies using next-generation sequencing (NGS) analysis disclosed the importance of the intrinsic activation of the B-cell receptor (BCR) pathway in the pathogenesis of sporadic Burkitt lymphoma (sBL) due to mutations of TCF3/ID3 genes. Since no definitive data are available on the genetic landscape of endemic Burkitt (eBL), we first assessed the mutation frequency of TCF3/ID3 in eBL compared with sBL and subsequently the somatic hypermutation status of the BCR to answer whether an extrinsic activation of BCR signaling could also be demonstrated in Burkitt lymphoma. Methods: We assessed the mutations of TCF3/ID3 by RNAseq and the BCR status by NGS analysis of the immunoglobulin genes (IGs). Results: We detected mutations of TCF3/ID3 in about 30% of the eBL cases. This rate is significantly lower than that detected in sBL (64%). The NGS analysis of IGs revealed intraclonal diversity, suggesting an active targeted somatic hypermutation process in eBL compared with sBL. Conclusions: These findings support the view that the antigenic pressure plays a key role in the pathogenetic pathways of eBL, which may be partially distinct from those driving sBL development.
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Affiliation(s)
- Teresa Amato
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Francesco Abate
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Pierpaolo Piccaluga
- Hematopathology Section, Department of Experimental, Diagnostic, and Experimental Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Michele Iacono
- Roche Tissue Diagnostic & Sequencing, Roche Diagnostic S.P.A. Monza (MB), Italy
| | - Chiara Fallerini
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandra Renieri
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giulia De Falco
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Vaselious Mourmouras
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | - Roul Rabadan
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Michael Hummel
- Institut Fur Pathologie, Campus Benjamin Franklin, Charitè, Universitatsmedizin, Berlin, Germany
| | - Stefano Pileri
- Hematopathology Section, Department of Experimental, Diagnostic, and Experimental Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Lorenzo Leoncini
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Cristiana Bellan
- From the Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Abate F, Ambrosio MR, Mundo L, Laginestra MA, Fuligni F, Rossi M, Zairis S, Gazaneo S, De Falco G, Lazzi S, Bellan C, Rocca BJ, Amato T, Marasco E, Etebari M, Ogwang M, Calbi V, Ndede I, Patel K, Chumba D, Piccaluga PP, Pileri S, Leoncini L, Rabadan R. Distinct Viral and Mutational Spectrum of Endemic Burkitt Lymphoma. PLoS Pathog 2015; 11:e1005158. [PMID: 26468873 PMCID: PMC4607508 DOI: 10.1371/journal.ppat.1005158] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/19/2015] [Indexed: 12/15/2022] Open
Abstract
Endemic Burkitt lymphoma (eBL) is primarily found in children in equatorial regions and represents the first historical example of a virus-associated human malignancy. Although Epstein-Barr virus (EBV) infection and MYC translocations are hallmarks of the disease, it is unclear whether other factors may contribute to its development. We performed RNA-Seq on 20 eBL cases from Uganda and showed that the mutational and viral landscape of eBL is more complex than previously reported. First, we found the presence of other herpesviridae family members in 8 cases (40%), in particular human herpesvirus 5 and human herpesvirus 8 and confirmed their presence by immunohistochemistry in the adjacent non-neoplastic tissue. Second, we identified a distinct latency program in EBV involving lytic genes in association with TCF3 activity. Third, by comparing the eBL mutational landscape with published data on sporadic Burkitt lymphoma (sBL), we detected lower frequencies of mutations in MYC, ID3, TCF3 and TP53, and a higher frequency of mutation in ARID1A in eBL samples. Recurrent mutations in two genes not previously associated with eBL were identified in 20% of tumors: RHOA and cyclin F (CCNF). We also observed that polyviral samples showed lower numbers of somatic mutations in common altered genes in comparison to sBL specimens, suggesting dual mechanisms of transformation, mutation versus virus driven in sBL and eBL respectively. Burkitt lymphoma is endemic in sub-Saharan Africa and affects primarily children of age 4–7 years. Historically, it was one of the first tumors associated with a virus (EBV) and bearing a translocation involving an oncogene, i.e. MYC. There are three distinct clinical variants of Burkitt lymphoma according to the World Health Organization: sporadic, endemic and immunodeficiency-related. Although there has been some recent work on the molecular characterization of sporadic Burkitt lymphomas, little is known about the pathogenesis of endemic cases. In this work, we analyzed 20 samples of RNASeq from Burkitt lymphoma collected in Lacor Hospital (Uganda, Africa) and validated in an extension panel of 73 samples from Uganda and Kenya. We identify the presence in the adjacent non-neoplastic tissue of other herpesviridae family members in 53% of the cases, namely cytomegalovirus (CMV) and Kaposi sarcoma herpesvirus (KSHV). We also demonstrate expression of EBV lytic genes in primary tumor samples and find an inverse association between EBV lytic expression and TCF3 activity. When studying the mutational profile of endemic Burkitt tumors, we find recurrent alterations in genes rarely mutated in sporadic Burkitt lymphomas, i.e. ARID1A, CCNF and RHOA, and lower numbers of mutations in genes previously reported to be commonly mutated in sporadic cases, i.e. MYC, ID3, TCF3, TP53. Together, these results illustrate a distinct genetic and viral profile of endemic Burkitt lymphoma, suggesting a dual mechanism of transformation (mutation versus virus driven in sBL and eBL respectively).
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Affiliation(s)
- Francesco Abate
- Department of Systems Biology, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | | | - Lucia Mundo
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Maria Antonella Laginestra
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Fabio Fuligni
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Maura Rossi
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Sakellarios Zairis
- Department of Systems Biology, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | - Sara Gazaneo
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Giulia De Falco
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Stefano Lazzi
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Cristiana Bellan
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Bruno Jim Rocca
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Teresa Amato
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
| | - Elena Marasco
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Maryam Etebari
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | | | | | - Pier Paolo Piccaluga
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
| | - Stefano Pileri
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
- Unit of Haematopathology, European Institute of Oncology, Milan and Bologna University School of Medicine, Bologna, Italy
- * E-mail: , (SP); (LL); (RR)
| | - Lorenzo Leoncini
- Department of Medical Biotechnologies, Section of Pathology, University of Siena, Siena, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University School of Medicine, Bologna, Italy
- * E-mail: , (SP); (LL); (RR)
| | - Raul Rabadan
- Department of Systems Biology, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York, United States of America
- * E-mail: , (SP); (LL); (RR)
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Laginestra MA, Abate F, Etebari M, Falco GD, Fuligni F, Rossi M, Zairis S, Sapienza MR, Gazzola A, Mannu C, Melle F, Agostinelli C, Navari M, Bellan C, Gazaneo S, Mundo L, Ogwang M, Calbi V, Leoncini L, Pileri SA, Rabadan R, Piccaluga PP. Abstract 5173: Identification of single-nucleotide variants by high-throughput RNA sequencing in endemic Burkitt Lymphoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Endemic Burkitt lymphoma (eBL) constitutes the commonest cancer in children in Developing Countries, while the sporadic (sBL) and immunodeficiency associated BL (ID-BL) forms are mainly encountered in Western Countries. The molecular hallmark of three BL variants is the translocation of MYC proto-oncogene to the immunoglobulin-heavy [t(8;14)(q24;q32)] or one of the light chain genes [t(2;8)(p12; q24) and t(8;22)(q24; q11)], leading to constitutive MYC activation. However, additional genetic events contributes to BL pathogenesis, most of which have been studies in sBL only.
Here, we performed RNA Sequencing aiming to identify genetic changes possibly cooperating with MYC in the pathogenesis of eBL. We studied by RNA Sequencing (Illumina HiScanSQ) 21 eBL cases, collected at different African Institutions as discovery set. Total RNA was extracted with Trizol and libraries were prepared according to TruSeq RNA sample preparation v2 protocol. Sequence variants were obtained using the SAVI (Statistical Algorithm for Variant Identification) algorithm independently for each sample. Candidate somatic mutations were obtained by eliminating common germline variants and recurrence. To validate single-nucleotide variants (SNVs) we performed Sanger sequencing on these 21 cases. Further, we studied these SNVs by Sequenom Technology and Sanger sequencing on additional 24 eBL cases as validation set. 41 sBL and 8 ID-BL were also considered as controls.
We found 66 genes affected by 219 total SNVs with different frequency in 21 samples (range 2-22 for sample). We then focused on genes mutated in at least three samples and predicted to induce somatic protein-changing. We identified 25 genes affected by 172 total SNVs, that were recurrently mutated (min. 3/21 samples; max 11/21 samples). These included genes previously known to be involved in sBL, such as TP53, MYC, ID3, PCBP1 and TCF3 as well as genes involved in other lymphomas such as DDX3X and RHOA. The remaining 18 genes (AGAP6, APBB1IP, ARID1A, ASPSCR1, AVEN, CAD, CCNF, GPATCH4, HERC2, KPNA2, MTBP, MTERFD1, NEK9, NUP133,
PARP1, POLQ, SCFD2, TIGD1) were previously not related to BL, and resulted to be involved in several important molecular pathways as cell cycle progression, apoptosis, matrix remodelling, angiogenesis.
Sanger sequencing confirmed such SNVs with 100% accuracy in 21 cases of discovery set. Subsequently, we studied them in 24 independent cases of validation set by both Sanger sequencing and by mass spectrometry (Sequenom). We found that most eBL cases carried additional SNVs rather than MYC translocations. Noteworthy, we failed to find these mutations in sBL, confirming the concept that different pathogenetic events may contribute to the pathogenesis of BL subtypes.
In conclusion , we discovered new SNVs that might have a significant role in the pathogenesis of eBL. Functional experiments are required to definitely assess their impact.
Citation Format: Maria Antonella Laginestra, Francesco Abate, Maryam Etebari, Giulia De Falco, Fabio Fuligni, Maura Rossi, Sakellarios Zairis, Maria Rosaria Sapienza, Anna Gazzola, Claudia Mannu, Federica Melle, Claudio Agostinelli, Mohsen Navari, Cristiana Bellan, Sara Gazaneo, Lucia Mundo, Martin Ogwang, Valeria Calbi, Lorenzo Leoncini, Stefano A. Pileri, Raul Rabadan, Pier Paolo Piccaluga. Identification of single-nucleotide variants by high-throughput RNA sequencing in endemic Burkitt Lymphoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5173. doi:10.1158/1538-7445.AM2014-5173
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Affiliation(s)
| | - Francesco Abate
- 2Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raul Rabadan
- 2Columbia University College of Physicians and Surgeons, New York, NY
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16
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Ogwang M, Paramatti D, Molteni T, Ochola E, Okello TR, Ortiz Salgado JC, Kayanja A, Greco C, Kizza D, Gondoni E, Okot J, Praticò L, Granata V, Filia A, Kellar Ayugi H, Greco D. Prevalence of hospital-associated infections can be decreased effectively in developing countries. J Hosp Infect 2013; 84:138-42. [PMID: 23643293 DOI: 10.1016/j.jhin.2013.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 02/10/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI. AIM To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital. METHODS A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011. FINDINGS The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities. CONCLUSION This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.
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Affiliation(s)
- M Ogwang
- St. Mary's Hospital Lacor, Gulu, Uganda
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17
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Amito Florence P, Otim F, Okongo F, Ogwang M, Greco D. The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary's Hospital Lacor Uganda. J Prev Med Hyg 2012; 53:186-189. [PMID: 23469585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Gonorrhea is one of the most common sexually transmitted infections (STls) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical determination of the prevalence and monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. METHODS A total of 640 consecutive patients who attended the Outpatient Department (OPD) Clinics at St. Mary's Hospital Lacor between Jan 2007-Dec 2011, with gonococcal urethriris symptoms and whose urethral swabs and high vagina swabs (HVS) were cultured, were involved in the study. Two hundred and fifty six (256) patients had positive pus swab culture, of which 151 (23.6%) showed growth of Neisseria gonorrhoeae. All the isolates were tested for antimicrobial susceptibility using the Kirby Bauer-disc diffusion techniques. RESULTS Gonococcal isolates showed rapid decrease in susceptibility to the antimicrobials especially to ampicillin, tetracycline and erythomycin, ciprofloxacin, and intermediate to chloramphenicol, however, gentamicin and cefotaxime have remained as a single dose sensitive treatment for Neisseria gonorrhoeae. Sensitization on drug use and adopting preventive measures and continuous education on safer sexual behavior through health care authorities would lead to reduction in the prevalence of Neisseria gonorrhoeae and resistance to antimicrobial. DISCUSSION Gonorrhea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhea is essential for the early detection of emergence of drug resistance.
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Affiliation(s)
- P Amito Florence
- Department of Microbiology, St. Mary's Hospital Lacor, Gulu, Uganda.
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18
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Ambrosio MR, Piccaluga PP, Ponzoni M, Rocca BJ, Malagnino V, Onorati M, De Falco G, Calbi V, Ogwang M, Naresh KN, Pileri SA, Doglioni C, Leoncini L, Lazzi S. The alteration of lipid metabolism in Burkitt lymphoma identifies a novel marker: adipophilin. PLoS One 2012; 7:e44315. [PMID: 22952953 PMCID: PMC3432109 DOI: 10.1371/journal.pone.0044315] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/01/2012] [Indexed: 11/24/2022] Open
Abstract
Background Recent evidence suggests that lipid pathway is altered in many human tumours. In Burkitt lymphoma this is reflected by the presence of lipid droplets which are visible in the cytoplasm of neoplastic cells in cytological preparations. These vacuoles are not identifiable in biopsy section as lipids are “lost” during tissue processing. Methods and Results In this study we investigated the expression of genes involved in lipid metabolism, at both RNA and protein level in Burkitt lymphoma and in other B-cell aggressive lymphoma cases. Gene expression profile indicated a significant over-expression of the adipophilin gene and marked up-regulation of other genes involved in lipid metabolism in Burkitt lymphoma. These findings were confirmed by immunohistochemistry on a series od additional histological samples: 45 out of 47 BL cases showed strong adipophilin expression, while only 3 cases of the 33 of the not-Burkitt lymphoma category showed weak adipophilin expression (p<0.05). Conclusions Our preliminary results suggest that lipid metabolism is altered in BL, and this leads to the accumulation of lipid vacuoles. These vacuoles may be specifically recognized by a monoclonal antibody against adipophilin, which may therefore be a useful marker for Burkitt lymphoma because of its peculiar expression pattern. Moreover this peptide might represent an interesting candidate for interventional strategies.
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Affiliation(s)
- Maria R. Ambrosio
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
| | - Pier P. Piccaluga
- Molecular Pathology Laboratory, Haematopathology Unit, Department of Haematology and Oncology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maurilio Ponzoni
- Pathology Unit, Department of Oncology, University Scientific Institute San Raffaele, Milan, Italy
| | - Bruno J. Rocca
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
| | - Valeria Malagnino
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
| | - Monica Onorati
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
| | - Giulia De Falco
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
| | | | | | - Kikkeri N. Naresh
- Department of Histopathology, Hammersmith Hospital Campus, Imperial College, London, United Kingdom
| | - Stefano A. Pileri
- Molecular Pathology Laboratory, Haematopathology Unit, Department of Haematology and Oncology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Doglioni
- Pathology Unit, Department of Oncology, University Scientific Institute San Raffaele, Milan, Italy
| | - Lorenzo Leoncini
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
- * E-mail:
| | - Stefano Lazzi
- Department of Human Pathology and Oncology, Anatomical Pathology Section, University of Siena, Siena, Italy
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Naresh KN, Ibrahim HAH, Lazzi S, Rince P, Onorati M, Ambrosio MR, Bilhou-Nabera C, Amen F, Reid A, Mawanda M, Calbi V, Ogwang M, Rogena E, Byakika B, Sayed S, Moshi E, Mwakigonja A, Raphael M, Magrath I, Leoncini L. Diagnosis of Burkitt lymphoma using an algorithmic approach--applicable in both resource-poor and resource-rich countries. Br J Haematol 2011; 154:770-6. [PMID: 21718280 DOI: 10.1111/j.1365-2141.2011.08771.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Distinguishing Burkitt lymphoma (BL) from B cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma (DLBCL) and BL (DLBCL/BL), and DLBCL is challenging. We propose an immunohistochemistry and fluorescent in situ hybridization (FISH) based scoring system that is employed in three phases - Phase 1 (morphology with CD10 and BCL2 immunostains), Phase 2 (CD38, CD44 and Ki-67 immunostains) and Phase 3 (FISH on paraffin sections for MYC, BCL2, BCL6 and immunoglobulin family genes). The system was evaluated on 252 aggressive B-cell lymphomas from Europe and from sub-Saharan Africa. Using the algorithm, we determined a specific diagnosis of BL or not-BL in 82%, 92% and 95% cases at Phases 1, 2 and 3, respectively. In 3·4% cases, the algorithm was not completely applicable due to technical reasons. Overall, this approach led to a specific diagnosis of BL in 122 cases and to a specific diagnosis of either DLBCL or DLBCL/BL in 94% of cases that were not diagnosed as BL. We also evaluated the scoring system on 27 cases of BL confirmed on gene expression/microRNA expression profiling. Phase 1 of our scoring system led to a diagnosis of BL in 100% of these cases.
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Affiliation(s)
- Kikkeri N Naresh
- Department of Histopathology, Hammersmith Hospital Campus, Imperial College, London, UKDepartment of Human Pathology and Oncology, University of Siena, Siena, ItalyUniv Paris-Sud, F-94270, Le Kremlin-Bicêtre; AP-HP, Hôpital Bicêtre, Service d'Hématologie et Immunologie Biologiques, Cytogénétique, F-94270, Le Kremlin Bicêtre, FranceDepartment of Haematology, Hammersmith Hospital Campus, Imperial College, London, UKSaint Mary Hospital, Lacor, Gulu, UgandaUniversity of NairobiNairobi HospitalAga Khan University Hospital, Nairobi, KenyaMuhimbili National HospitalMuhimbili University of Health and Allied Sciences, Dar Es Salam, TanzaniaInternational Network for Cancer Treatment and Research, Brussels, BelgiumDepartment of Histopathology, Faculty of Medicine, Mansoura University, Egypt
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Prugger C, Engl M, Ogwang M, Ploner F, Ploner M, Gluderer D, Wernsdorfer G, Wernsdorfer WH. Malariological baseline survey and in vitro antimalarial drug resistance in Gulu district, Northern Uganda. Wien Klin Wochenschr 2009; 120:63-8. [PMID: 19066776 DOI: 10.1007/s00508-008-1037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A comprehensive, representative malaria survey has been carried out in a population of internally displaced persons (IDP) in the district of Gulu, Northern Uganda. It included 74 households and 390 persons, and covered socio-economic and environmental information, individual physical data, malaria and the drug sensitivity of Plasmodium falciparum. The prevalence of infections with Plasmodium falciparum was 54.4% at a geometric mean asexual parasitaemia of 229/microl blood, typical for hyperendemic conditions. P. falciparum turned out to be highly resistant to chloroquine and amodiaquine. It showed also reduced sensitivity against lumefantrine and artemisinin, obviously the result of the liberal use of the lumefantrine-artemether combination without evidence-based indication.
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Affiliation(s)
- Christof Prugger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Ayers LW, Ogwang M, Zhou W, Mbulaiteye SM, Bhatia K. Value of CD44 immunostaining (IHC) as a surrogate in the differentiation of MYC-positive Burkitt lymphoma (BL) and Burkitt lymphoma-like (BLL) from MYC-negative Diffuse Large B-Cell Lymphoma (DLBCL) in a resource constrained clinical setting. Infect Agent Cancer 2009. [PMCID: PMC4261845 DOI: 10.1186/1750-9378-4-s2-p6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fabiani M, Cawthorne A, Nattabi B, Ayella EO, Ogwang M, Declich S. Investigating factors associated with uptake of HIV voluntary counselling and testing among pregnant women living in North Uganda. AIDS Care 2007; 19:733-9. [PMID: 17573592 DOI: 10.1080/09540120601087731] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated factors potentially associated with the uptake of HIV voluntary counselling and testing (VCT), which is the first step in acceding to programmes for the prevention of mother-to-child transmission of HIV infection. For the period 2001-2003, we estimated the VCT uptake among the 12,252 first-time attendees of the Antenatal Clinic (ANC) at Lacor Hospital (Gulu District, North Uganda). Associations between VCT uptake and socio-demographic characteristics and reproductive history were evaluated using log binomial regression models. VCT uptake was 55.6% for the overall study period; it increased from 51.0% in 2001 to 58.6% in 2002 and 57.7% in 2003 (P <0.001). Having some education [primary versus none, adjusted prevalence proportion ratio (PPR) =1.05, 95% confidence intervals (CI): 1.00-1.10] and being unmarried (cohabitating, PPR =1.07, 95% CI: 1.03-1.10; single/widowed/divorced, PPR =1.10, 95% CI: 1.03-1.18) were significantly associated with VCT uptake. Associations of borderline significance were found for: recent change of residence, having a partner with a modern occupation, and past use of contraceptives. VCT uptake is still low in this district of North Uganda. Although some socio-demographic factors were found to have been associated with uptake, the associations were weak and not of public-health significance.
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Affiliation(s)
- M Fabiani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
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Accorsi S, Fabiani M, Nattabi B, Ferrarese N, Corrado B, Iriso R, Ayella EO, Pido B, Yoti Z, Corti D, Ogwang M, Declich S. Differences in hospital admissions for males and females in northern Uganda in the period 1992–2004: a consideration of gender and sex differences in health care use. Trans R Soc Trop Med Hyg 2007; 101:929-38. [PMID: 17590396 DOI: 10.1016/j.trstmh.2007.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 03/21/2007] [Accepted: 03/21/2007] [Indexed: 10/23/2022] Open
Abstract
To inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992-2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0-14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15-44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (>or=45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.
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Affiliation(s)
- Sandro Accorsi
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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Fabiani M, Nattabi B, Opio AA, Musinguzi J, Biryahwaho B, Ayella EO, Ogwang M, Declich S. A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife. Trans R Soc Trop Med Hyg 2006; 100:586-93. [PMID: 16289650 DOI: 10.1016/j.trstmh.2005.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Revised: 08/29/2005] [Accepted: 09/01/2005] [Indexed: 11/20/2022] Open
Abstract
This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; >or=25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; >or=35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.
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Affiliation(s)
- Massimo Fabiani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
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Fabiani M, Nattabi B, Ayella EO, Ogwang M, Declich S. Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda. Trop Med Int Health 2006; 11:182-7. [PMID: 16451342 DOI: 10.1111/j.1365-3156.2005.01554.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate differences in fertility by HIV serostatus and to validate an adjustment method for estimating the HIV prevalence in the general female population using data from an antenatal clinic. METHODS We used Cox regression models to retrospectively estimate the age-specific relative fertility (RF) of HIV-positive compared to HIV-negative women among 3314 antenatal clinic attenders in northern Uganda. RF and the age distribution of women in the general female population were used to extrapolate the antenatal clinic-based HIV prevalence. This procedure was indirectly validated by comparing the adjusted estimate with those based on standard adjustment factors derived from general female populations in Uganda and Tanzania. RESULTS HIV-positive women reported a lower fertility than HIV-negative women [age-adjusted RF=0.83, 95% confidence interval (CI): 0.75-0.93]. Except for girls aged 15-19 (RF=0.96, 95% CI: 0.74-1.24) HIV-positive women in all age groups were less fertile (20-24 year: RF=0.83, 95% CI: 0.67-1.01; 25-29 years: RF=0.79, 95% CI: 0.62-1.00; 30-49 year: RF=0.79, 95% CI: 0.65-0.96]. Adjusting the antenatal clinic-based HIV prevalence (11.6%) for these differences yields a higher estimate (13.8%) that is lower than those based on standard adjustment factors derived from general female populations (from 14.6% to 17.7%). CONCLUSIONS The age-specific pattern of differential fertility by HIV serostatus derived from antenatal clinic data is consistent with findings from population-based studies conducted in Africa. However, differences in fertility between HIV positive and HIV-negative clients underestimate those in the general female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.
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Affiliation(s)
- Massimo Fabiani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
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Fabiani M, Nattabi B, Ayella EO, Ogwang M, Declich S. Using prevalence data from the programme for the prevention of mother-to-child-transmission for HIV-1 surveillance in North Uganda. AIDS 2005; 19:823-7. [PMID: 15867497 DOI: 10.1097/01.aids.0000168977.51843.d6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To validate the use of data from a programme for the prevention of mother-to-child transmission (PMTCT) in estimating HIV-1 prevalence in North Uganda. METHODS The study was conducted at St. Mary's Hospital Lacor. We compared the estimated prevalence for 3580 attendees at the antenatal clinic who were selected for anonymous surveillance to that for 6785 pregnant women who agreed to undergo voluntary counselling and testing (VCT) for enrolment in the PMTCT programme. Log-binomial regression models were used to identify the factors associated with both VCT uptake and HIV-1 infection, which could bias the prevalence estimates based on PMTCT data. RESULTS In 2001-2003, the age-standardized prevalence was similar (11.1% in the anonymous surveillance group and 10.9% in the VCT group). The estimates were also similar when compared for each year tested. Analogously, no important differences were observed in age-specific prevalence. Of the factors associated with HIV-1 infection, only time of residence at current address [prevalence proportion ratio (PPR) = 1.05; 95% confidence interval (CI), 1.00-1.10], marital status (PPR = 1.05; 95% CI, 1.01-1.10) and partner's occupation (PPR = 1.05; 95% CI, 1.01-1.10) were associated with VCT uptake, yet the associations were weak. CONCLUSIONS The prevalence estimated based on the VCT data collected as part of the PMTCT programme could be used for HIV-1 surveillance in North Uganda. At the national level, however, it needs to be evaluated whether PMTCT data could replace, or instead be combined with, the data from sentinel surveillance.
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Affiliation(s)
- Massimo Fabiani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
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Accorsi S, Fabiani M, Nattabi B, Corrado B, Iriso R, Ayella EO, Pido B, Onek PA, Ogwang M, Declich S. The disease profile of poverty: morbidity and mortality in northern Uganda in the context of war, population displacement and HIV/AIDS. Trans R Soc Trop Med Hyg 2005; 99:226-33. [PMID: 15653126 DOI: 10.1016/j.trstmh.2004.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 09/01/2004] [Accepted: 09/22/2004] [Indexed: 11/20/2022] Open
Abstract
The population of Gulu District (northern Uganda) has been severely incapacitated by war, epidemics and social disruption. This study is aimed at describing disease patterns and trends in this area through a retrospective analysis of discharge records for 155205 in-patients of Lacor Hospital in the period 1992-2002. The burden of infectious diseases in childhood is overwhelming, with malaria accounting for the steepest increase in admissions. Admissions for war-related injuries and malnutrition fluctuated with the intensity of the war and the severity of famine. Emerging and re-emerging infections, such as HIV/AIDS, tuberculosis and Ebola, accounted for a heavy disease burden; however, there has been a trend for admissions related to HIV/AIDS and tuberculosis to decrease since the implementation of community-based services. Vulnerable groups (infants, children and women) accounted for 79.8% of admissions. Long-term war, population displacement, the collapse of social structures and the breakdown of the health system place people at a much greater risk of persistent, emerging and re-emerging infectious diseases, malnutrition and war-related injuries, shaping the 'disease profile of poverty'. Most of the disease burden results from infectious diseases of childhood, whose occurrence could be dramatically reduced by low-cost and effective preventive and curative interventions.
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Affiliation(s)
- S Accorsi
- Istituto Superiore di Sanità, National Centre for Epidemiology, Surveillance and Health Promotion, Viale Regina Elena 299, 00161 Rome, Italy
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