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Namiiro FB, Batte A, Rujumba J, Nabukeera-Barungi N, Kayom VO, Munabi IG, Serunjogi R, Kiguli S. Nutritional status of young children born with low birthweight in a low resource setting: an observational study. BMC Pediatr 2023; 23:520. [PMID: 37858130 PMCID: PMC10585881 DOI: 10.1186/s12887-023-04356-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda. METHODS We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14. RESULTS Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. CONCLUSION Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.
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Affiliation(s)
- Flaviah B Namiiro
- Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda.
| | - Anthony Batte
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Violet O Kayom
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G Munabi
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-John Hopkins University Institute, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Mercedes RA, Kasbaum MA, George PE, Tumweheire EG, Scheurer ME, Nabukeera-Barungi N. Nutritional Recovery of Children With HIV and Severe Acute Malnutrition Attending an Outpatient Therapeutic Care Program. J Acquir Immune Defic Syndr 2023; 94:66-72. [PMID: 37314836 DOI: 10.1097/qai.0000000000003222] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite significant morbidity and mortality from HIV and severe acute malnutrition (SAM) among children in sub-Saharan Africa, research is lacking in these children. We describe the proportion of children living with HIV with SAM achieving recovery, the factors associated with recovery, and time to recovery in an outpatient therapeutic care program. SETTING AND METHODS This is a retrospective observational study of children with SAM and HIV on antiretroviral therapy (6 months-15 years), enrolled in outpatient therapeutic care from 2015 to 2017 at a pediatric HIV clinic in Kampala, Uganda. SAM diagnosis and recovery by 120 days after enrollment were determined per World Health Organization guidelines. Cox-proportional hazards models were used to determine predictors of recovery. RESULTS Data from 166 patients were analyzed (mean age 5.4 years, SD 4.7). Outcomes showed 36.1% recovered, 15.6% were lost to follow-up, 2.4% died, and 45.8% failed. Average time to recovery was 59.9 days (SD 27.8). Patients 5 years or older were less likely to recover (crude hazard ratio [CHR] = 0.33, 95% CI: 0.18 to 0.58). In multivariate analysis, febrile patients were less likely to recover (adjusted hazard ratio = 0.53, 95% CI: 0.12 to 0.65). Patients with CD4 count of 200 or less at enrollment were less likely to recover (CHR = 0.46, 95% CI: 0.22 to 0.96). CONCLUSIONS Despite treatment with antiretroviral therapy for children living with HIV, we observed poor rates of recovery from SAM, below the international target of >75%. Moreover, patients 5 years and older, fever, or low CD4 at diagnosis of SAM may require more intense therapy or closer monitoring than their counterparts.
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Affiliation(s)
| | - Marie A Kasbaum
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Paul E George
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Currently, Department of Pediatrics, Emory University, Atlanta, GA
| | - Enid G Tumweheire
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; and
| | | | - Nicolette Nabukeera-Barungi
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; and
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Mutumba R, Pesu H, Mbabazi J, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Nabukeera-Barungi N, Mupere E, Filteau S, Friis H, Grenov B. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients 2023; 15:3429. [PMID: 37571364 PMCID: PMC10421162 DOI: 10.3390/nu15153429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Micronutrient deficiencies and stunting are prevalent. We assessed correlates of iron, cobalamin, folate, and vitamin A biomarkers in a cross-sectional study of stunted children aged 12-59 months in eastern Uganda. The biomarkers measured were serum ferritin (S-FE), soluble transferrin receptor (S-TfR), retinol binding protein (S-RBP), plasma cobalamin (P-Cob), methylmalonic acid (P-MMA), and folate (P-Fol). Using linear regression, we assessed socio-demography, stunting severity, malaria rapid test, and inflammation as correlates of micronutrient biomarkers. Of the 750 children, the mean (SD) age was 32.0 (11.7) months, and 45% were girls. Iron stores were depleted (inflammation-corrected S-FE < 12 µg/L) in 43%, and 62% had tissue iron deficiency (S-TfR > 8.3 mg/L). P-Cob was low (<148 pmol/L) and marginal (148-221 pmol/L) in 3% and 20%, and 16% had high P-MMA (>0.75 µmol/L). Inflammation-corrected S-RBP was low (<0.7 µmol/L) in 21% and P-Fol (<14 nmol/L) in 1%. Age 24-59 months was associated with higher S-FE and P-Fol and lower S-TfR. Breastfeeding beyond infancy was associated with lower iron status and cobalamin status, and malaria was associated with lower cobalamin status and tissue iron deficiency (higher S-TfR) despite iron sequestration in stores (higher S-FE). In conclusion, stunted children have iron, cobalamin, and vitamin A deficiencies. Interventions addressing stunting should target co-existing micronutrient deficiencies.
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Affiliation(s)
- Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark;
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - André Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33520 Tampere, Finland;
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark;
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
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Orey F, Ndeezi G, Mugalu J, Mohamud L, Nabukeera-Barungi N. Early perinatal outcomes of babies born to adolescent mothers at two maternity hospitals in Mogadishu, Somalia. Afr Health Sci 2023; 23:715-725. [PMID: 38223577 PMCID: PMC10782356 DOI: 10.4314/ahs.v23i2.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 01/16/2024] Open
Abstract
Background Adolescent motherhood remains a major problem in developing countries. We set out to describe the perinatal outcomes of infants born to adolescent mothers and to determine factors associated with birth asphyxia among these infants in Mogadishu, Somalia. Methods This cross-sectional study involved adolescent mothers who presented in labor. Sociodemographic and medical data was collected and mother-infant pairs were followed up at 24hrs. Poor perinatal outcomes were: low birth weight, birth asphyxia, death or hospitalization after 24 hours. Data was entered into Epi data 3.1 and analysed using STATA version 12.0. Results Of the 270 adolescents, mean age was 17.7 years (±1.19), 89% were married, 94% were unemployed and 54% had not received formal education. Of the 270 babies born, 70 (25.9%) had poor perinatal outcomes which included; 35 (12.9%) died; of whom 30 (11.1%) were stillbirths. Thirty-two infants (13.3%) had birth asphyxia and 18 (6.7%) had low birth weight. Prolonged labor (p-value=<0.001) and preterm birth (p-value=0.023) were significantly associated with birth asphyxia while living in Mogadishu was protective (p- value=0.018). Conclusions About one in four adolescent mother's babies had poor perinatal outcomes. Prolonged labor and preterm delivery and were associated with birth asphyxia while residing closer to the facilities was protective.
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Affiliation(s)
- Fartun Orey
- Makerere University College of Health Sciences, Paediatrics and Child Health
| | - Grace Ndeezi
- Makerere University College of Health Sciences, Paediatrics and Child Health
| | - Jamiir Mugalu
- Mulago National Referral Hospital, Paediatrics and Child Health
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Mbabazi J, Pesu H, Mutumba R, Filteau S, Lewis JI, Wells JC, Olsen MF, Briend A, Michaelsen KF, Mølgaard C, Ritz C, Nabukeera-Barungi N, Mupere E, Friis H, Grenov B. Effect of milk protein and whey permeate in large quantity lipid-based nutrient supplement on linear growth and body composition among stunted children: A randomized 2 × 2 factorial trial in Uganda. PLoS Med 2023; 20:e1004227. [PMID: 37220111 DOI: 10.1371/journal.pmed.1004227] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/29/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Despite possible benefits for growth, milk is costly to include in foods for undernourished children. Furthermore, the relative effects of different milk components, milk protein (MP), and whey permeate (WP) are unclear. We aimed to assess the effects of MP and WP in lipid-based nutrient supplement (LNS), and of LNS itself, on linear growth and body composition among stunted children. METHODS AND FINDINGS We performed a randomized, double-blind, 2 × 2 factorial trial among 12 to 59 months old stunted children in Uganda. Children were randomized to 4 formulations of LNS with MP or soy protein isolate and WP or maltodextrin (100 g/day for 12 weeks) or no supplementation. Investigators and outcome assessors were blinded; however, participants were only blinded to the ingredients in LNS. Data were analyzed based on intention-to-treat (ITT) using linear mixed-effects models adjusted for age, sex, season, and site. Primary outcomes were change in height and knee-heel length, and secondary outcomes included body composition by bioimpedance analysis (ISRCTN13093195). Between February and September 2020, we enrolled 750 children with a median age of 30 (interquartile range 23 to 41) months, with mean (± standard deviation) height-for-age z-score (HAZ) -3.02 ± 0.74 and 12.7% (95) were breastfed. The 750 children were randomized to LNS (n = 600) with or without MP (n = 299 versus n = 301) and WP (n = 301 versus n = 299), or no supplementation (n = 150); 736 (98.1%), evenly distributed between groups, completed 12-week follow-up. Eleven serious adverse events occurred in 10 (1.3%) children, mainly hospitalization with malaria and anemia, all deemed unrelated to the intervention. Unsupplemented children had 0.06 (95% confidence interval, CI [0.02, 0.10]; p = 0.015) decline in HAZ, accompanied by 0.29 (95% CI [0.20, 0.39]; p < 0.001) kg/m2 increase in fat mass index (FMI), but 0.06 (95% CI [-0.002; 0.12]; p = 0.057) kg/m2 decline in fat-free mass index (FFMI). There were no interactions between MP and WP. The main effects of MP were 0.03 (95% CI [-0.10, 0.16]; p = 0.662) cm in height and 0.2 (95% CI [-0.3, 0.7]; p = 0.389) mm in knee-heel length. The main effects of WP were -0.08 (95% CI [-0.21, 0.05]; p = 220) cm and -0.2 (95% CI [-0.7; 0.3]; p = 403) mm, respectively. Interactions were found between WP and breastfeeding with respect to linear growth (p < 0.02), due to positive effects among breastfed and negative effects among non-breastfed children. Overall, LNS resulted in 0.56 (95% CI [0.42, 0.70]; p < 0.001) cm height increase, corresponding to 0.17 (95% CI [0.13, 0.21]; p < 0.001) HAZ increase, and 0.21 (95% CI [0.14, 0.28]; p < 0.001) kg weight increase, of which 76.5% (95% CI [61.9; 91.1]) was fat-free mass. Using height-adjusted indicators, LNS increased FFMI (0.07 kg/m2, 95% CI [0.0001; 0.13]; p = 0.049), but not FMI (0.01 kg/m2, 95% CI [-0.10, 0.12]; p = 0.800). Main limitations were lack of blinding of caregivers and short study duration. CONCLUSIONS Adding dairy to LNS has no additional effects on linear growth or body composition in stunted children aged 12 to 59 months. However, supplementation with LNS, irrespective of milk, supports linear catch-up growth and accretion of fat-free mass, but not fat mass. If left untreated, children already on a stunting trajectory gain fat at the expense of fat-free mass, thus nutrition programs to treat such children should be considered. TRIAL REGISTRATION ISRCTN13093195.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jack I Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mette F Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Nkurunziza JC, Nabukeera-Barungi N, Kalyango JN, Niyongabo A, Mwanja MM, Mupere E, Nankabirwa JI. Prevalence and factors associated with anaemia in children aged 6–24 months living a high malaria transmission setting in Burundi. PLoS One 2022; 17:e0273651. [PMID: 36054118 PMCID: PMC9439186 DOI: 10.1371/journal.pone.0273651] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6–24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi. Methods Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6–24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child’s primary caregiver to capture information on child’s demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections. Results The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79–6.99, p<0.001), the child’s home location (Mukenke II: aOR = 2.22, 95% CI 1.89–2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46–3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94–3.31, p<0.001) and the child’s age group (Children aged 6–11 months: aOR = 2.27, 95% CI 1.32–3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child’s primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47–0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38–0.61, p<0.001). Conclusion Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.
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Affiliation(s)
- Jean Claude Nkurunziza
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Community Medicine, Kamenge University Hospital Center (CHUK), University of Burundi, Bujumbura, Burundi
- * E-mail:
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloys Niyongabo
- Department of Laboratory, Kamenge University Hospital Center (CHUK), University of Burundi, Bujumbura, Burundi
| | - Mercy Muwema Mwanja
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joaniter I. Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
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Kamugisha JGK, Lanyero B, Nabukeera-Barungi N, Ritz C, Mølgaard C, Michaelsen KF, Briend A, Mupere E, Friis H, Grenov B. Weight-for-Height Z-score Gain during Inpatient Treatment and Subsequent Linear Growth during Outpatient Treatment of Young Children with Severe Acute Malnutrition: A Prospective Study from Uganda. Curr Dev Nutr 2021; 5:nzab118. [PMID: 34712895 PMCID: PMC8546154 DOI: 10.1093/cdn/nzab118] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Linear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth. OBJECTIVE The study assessed the association of weight-for-height z-score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers. METHODS This was a prospective study, nested in a trial (ISRCTN16454889), among 6-59-mo-old children treated for SAM in Uganda. Weight, total length (TL), and knee-heel length (KHL) were measured at admission, weekly during inpatient therapeutic care (ITC), at discharge, and fortnightly during outpatient therapeutic care (OTC) for 8 wk. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC. RESULTS Of 400 children, 327 were discharged to OTC and 290 were followed up for 8 wk. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age z-score (HAZ) declined by 0.41 during ITC and increased by 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL, and KHL gains during OTC [regression coefficients (β) (95% CI): 0.12 (0.09, 0.15) z-score; 3.1 (2.4, 3.8) mm and 0.5 (0.1, 0.7) mm, respectively]. The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC (P < 0.001). In contrast, pneumonia (P = 0.051) and elevated plasma C-reactive protein (P < 0.001) increased the association with TL gain, but reduced the association with KHL gain (P < 0.001). CONCLUSIONS Among children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary.
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Affiliation(s)
- Jolly G K Kamugisha
- Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Betty Lanyero
- World Health Organization, Ethiopia Country Office, UNECA Compound, Addis Ababa, Ethiopia
| | | | - Christian Ritz
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - André Briend
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
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Kamugisha JGK, Lanyero B, Nabukeera-Barungi N, Nambuya-Lakor H, Ritz C, Mølgaard C, Michaelsen KF, Briend A, Mupere E, Friis H, Grenov B. Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda. BMC Nutr 2021; 7:26. [PMID: 34140028 PMCID: PMC8212498 DOI: 10.1186/s40795-021-00428-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). However, changes in weight and mid-upper arm circumference (MUAC) gain velocities over time are scarcely described. We assessed weight and MUAC gain velocities in 6–59 mo-old children with complicated SAM by treatment phase and edema status. Methods This was a prospective study, nested in a randomized/probiotic trial (ISRCTN16454889). Weight and MUAC gain velocities were assessed by treatment phase and edema at admission using linear mixed-effects models. Results Among 400 children enrolled, the median (IQR) age was 15.0 (11.2;19.2) months, 58% were males, and 65% presented with edema. During inpatient therapeutic care (ITC), children with edema vs no edema at admission had negative weight gain velocity in the stabilization phase [differences at day 3 and 4 were − 11.26 (95% CI: − 20.73; − 1.79) g/kg/d and − 13.09 (95% CI: − 23.15; − 3.02) g/kg/d, respectively]. This gradually changed into positive weight gain velocity in transition and eventually peaked at 12 g/kg/d early in the rehabilitation phase, with no difference by edema status (P > 0.9). During outpatient therapeutic care (OTC), overall, weight gain velocity showed a decreasing trend over time (from 5 to 2 g/kg/d), [difference between edema and non-edema groups at week 2 was 2.1 (95% CI: 1.0;3.2) g/kg/d]. MUAC gain velocity results mirrored those of weight gain velocity [differences were − 2.30 (95% CI: − 3.6; − 0.97) mm/week at week 1 in ITC and 0.65 (95% CI: − 0.07;1.37) mm/week at week 2 in OTC]. Conclusions Weight and MUAC gain velocities among Ugandan children with complicated SAM showed an increasing trend during transition and early in the rehabilitation phase, and a decreasing trend thereafter, but, overall, catch-up growth was prolonged. Further research to establish specific cut-offs to assess weight and MUAC gain velocities during different periods of rehabilitation is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00428-0.
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Affiliation(s)
- Jolly G K Kamugisha
- Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. .,Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark.
| | - Betty Lanyero
- Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Harriet Nambuya-Lakor
- Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda.,Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark.,Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo building, Arvo Ylpön katu 34, FIN-33014 Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958, Frederiksberg C, Denmark
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9
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Nabukeera-Barungi N, Lanyero B, Grenov B, Friis H, Namusoke H, Mupere E, Michaelsen KF, Mølgaard C, Wiese M, Nielsen DS, Mohammed MK, Christensen VB, Rytter M. Thymus size and its correlates among children admitted with severe acute malnutrition: a cross-sectional study in Uganda. BMC Pediatr 2021; 21:1. [PMID: 33397296 PMCID: PMC7780382 DOI: 10.1186/s12887-020-02457-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Malnutrition continues to be a major cause of mortality and morbidity among children in resource limited settings. Children with severe acute malnutrition (SAM) experience severe thymus atrophy, possibly reflecting poor immune function. This immune dysfunction is responsible for the severe infections they experience which lead to mortality. Since their immune dysfunction is not fully understood and there has been a lapse in research in this field, more research is needed. Knowing the correlates of thymus size may help clinicians identify those with more severe atrophy who might have more severe immune impairment. We aimed to describe thymus size and its correlates at admission among children hospitalized with SAM. Methods This cross-sectional study involved children 6-59 months admitted with complicated SAM in Mulago National Referral Hospital. Well-nourished children from same communities were used as a community reference group for thymus size. At admission, thymus size was measured by ultrasound scan. Demographic, clinical and laboratory variables were identified at admission. A linear regression model was used to determine correlates of thymus size among children with SAM. Results Among 388 children with SAM, the mean age was 17±8.5 months and 58% were boys. The mean thymus size was 3.14 (95% CI 2.9; 3.4) cm2 lower than that of the 27 healthy community reference children (1.06 vs 4.2 cm2, p<0.001) when controlled for age. Thymus size positively correlated with current breastfeeding (0.14, 95% CI 0.01, 0.26), anthropometric measurements at admission (weight, length, mid-upper-arm circumference, weight-for-height Z scores and length-for-age Z scores) and suspected tuberculosis (0.12, 95% CI 0.01; 0.22). Thymus size negatively correlated with > 2 weeks duration of sickness (-0.10; 95% CI -0.19; -0.01). Conclusion The thymus is indeed a barometer for nutrition since all anthropometric measurements and breastfeeding were associated with bigger thymus. The immune benefits of breastfeeding among children with SAM is underscored. Children with longer duration of illness had a smaller thymus gland indicating that infections have a role in the cause or consequence of thymus atrophy.
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Affiliation(s)
- Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. .,Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark.
| | - Betty Lanyero
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark.,Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Hanifa Namusoke
- Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Maria Wiese
- Department of Food Science, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Dennis S Nielsen
- Department of Food Science, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Musemma K Mohammed
- Department of Food Science, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
| | - Vibeke B Christensen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, DK-2100, Copenhagen Ø, Denmark
| | - Maren Rytter
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
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10
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Castro-Mejía JL, O’Ferrall S, Krych Ł, O’Mahony E, Namusoke H, Lanyero B, Kot W, Nabukeera-Barungi N, Michaelsen KF, Mølgaard C, Friis H, Grenov B, Nielsen DS. Restitution of gut microbiota in Ugandan children administered with probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12) during treatment for severe acute malnutrition. Gut Microbes 2020; 11:855-867. [PMID: 31959047 PMCID: PMC7524335 DOI: 10.1080/19490976.2020.1712982] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Severe acute malnutrition (SAM) is a major challenge in low-income countries and gut microbiota (GM) dysbiosis may play a role in its etiology. Here, we determined the GM evolution during rehabilitation from SAM and the impact of probiotics (Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12) supplementation. The GM (16S rRNA gene amplicon sequencing) of children admitted to hospital with SAM showed distinct composition over admission (e.g. Klebsiella spp., and Enterobacteriaceae spp.), discharge (e.g. Clostridiaceae spp., Veilonella dispar) and follow-up (e.g. Lactobacillus ruminis, Blautia spp., Faecalibacterium prausnitzii), reaching similar β- and α-diversity as healthy individuals. Children with diarrhea had reduced distribution of Bacteroidaceae, Lachnospiraceae, increased Enterobacteriaceae and Moraxellaceae, and lower α-diversity. Children suffering from edematous SAM had diminished proportion of Prevotellaceae, Lachnospiraceae, Ruminoccaceae and a higher α-diversity when compared to non-edematous SAM. Supplementation of probiotics did not influence β-diversity upon discharge or follow-up, but it increased (p < .05) the number of observed species [SE: > 4.5]. Children where the probiotic species were detected had lower cumulative incidence (p < .001) of diarrhea during the follow-up period compared to children receiving placebo and children receiving probiotics, but where the probiotics were not detected. The GM of children with non-edematous and edematous SAM differ in composition, which might have implications for future GM targeted treatments. Probiotics treatment reduced the cumulative incidence of diarrhea during the outpatient phase, with the strongest effect in children where the administered probiotics could be detected in the GM.
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Affiliation(s)
- Josué L. Castro-Mejía
- Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark,CONTACT Josué L. Castro-Mejía Food Microbiology & Fermentation Section, Department of Food Science, University of Copenhagen, 1958Frederiksberg C, Denmark
| | - Sinéad O’Ferrall
- Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Łukasz Krych
- Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Elaine O’Mahony
- Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Hanifa Namusoke
- Mwanamugimu Nutrition Unit, Department of Paediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Betty Lanyero
- Mwanamugimu Nutrition Unit, Department of Paediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Witold Kot
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Dennis S. Nielsen
- Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
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11
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Otto SBJ, George PE, Mercedes R, Nabukeera-Barungi N. Cryptococcal meningitis and immune reconstitution inflammatory syndrome in a pediatric patient with HIV after switching to second line antiretroviral therapy: a case report. BMC Infect Dis 2020; 20:68. [PMID: 31964348 PMCID: PMC6974974 DOI: 10.1186/s12879-020-4797-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 07/27/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CCM) is a common and deadly disease among HIV-infected patients. Notable about CCM is its association with the immune reconstitution inflammatory syndrome (IRIS). Though it has been posited a switch from first to second-line antiretroviral therapy (ART) can induce CCM IRIS, a case presentation of CCM IRIS has not been published. CASE PRESENTATION A 10-year-old, HIV-infected girl who initially presented with severe headache and new-onset seizures, with cerebrospinal fluid that returned antigen, India Ink, and culture positive for Cryptococcus neoformans. Notably, 8 weeks prior to seizures, she had switched from first line to second-line ART (abacavir-lamivudine-efavirenz to zidovudine-lamivudine-lopinavir/ritonavir) due to virologic failure, with a viral load of 224,000 copies/milliliter. At time of seizures and 8 weeks on second-line ART, her viral load had reduced to 262 copies/milliliter. Her hospital course was prolonged, as she had ongoing headaches and developed bilateral cranial nerve VI palsies despite clearance of Cryptococcus from cerebrospinal fluid on antifungal therapy and therapeutic lumbar punctures. However, symptoms stabilized, and she was discharged with oral fluconazole. Cranial nerve palsies resolved 10 weeks post discharge and she has remained disease free. CONCLUSIONS We describe a case of CCM IRIS in a 10-year-old HIV infected child after changing to second-line ART. This case provides evidence that screening for cryptococcal antigenaemia prior to switch from first-line to second-line ART could be an important measure to prevent cryptococcal disease.
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Affiliation(s)
- Ssegujja Boniface Joseph Otto
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda.
| | - Paul E George
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Rebecca Mercedes
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda
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12
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Grenov B, Lanyero B, Nabukeera-Barungi N, Namusoke H, Ritz C, Friis H, Michaelsen KF, Mølgaard C. Diarrhea, Dehydration, and the Associated Mortality in Children with Complicated Severe Acute Malnutrition: A Prospective Cohort Study in Uganda. J Pediatr 2019; 210:26-33.e3. [PMID: 30992218 DOI: 10.1016/j.jpeds.2019.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/26/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess predictors of diarrhea and dehydration and to investigate the role of diarrhea in mortality among children with complicated severe acute malnutrition. STUDY DESIGN A prospective cohort study, nested in a probiotic trial, was conducted in children with complicated severe acute malnutrition. Children were treated according to World Health Organization and national guidelines, and diarrhea and dehydration were assessed daily. Multiple linear and log-linear Poisson regression models were used to identify predictors of days with diarrhea and dehydration, respectively, and multiple logistic regression was used to assess their role in mortality. RESULTS Among 400 children enrolled, the median (IQR) age was 15.0 months (11.2-19.2 months), 58% were boys, and 61% had caregiver-reported diarrhea at admission. During hospitalization, the median (range) number of days with diarrhea was 5 (0-31), the median duration of hospitalization was 17 days (1-69 days), and 39 (10%) died. Of 592 diarrhea episodes monitored, 237 were admission episodes and 355 were hospital acquired. During hospitalization, young age was associated with days with diarrhea, and young age and HIV infection were associated with dehydration. Both days with diarrhea and dehydration predicted duration of hospitalization as well as mortality. The odds of mortality increased by a factor of 1.4 (95% CI, 1.2-1.6) per day of diarrhea and 3.5 (95% CI, 2.2-6.0) per unit increase in dehydration score. CONCLUSIONS Diarrhea is a strong predictor of mortality among children with complicated severe acute malnutrition. Improved management of diarrhea and prevention of hospital-acquired diarrhea may be critical to decreasing mortality.
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Affiliation(s)
- Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
| | - Betty Lanyero
- Mwanamugimu Nutrition Unit, Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Hanifa Namusoke
- Mwanamugimu Nutrition Unit, Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Christian Ritz
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
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13
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Kiyaga C, Urick B, Fong Y, Okiira C, Nabukeera-Barungi N, Nansera D, Ochola E, Nteziyaremye J, Bigira V, Ssewanyana I, Olupot-Olupot P, Peter T, Ghadrshenas A, Vojnov L. Where have all the children gone? High HIV prevalence in infants attending nutrition and inpatient entry points. J Int AIDS Soc 2019; 21. [PMID: 29479861 PMCID: PMC6426069 DOI: 10.1002/jia2.25089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/30/2017] [Accepted: 02/08/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Despite notable progress towards PMTCT, only 50% of HIV‐exposed infants in sub‐Saharan Africa were tested within the first 2 months of life and only 30% of HIV‐infected infants are on antiretroviral treatment. This study assessed HIV prevalence in infants and children receiving care at various service entry points in primary healthcare facilities in Uganda. Methods A total of 3600 infants up to 24 months of age were systematically enrolled and tested at four regional hospitals across Uganda. Six hundred infants were included and tested from six facility entry points: PMTCT, immunization, inpatient, nutrition, outpatient and community outreach services. Findings The traditional EID entry point, PMTCT, had a prevalence of 3.8%, representing 19.6% of the total HIV‐positive infants identified in the study. Fifty percent of the 117 identified HIV‐positive infants were found in the nutrition wards, which had a prevalence of 9.8% (p < 0.001 compared to PMTCT). Inpatient wards had a prevalence of 3.5% and yielded 17.9% of the HIV‐positive infants identified. Infants tested at immunization wards and through outreach services identified 0.8% and 1.7% of the HIV‐positive infants respectively, and had a prevalence of less than 0.3%. Conclusions Expanding routine early infant diagnosis screening beyond the traditional PMTCT setting to nutrition and inpatient entry points will increase the identification of HIV‐infected infants. Careful reflection for appropriate testing strategies, such as maternal re‐testing to identify new HIV infections and HIV‐exposed infants in need of follow‐up testing and care, at immunization and outreach services should be considered given the expectedly low prevalence rates. These findings may help HIV care programmes significantly expand testing to improve access to early infant diagnosis and paediatric treatment.
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Affiliation(s)
| | | | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Emmanuel Ochola
- Department of HIV, Research and Documentation, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Julius Nteziyaremye
- Department of Paediatrics/Research Unit, Mbale Regional Referral Hospital, Busitema University, Mbale, Uganda
| | | | | | - Peter Olupot-Olupot
- Department of Paediatrics/Research Unit, Mbale Regional Referral Hospital, Busitema University, Mbale, Uganda
| | - Trevor Peter
- Clinton Health Access Initiative, Kampala, Uganda
| | | | - Lara Vojnov
- Clinton Health Access Initiative, Kampala, Uganda
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14
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Nabukeera-Barungi N, Grenov B, Friis H, Lanyero B, Namusoke H, Mupere E, Michaelsen KF, Mølgaard C, Christensen VB, Rytter MJ. Thymus gland size during recovery from complicated severe acute malnutrition: a prospective study of the role of probiotics. Paediatr Int Child Health 2019; 39:95-103. [PMID: 30382002 DOI: 10.1080/20469047.2018.1535871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Children with severe acute malnutrition (SAM) are prone to infections due to immune dysfunction including severe thymus atrophy which recovers during nutritional rehabilitation. Aim: To investigate predictors of thymus size recovery, including probiotics during nutritional rehabilitation of children admitted with complicated SAM. Methods: In this prospective study nested in a randomized controlled trial, children 6-59 months admitted with SAM received standard care and either probiotics or placebo during hospitalization until 8 weeks post-discharge. Thymus size was measured using ultrasound at admission, discharge, 8 weeks post-discharge and among 27 community controls. Predictors of thymus size recovery were assessed using linear regression. Results: Among 388 children with SAM, mean (SD) thymus size was 1.06 cm2 (0.41), 1.24 cm2 (0.48), 2.85 cm2 (1.07) and 4.2 cm2 (0.93) at admission, discharge, follow-up and in the healthy controls respectively (p < 0.05).Probiotics did not affect thymus recovery. During both inpatient therapeutic care (ITC) and outpatient therapeutic care (OTC), thymus recovery correlated positively with anthropometry but negatively with caregiver-perceived illness severity and Haemoglobin <8 g/dl. Negative predictors of thymus recovery during ITC included grade 3 oedema (β -0.13, 95%CI -0.25; -0.01), dermatosis (β -0.21, 95%CI -0.41; -0.01), C-reactive protein (CRP) >15mg/L (β -0.13, 95%CI -0.25; -0.02) and neutrophils (β -0.01, 95%CI -0.02; -0.002). During OTC, HIV negatively predicted thymus recovery. Conclusion: Children with SAM failed to regain thymus size at 8 weeks post-discharge. Probiotics did not predict thymus recovery during nutritional rehabilitation. More research is needed to find interventions which can accelerate immune recovery. Abbreviations: ART, Antiretroviral therapy; BB-12, Bifidobacterium animalis subsp. Lactis; CRP, C-reactive protein; ITC, inpatient therapeutic care; LGG, Lactobacillus rhamnosus; MNU, Mwanamugimu Nutrition Unit; MUAC, mid-upper arm circumference; OTC, outpatient therapeutic care; PCR, Polymerised chain reaction; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition; VAS, visual analogue score; WHO, World Health Organization; WHZ, weight-for-height score.
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Affiliation(s)
- Nicolette Nabukeera-Barungi
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark.,b Department of Paediatrics and Child Health, College of Health Sciences , Makerere University , Kampala , Uganda
| | - Benedikte Grenov
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - Henrik Friis
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - Betty Lanyero
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark.,c Mwanamugimu Nutrition Unit, Department of Paediatrics , Mulago National Referral Hospital , Kampala , Uganda
| | - Hanifa Namusoke
- c Mwanamugimu Nutrition Unit, Department of Paediatrics , Mulago National Referral Hospital , Kampala , Uganda
| | - Ezekiel Mupere
- b Department of Paediatrics and Child Health, College of Health Sciences , Makerere University , Kampala , Uganda
| | - Kim F Michaelsen
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - Christian Mølgaard
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
| | - Vibeke B Christensen
- d Department of Paediatrics and Adolescent Medicine , Rigshospitalet , Copenhagen , Denmark
| | - Maren Johanne Rytter
- a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark
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15
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Nakiriba R, Mayega RW, Piloya T, Nabukeera-Barungi N, Idro R. Prevalence and factors associated with dysglycemia among girls in selected boarding secondary schools in Wakiso District, Uganda. Adolesc Health Med Ther 2018; 9:167-176. [PMID: 30464672 PMCID: PMC6211585 DOI: 10.2147/ahmt.s178746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is limited information on dysglycemia in adolescents in low-income countries. The objective of this study was to determine the prevalence and factors associated with dysglycemia among boarding secondary school adolescent girls in a peri-urban district. METHODS The design was a cross-sectional survey. A total of 688 adolescents from four randomly selected girls-only boarding secondary schools in Wakiso District, Uganda, participated in this study. Fasting plasma glucose, body mass index (BMI), and blood pressure (BP) were measured. A questionnaire was used to assess demographic and lifestyle factors. Suspected dysglycemia was defined using the American Diabetes Association cutoff of fasting glucose ≥5.6 mmol/L. Overweight and hypertension were defined being above two SDs or the 95th percentile of the WHO BMI for age and BP for age reference charts, respectively. Logistic regression was used to determine the factors independently associated with dysglycemia. RESULTS The mean age of the participants was 15.4 years (SD=1.7 years). Probable dysglycemia was found in 44 of 688 (6.4%) participants, ranging from 3.5% in the least affluent school to 9.8% in the most affluent school. No case of type 2 diabetes was found. 11.6% of the participants were found to have probable hypertension. Dysglycemia was higher in adolescents who were overweight (adjusted OR [AOR] 2.3; 95% CI 1.22-4.48), those with hypertension (AOR 4.0; 95% CI 1.86-8.45), and those who frequently stocked biscuits (AOR 3.0; 95% CI 1.21-7.28). Dysglycemia was lower in older adolescents (AOR 0.3; 95% CI 0.10-0.86) and those who took water with meals (AOR 3.0; 95% CI 1.21-7.28). CONCLUSION In these predominantly peri-urban boarding secondary schools, 6.4% of the adolescent girls have probable dysglycemia. As Africa undergoes the epidemiological transition, there is a need for closer surveillance for diabetes and hypertension in peri-urban schools and school health measures against lifestyle diseases.
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Affiliation(s)
- Rhoda Nakiriba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda,
| | - Thereza Piloya
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Mustapha M, Musiime V, Bakeera-Kitaka S, Rujumba J, Nabukeera-Barungi N. Utilization of "prevention of mother-to-child transmission" of HIV services by adolescent and young mothers in Mulago Hospital, Uganda. BMC Infect Dis 2018; 18:566. [PMID: 30428835 PMCID: PMC6236935 DOI: 10.1186/s12879-018-3480-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 10/25/2017] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of mother to child transmission (PMTCT) has lowered the incidence of paediatric HIV globally. The risk of mother-to-child transmission of HIV (MTCT) remains high in Africa, where there is a high prevalence of pregnancy and poor health-seeking behaviour among young girls and women. METHODS In this cross-sectional, mixed-methods study, we evaluated the utilization of PMTCT services and associated factors among adolescent and young postpartum mothers aged 15 to 24 years at a public urban referral hospital in Uganda. Both HIV-positive and HIV-negative participants were recruited. Utilization of PMTCT services was defined as use of the PMTCT cascade of services including ever testing for HIV, receiving HIV test results; If tested negative, subsequent retesting up to 14 weeks; If tested positive, Antiretroviral drugs (ARVs) for the mother, ARVs and septrin prophylaxis for infant, safe delivery, safer infant feeding, early infant diagnosis within 6 weeks, and linkage to treatment and care. Optimal utilization of PMTCT was defined as being up to date with utilization of PMTCT services for reported HIV status at the time of being interviewed. The overall proportion of participants who optimally utilized PMTCT services was determined using descriptive statistics. Qualitative data was analyzed manually using the content thematic approach. RESULTS Of the 418 participants, 65 (15.5%) were HIV positive. Overall, only 126 of 418 participants (30.1%) had optimally utilized PMTCT services. However, utilization of PMTCT services was better among HIV positive mothers, with 83% (54/65) having utilized the services optimally, compared to only 20% (72/353) of the HIV negative mothers (OR 18.2 (95% CI; 9.0-36.7)). The benefits of knowing ones HIV status, health of the unborn child, and counseling and support from health workers and peers, were the major factors motivating adolescent and young mothers to utilize PMTCT services, while stigma, financial constraints, non-disclosure, and lack of partner and family support were key demotivating factors. CONCLUSION Utilization of PMTCT services by these adolescent and young mothers was suboptimal. Special consideration should be given to adolescents and young women in the design of elimination of mother to child transmission (EMTCT) programs, to improve the utilization of PMTCT services.
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Affiliation(s)
- Mariama Mustapha
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
| | - Sabrina Bakeera-Kitaka
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Lanyero B, Namusoke H, Nabukeera-Barungi N, Grenov B, Mupere E, Michaelsen KF, Mølgaard C, Christensen VB, Friis H, Briend A. Transition from F-75 to ready-to-use therapeutic food in children with severe acute malnutrition, an observational study in Uganda. Nutr J 2017; 16:52. [PMID: 28854929 PMCID: PMC5577749 DOI: 10.1186/s12937-017-0276-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 06/06/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND World Health Organization now recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM). We described the transition from F-75 to RUTF and identified correlates of failed transition. METHODS We conducted an observational study among children aged 6-59 months treated for SAM at Mulago hospital, Kampala, Uganda. Therapeutic feeding during transition phase was provided by first offering half of the energy requirements from RUTF and the other half from F-75 and then increasing gradually to RUTF as only energy source. The child was considered to have successfully transitioned to RUTF if child was able to gradually consume up to 135 kcal/kg/day of RUTF in the transition phase on first attempt. Failed transition to RUTF included children who failed the acceptance test or those who had progressively reduced RUTF intake during the subsequent days. Failure also included those who developed profuse diarrhoea or vomiting when RUTF was ingested. RESULTS Among 341 of 400 children that reached the transition period, 65% successfully transitioned from F-75 to RUTF on first attempt while 35% failed. The median (IQR) duration of the transition period was 4 (3-8) days. The age of the child, mid-upper arm circumference, weight-for-height z-score and weight at transition negatively predicted failure. Each month increase in age reflected a 4% lower likelihood of failure (OR 0.96 (95% CI 0.93; 0.99). Children with HIV (OR 2.73, 95% CI 1.27; 5.85) and those rated as severely ill by caregiver (OR 1.16, 95% CI: 1.02; 1.32) were more likely to fail. At the beginning of the rehabilitation phase, the majority (95%) of the children eventually accepted RUTF while only 5% completed rehabilitation in hospital on F-100. CONCLUSION Transition from F-75 to RUTF for hospitalized children with SAM by gradual increase of RUTF was possible on first attempt in 65% of cases. Younger children, severely wasted, HIV infected and those with severe illness as rated by the caregiver were more likely to fail to transit from F-75 to RUTF on first attempt.
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Affiliation(s)
- Betty Lanyero
- Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
| | - Hanifa Namusoke
- Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Kim Fleischer Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
| | | | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958 Frederiksberg C, DK Denmark
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Lääkärinkatu 1, 33014 Tampere, Finland
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Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E, Musinguzi J, Atuyambe L, Tumwesigye N. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis 2015; 15:520. [PMID: 26573923 PMCID: PMC4647509 DOI: 10.1186/s12879-015-1265-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 11/25/2022] Open
Abstract
Background Adolescents have gained increased attention because they are the only age group where HIV related mortality is going up. We set out to describe the level and factors associated with adherence to antiretroviral therapy (ART) as well as the 1 year retention in care among adolescents in 10 representative districts in Uganda. In addition, we explored the barriers and facilitators of adherence to ART among adolescents. Methods The study involved 30 health facilities from 10 representative districts in Uganda. We employed both qualitative and quantitative data collection methods in convergent design. The former involved Focus group discussions with adolescents living with HIV, Key informant interviews with various stakeholders and in depth interviews with adolescents. The quantitative involved using retrospective records review to extract the last recorded adherence level from all adolescents who were active in HIV care. Factors associated with adherence were extracted from the ART cards. For the 1 year retention in care, we searched the hospital records of all adolescents in the 30 facilities who had started ART 1 year before the study to find out how many were still in care. Results Out of 1824 adolescents who were active on ART, 90.4 % (N = 1588) had ≥95 % adherence recorded on their ART cards at their last clinic visit. Only location in rural health facilities was independently associated with poor adherence to ART (P = 0.008, OR 2.64 [1.28 5.43]). Of the 156 adolescents who started ART, 90 % (N = 141) were still active in care 1 year later. Stigma, discrimination and disclosure issues were the most outstanding of all barriers to adherence. Other barriers included poverty, fatigue, side effects, pill burden, depression among others. Facilitators of adherence mainly included peer support groups, counseling, supportive health care workers, short waiting time and provision of food and transport. Conclusion Adherence to ART was good among adolescents. Being in rural areas was associated with poor adherence to ART and 1 year retention in care was very good among adolescents who were newly started on ART. Stigma and disclosure issues continue to be the main barriers to adherence among adolescents.
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Affiliation(s)
- Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, P O Box 7062, Kampala, Uganda.
| | - Peter Elyanu
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | - Barbara Asire
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | | | - Ivan Lukabwe
- AIDS Control Program, Ministry of Health, Kampala, Uganda.
| | | | | | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Nathan Tumwesigye
- USAID SUSTAIN Project, University Research Co., LLC, Kampala, Uganda.
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Nabukeera-Barungi N, Wilmshurst J, Rudzani M, Nuttall J. Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital. Afr Health Sci 2014; 14:143-9. [PMID: 26060471 PMCID: PMC4449047 DOI: 10.4314/ahs.v14i1.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Early diagnosis and prompt treatment are vital in effective treatment. We set out to describe experiences in the management and immediate outcome of TBM a tertiary-level children's hospital in a high HIV and tuberculosis co-infection setting. METHODS This retrospective study included children who were diagnosed with TBM in the year 2009. A pre-coded questionnaire was used to extract data on presentation, diagnostics, treatment and outcome at the time of hospital discharge. Data was analyzed using STATA statistical package (StataCorp, Version 11). RESULTS Of the 40 children diagnosed with TBM, 6 (15%) had definitive TBM, 17 (42.5%) had probable TBM and 17 (42.5%) had possible TBM. The cerebrospinal fluid (CSF) chemistry and cells were abnormal in 39/40 (98%). Mantoux test was reactive in 16/29 (55%) and 17/30 (57%) had Chest X-rays suggestive of tuberculosis. Only 3/21 (14%) had positive sputum tuberculosis culture and 89% (32/36) had neuro-imaging abnormalities. Outcome at discharge was; 8% died, 49% improved with neurological sequelae and 43% improved without sequelae. Having TBM stage 3 at admission was associated with mortality (p=0.001). CONCLUSIONS Most children had early diagnosis of TBM and mortality was lower than in previous studies. We recommend a larger prospective study to further understand the outcome of TBM.
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Affiliation(s)
| | - Jo Wilmshurst
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
| | - Muloiwa Rudzani
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
| | - James Nuttall
- Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town
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Nabukeera-Barungi N, Kalyesubula I, Kekitiinwa A, Byakika-Tusiime J, Musoke P. Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala. ACTA ACUST UNITED AC 2013; 27:123-31. [PMID: 17565809 DOI: 10.1179/146532807x192499] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [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: 10/31/2022]
Abstract
BACKGROUND Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala. AIM To determine the levels of adherence to HAART and identify factors associated with non-adherence. METHODS A cross-sectional study of 170 children aged 2-18 years. Adherence to HAART was defined as taking > or =95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2-3 weeks later. RESULTS The 3-day self-reported > or =95% adherence was 89.4% (n=170). Using clinic-based pill counts, 94.1% (n=170) had > or =95% adherence to treatment compared with only 72% (n=164) by unannounced pill counts. When the primary caregiver was the only one who knew the child's serostatus, he/she was three times more likely to be non-adherent (p=0.02, OR 3.34, 95% CI 1.14-9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have > or =95% adherence (p=0.02, OR 0.44, 95% CI 0.20-0.92). CONCLUSION The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child's HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum MALARIA in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 2013; 88:747-756. [PMID: 23358640 PMCID: PMC3617864 DOI: 10.4269/ajtmh.12-0668] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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] [Indexed: 11/07/2022] Open
Abstract
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Walter H. Dzik
- *Address correspondence to Walter H. Dzik, Department of Pathology, Blood Transfusion Service, J224, Harvard University, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail:
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Cytoadherence in paediatric malaria: ABO blood group, CD36, and ICAM1 expression and severe Plasmodium falciparum infection. Br J Haematol 2012; 159:223-36. [PMID: 22909232 PMCID: PMC3470923 DOI: 10.1111/bjh.12014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
Abstract
As a leading cause of childhood mortality worldwide, selection pressure by Plasmodium falciparum continues to shape the human genome. Severe disturbances within the microcirculation result from the adhesion of infected erythrocytes to host receptors on monocytes, platelets, and endothelium. In this prospective study, we compared expression of all major host cytoadhesion receptors among Ugandan children presenting with uncomplicated malaria (n = 1078) versus children with severe malaria (n = 855), including cerebral malaria (n = 174), severe anaemia (n = 522), and lactic acidosis (n = 154). We report a significant survival advantage attributed to blood group O and increased monocyte expression of CD36 and ICAM1 (CD54). The high case fatality rate syndromes of cerebral malaria and lactic acidosis were associated with high platelet CD36 expression and thrombocytopenia, and severe malaria anaemia was characterized by low ICAM1 expression. In a logistic regression model of disease severity, odds ratios for the mitigating effects of blood group O, CD36, and ICAM1 phenotypes were greater than that of sickle haemoglobin. Host genetic adaptations to Plasmodium falciparum suggest new potential malaria treatment strategies.
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Nazziwa R, Sekadde M, Kanyike F, Wobudeya E, Nabukeera-Barungi N. Efavirenz poisoning in a 12 year old HIV negative African boy. Pan Afr Med J 2012; 12:86. [PMID: 23077707 PMCID: PMC3473972] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/17/2012] [Indexed: 11/07/2022] Open
Abstract
Efavirenz is an oral antiretroviral drug in the class of non nucleoside reverse transcriptase inhibitors. Toxicity at therapeutic doses has been documented but there is scarcity of data on presentation and management of Efavirenz overdose. We describe a case of Efavirenz poisoning in a 12-year old HIV Negative African boy with a very unique presentation after ingesting 3 grams of Efavirenz as a single dose. The most prominent problems were burning sensation in the throat immediately after ingestion then visual impairment one hour later then tremors, screaming at night and motor deficits in lower limbs for 5 days before admission. His medical history, physical exam and investigations revealed no other cause of his presentation other than the EFV. Unfortunately, it was not possible to do EFV levels. He was given supportive treatment and 10 days later he was completely well.
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Affiliation(s)
- Rose Nazziwa
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda
| | - Moorine Sekadde
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda
| | - Francis Kanyike
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda
| | - Eric Wobudeya
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda,Corresponding author: Nicolette Nabukeera-Barungi, Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Uganda
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Nabukeera-Barungi N, Mworozi E. Sudden onset methaemoglobinaemia in a previously well Ugandan child: a case report and literature review. Pan Afr Med J 2012; 11:49. [PMID: 22593785 PMCID: PMC3343677] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 01/23/2012] [Indexed: 11/16/2022] Open
Abstract
Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limited settings are very rare but clinical signs can be a good guide. We set out to describe a case of Methaemoglobinaemia, raise awareness among practitioners in resource limited settings and to share experiences in its diagnosis and management. A previously well three and a half year old girl was admitted with central cyanosis of sudden onset. She underwent clinical, laboratory and radiological evaluation. Having been in a resource limited setting, the process of making a diagnosis was slow and difficult. After the diagnosis, the treatment was not available in the country but we managed to get it all the way from Nairobi, Kenya. A diagnosis of Methaemoglobinaemia was made using Spectrophotometry and she was successfully treated using 2 doses of intravenous Methylene blue. The cause of Methaemoglobinaemia was established to have been nitrites from food preservatives.
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Affiliation(s)
- Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Kampala, Uganda,Corresponding author: Nicolette Nabukeera-Barungi, Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Kampala, Uganda
| | - Edison Mworozi
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences and Mulago National Referral Hospital, Kampala, Uganda
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Bakeera-Kitaka S, Nabukeera-Barungi N, Nöstlinger C, Addy K, Colebunders R. Sexual risk reduction needs of adolescents living with HIV in a clinical care setting. AIDS Care 2008; 20:426-33. [PMID: 18449819 DOI: 10.1080/09540120701867099] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As anti-retroviral therapy becomes increasingly available, young people living with HIV need tailored support to adopt healthy sexual behaviors. There has been a gap in the availability of culturally appropriate techniques for secondary prevention and sexual risk reduction in this target group. This formative study assessed sexual and reproductive health needs and problems, as well as determinants of sexual risk-taking among young people living with HIV aged 11-21 years attending the Paediatric Infectious Disease Clinic in Kampala, Uganda. Theoretical guidance was provided by the Information-Motivation-Behavioral Skills Model. Socio-demographic and selected psychosexual data were assessed using a brief anonymous questionnaire. A total of 75 young people living with HIV participated in eight focus group discussions. In addition, one focus group was conducted with adult key informants (service providers). About a quarter of the young participants reported prior or current sexual experience. The study revealed knowledge gaps relating to reproductive health, HIV transmission, and contraceptive methods. Motivations for protection included hope for the future, good counseling, and fear of the consequences of sexual activity such as unwanted pregnancies. Barriers to adopting preventive behaviors included peer pressure, poverty, HIV-related stigma, ignorance of their partners, alcohol use, and a desire to have children for the older ones. Young sero-positive people in this setting lacked specific behavioral skills, such as disclosure of HIV status to their sexual partners, this being closely linked to fear of rejection and stigma. HIV-positive youths need support in developing the appropriate behavioral skills to adopt healthy sexual behaviors. Interventions in this field need to be developmentally appropriate and tailored to young people's specific needs. Structural interventions should at the same time address and reduce HIV-related stigma and socio-economic needs of young people living with HIV.
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Affiliation(s)
- Sabrina Bakeera-Kitaka
- Makerere University, Faculty of Medicine, Department of Paediatrics and Child Health, Kampala, Uganda.
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