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Institution

Makerere University

EducationKampala, Uganda
About: Makerere University is a education organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Acquired immunodeficiency syndrome (AIDS). The organization has 7220 authors who have published 12405 publications receiving 366520 citations. The organization is also known as: Makerere University Kampala & MUK.


Papers
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Journal ArticleDOI
27 Nov 2009-AIDS
TL;DR: In Rakai, Uganda, subtype A viruses have a significantly higher rate of heterosexual transmission than subtype D viruses, which may contribute to subtype-specific HIV epidemics in sub-Saharan Africa.
Abstract: Objective: To determine whether heterosexual transmission of HIV differs according to HIV-1 subtype. Design: A retrospective observational cohort. Methods: HIV-1 subtype effects on heterosexual HIV-1 transmission were determined among268 HIV-discordant couples retrospectively identified from a population cohort in Rakai, Uganda. HIV-1 subtype (gag and gp41 sequencing and multiregion hybridization assay) andviral loads (reversetranscriptase PCR) were determined. Adjusted incidence rate ratios (adj IRR) of HIV transmission by subtype were estimated by multivariable Poisson regression adjusting for characteristics of index HIV-positive and HIV-negative partners. Results: Adjusting for index HIV-positive partners' age, viral load, stage of disease, genital ulcer disease, and HIV-negative partners' genital ulcer disease and nonuse of condoms, subtype A viruses were associated with a higher rate of transmission than subtype D [adj.IRR 1.98, 95% confidence interval (CI) 1.17-3.34], but no differences in transmission were observed between recombinant viruses and subtype D (aIRR 1.53, P=0.25). Index-positive partners' age less than 30 years (adj.IRR 3.44, 95% CI 1.75-6.78) and viral load (adj.IRR 2.37, 95% CI 1.75-3.21), and index-negative partners' genital ulcer disease (adj.IRR 1.71, 95% CI 1.08―2.70) and nonuse of condoms (adj.IRR 1.94, 95% CI 1.15-3.28) were significant determinants of HIV transmission. Conclusion: In Rakai, Uganda, subtype A viruses have a significantly higher rate of heterosexual transmission than subtype D viruses. Differential subtype transmission efficiency may be important for HIV vaccine evaluation and could contribute to subtype-specific HIV epidemics in sub-Saharan Africa.

95 citations

Journal ArticleDOI
TL;DR: Village volunteers will distribute pre‐packed antimalarials free of charge to caretakers of febrile children 2’months to 5’years (‘Homapaks’).
Abstract: BACKGROUND The Ugandan Ministry of Health has adopted the WHO Home Based Fever Management strategy (HBM) to improve access to antimalarial drugs for prompt (<24 h) presumptive treatment of all fevers in children under 5 years. Village volunteers will distribute pre-packed antimalarials free of charge to caretakers of febrile children 2 months to 5 years ('Homapaks'). OBJECTIVE To explore the local understanding and treatment practices for childhood fever illnesses and discuss implications for the HBM strategy. METHODS Focus Group Discussions were held with child caretakers in three rural communities in Kasese district, West Uganda, and analysed for content in respect to local illness classifications and associated treatments for childhood fevers. RESULTS Local understanding of fever illnesses and associated treatments was complex. Some fever illness classifications were more commonly mentioned, including 'Fever of Mosquito', 'Chest Problem', 'the Disease', 'Stomach Wounds' and 'Jerks', all of which could be biomedical malaria. Although caretakers refer to all these classifications as 'fever' treatment differed; some were seen as requiring urgent professional western treatment and others were considered severe but 'non-western' and would preferentially be treated with traditional remedies. CONCLUSIONS The HBM strategy does not address local community understanding of 'fever' and its influence on treatment. While HBM improves drug access, Homapaks are likely to be used for only those fevers where 'western' treatment is perceived appropriate, implying continued delayed and under-treatment of potential malaria. Hence, HBM strategies also need to address local perceptions of febrile illness and adapt information and training material accordingly.

95 citations

Journal ArticleDOI
TL;DR: There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya and the most important causes are diseases that are preventable with available public health programs.
Abstract: Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya. We recruited all children with and without seizures, aged 0–13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint), was modelled from a census data. Seizures were reported in 900/4,921(18.3%) incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0–13 years was 425 (95%CI 386, 466) per 100,000/year and was 879 (95%CI 795, 968) per 100,000/year in children <5 years. This incidence data may however be an underestimate of the true incidence in the community. Over 80% of the seizures were associated with infections. Neonatal infections (28/43 [65.1%]) and falciparum malaria (476/821 [58.0%]) were the main diseases associated with seizures in neonates and in children six months or older respectively. Falciparum malaria was also the main illness (56/98 [57.1%]) associated with status epilepticus. Other illnesses associated with seizures included pyogenic meningitis, respiratory tract infections and gastroenteritis. Twenty-eight children (3.1%) with seizures died and 11 surviving children (1.3%) had gross neurological deficits on discharge. Status epilepticus, focal seizures, coma, metabolic acidosis, bacteraemia, and pyogenic meningitis were independently associated with mortality; while status epilepticus, hypoxic ischaemic encephalopathy and pyogenic meningitis were independently associated with neurological deficits on discharge. There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.

95 citations

Journal ArticleDOI
TL;DR: CSF centrifugation optimizes the diagnostic performance of Xpert in the detection of TBM, and a combination of culture and Xpert detected the largest number of cases.
Abstract: Introduction TB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert MTB/RIF (Xpert) as the initial TBM diagnostic test, based on two studies reporting suboptimal sensitivity (~50–60%).

95 citations

Journal ArticleDOI
TL;DR: Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania.
Abstract: Background: Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007. Methods: A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality. Results: Children who lived in homes with networked distance >5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02-1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11-8.40), death of preceding sibling (HR=1.9; 95% CI 1.37-2.65), and twin birth (HR=2.9; 95% CI 2.27-3.74) were the strongest independent predictors of child mortality. Conclusions: Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania. Keywords: child mortality; Health and Demographic Surveillance System; health facility; distance; Tanzania (Published: 9 November 2012) Citation: Glob Health Action 2012, 5 : 19099 - http://dx.doi.org/10.3402/gha.v5i0.19099

94 citations


Authors

Showing all 7286 results

NameH-indexPapersCitations
Pete Smith1562464138819
Joy E Lawn10833055168
Philip J. Rosenthal10482439175
William M. Lee10146446052
David R. Bangsberg9746339251
Daniel O. Stram9544535983
Richard W. Wrangham9328829564
Colin A. Chapman9249128217
Ronald H. Gray9252934982
Donald Maxwell Parkin8725971469
Larry B. Goldstein8543436840
Paul Gepts7826319745
Maria J. Wawer7735727375
Robert M. Grant7643726835
Jerrold J. Ellner7634717893
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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
202343
202289
20211,200
20201,120
2019900
2018790