Makerere University

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

Influences on uptake of reproductive health services in Nsangi community of Uganda and their implications for cervical cancer screening

Abstract: Cervical cancer is the most common female cancer in Uganda. Over 80% of women diagnosed or referred with cervical cancer in Mulago national referral and teaching hospital have advanced disease. Plans are underway for systematic screening programmes based on visual inspection, as Pap smear screening is not feasible for this low resource country. Effectiveness of population screening programmes requires high uptake and for cervical cancer, minimal loss to follow up. Uganda has poor indicators of reproductive health (RH) services uptake; 10% postnatal care attendance, 23% contraceptive prevalence, and 38% skilled attendance at delivery. For antenatal attendance, attendance to one visit is 90%, but less than 50% for completion of care, i.e. three or more visits. We conducted a qualitative study using eight focus group discussions with a total of 82 participants (16 men, 46 women and 20 health workers). We aimed to better understand factors that influence usage of available reproductive health care services and how they would relate to cervical cancer screening, as well as identify feasible interventions to improve cervical cancer screening uptake. Barriers identified after framework analysis included ignorance about cervical cancer, cultural constructs/beliefs about the illness, economic factors, domestic gender power relations, alternative authoritative sources of reproductive health knowledge, and unfriendly health care services. We discuss how these findings may inform future planned screening programmes in the Ugandan context. Knowledge about cervical cancer among Ugandan women is very low. For an effective cervical cancer-screening programme, awareness about cervical cancer needs to be increased. Health planners need to note the power of the various authoritative sources of reproductive health knowledge such as paternal aunts (Sengas) and involve them in the awareness campaign. Cultural and economic issues dictate the perceived reluctance by men to participate in women's reproductive health issues; men in this community are, however, potential willing partners if appropriately informed. Health planners should address the loss of confidence in current health care units, as well as consider use of other cervical cancer screening delivery systems such as mobile clinics/camps.

Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children

Abstract: Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children. We concurrently followed 300 HIV-infected children aged 1-10 years and a community-based cohort of 561 healthy children aged 1-11 years over 11 months in Kampala Uganda. The HIV-infected children received TMP/SMX prophylaxis and insecticide treated bednets. In the community cohort insecticide-treated bednets were introduced during the observation period. Children from both cohorts were followed using a standardized protocol to measure the incidence of malaria. Only nine episodes of malaria were diagnosed among HIV-infected children (incidence = 0.07/person-year) in comparison with 440 episodes among children from the community (incidence = 0.90/person-year; P less than 0.0001). The use of insecticide-treated bednets was associated with a 43%reduction in malaria incidence (P less than 0.001) and a combination of TMP/SMX and use of insecticide-treated bednets with a 97%reduction in malaria incidence (P less than 0.001). The prevalence of five mutations associated with antifolate resistance was high among malaria cases detected in both the HIV(100%)and community cohorts (75%). Malaria accounted for only 4% of febrile episodes in the HIV cohort in comparison with 33% in the community-based cohort (P less than 0.0001). In a malaria endemic area with a high level of molecular markers of antifolate resistance the combined use of TMP/SMX prophylaxis and insecticide-treated bednets was associated with a dramatic reduction in malaria incidence among HIV-infected children. (authors)

Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda.

Abstract: Background : Complications of rheumatic heart disease are associated with severe morbidity and mortality in developing countries where the disease prevalence remains high. Due to lack of screening services, many patients present late, with severe valve disease. In Uganda, the disease and its complications are still not well studied. Objective : To profile and describe cardiovascular complications in newly diagnosed rheumatic heart disease patients attending the Mulago National Referral Hospital in Uganda. Methods : This was a cross-sectional study where consecutive, newly diagnosed rheumatic heart disease patients were assessed and followed up for complications, such as heart failure, pulmonary hypertension, atrial fibrillation, recurrence of acute rheumatic fever, and stroke. Results : A total of 309 (115 males and 196 females) definite rheumatic heart disease patients aged 15-60 years were enrolled in the study and analysed. Complications occurred in 49% (152/309) of the newly diagnosed rheumatic heart disease cases, with heart failure (46.9%) the most common complication, followed by pulmonary arterial hypertension (32.7%), atrial fibrillation (13.9%), recurrence of acute rheumatic fever (11.4%), infective endocarditis (4.5%) and stroke (1.3%). Atrial fibrillation and acute rheumatic fever were the most common complications associated with heart failure. Conclusion : In this study we found that about 50% of newly diagnosed rheumatic heart disease patients in Uganda presented with complications. Heart failure and pulmonary arterial hypertension were the most commonly observed complications.

Relationship of immunodiagnostic assays for tuberculosis and numbers of circulating CD4+ T-cells in HIV infection

Abstract: Infection with HIV is the greatest risk factor for tuberculosis (TB) in Africa. Tuberculin skin test (TST), QuantiFERON-TB Gold In-Tube (QFT-G-IT) and T-Spot.TB assays were performed in newly diagnosed HIV-infected individuals with and without active TB and in HIV-uninfected subjects at a university outpatient clinic in Kampala, Uganda. A total of 135 individuals were enrolled: 109 with a new diagnosis of HIV-1 infection but no active TB, 19 with HIV-1 infection and active TB, and seven HIV-uninfected healthy subjects. In control subjects immune responses were positive in 57.2% by TST and in 100% by at least one interferon-gamma release assay. In HIV-1 infected patients without active TB, induration in the TST (mm) (rho = 0.41, p-value <0.0001) and concentration of interferon (IFN)-gamma in the QFT-G-IT tube with Mycobacterium tuberculosis-specific antigens (rho = 0.38; p = 0.0001) were negatively correlated to numbers of circulating CD4+ T-cells, while numbers of IFN-gamma producing cells (rho = 0.03-0.13; p-value = 0.21-0.77) and frequencies of positive test results for the T-Spot.TB test among groups of patients with different levels of immunodeficiency remained constant (p-value = 0.46). In HIV-1 infection, TST and QFT-G-IT immune responses are both strongly related to the degree of immunodeficiency, while results of the T-Spot.TB are independent of the level of CD4+ T-cell depletion.

Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality.

Abstract: Acute kidney injury (AKI) is a common complication of severe malaria (SM) in adults, affecting up to 40% of patients [1, 2]. In the absence of appropriate renal replacement therapy (RRT), the case fatality rate approaches 75% [1, 2]. Clinically and pathologically, AKI in adults with SM resembles acute tubular necrosis with oliguria in 60%–70% of cases [3]. Prompt initiation of RRT has been associated with reduction in malaria-associated AKI in adults [2]. It is recognized that children presenting to hospital with SM and AKI are at increased risk of death [4–7, 8 ]; however, estimates of the incidence of AKI in children with SM are limited with prior studies using measurements of urine output, which may be insensitive to mild to moderate AKI, or single estimates of creatinine (Cr) or blood urea nitrogen (BUN), which may not capture the extent of AKI over time in children with SM and may miss small changes in kidney function that are now known to be associated with less favorable outcomes [9]. Better estimates of the incidence of AKI and the morbidity and mortality associated with AKI in African children with SM are needed. There is increasing evidence that even small changes in kidney function are associated with increased morbidity, mortality, and risk of developing chronic kidney disease (CKD) [10]. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend broadening the definition of AKI to encompass acute changes in renal function, including patients with functional impairments relative to physiological demands [10]. In clinical settings, kidney function is assessed using the glomerular filtration rate (GFR) and/or urine output [10]. Glomerular filtration rate is estimated using filtration marker Cr. Data from a meta-analysis suggest that filtration marker cystatin C (CysC) may be an earlier marker of AKI than Cr [11]. Cystatin C is a 13-kDa nonglycosylated cysteine protease inhibitor produced by nucleated cells, filtered by the renal glomeruli, and reabsorbed and catabolized by proximal tubular cells [12]. Cystatin C is less subject to the effects of age, sex, and race than Cr [13, 14], making it an attractive biomarker of kidney functional status. Elevated CysC has been described in pediatric [15] and adult populations with Plasmodium falciparum infection [12]. Cystatin C has also been identified as a prognostic marker in critically ill children [16]. In this study, we evaluated the incidence and outcome of AKI in Ugandan children with SM enrolled in a clinical trial evaluating inhaled nitric oxide (iNO) as an adjunctive therapy to intravenous artesunate [17]. We also investigated the relationship between kidney biomarkers, AKI, and mortality.