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.

Neurocognitive and Motor Deficits in HIV-Infected Ugandan Children With High CD4 Cell Counts

Abstract: Human immunodeficiency virus (HIV) has been shown to cause both cognitive and motor dysfunction in perinatally infected children [1–4]. Severe compromise of the immune system from HIV is associated with high rates of neurodevelopmental disability [5], but little is known about the function of HIV-infected children before they have experienced a significant decrease in CD4 lymphocyte cell counts. Studies of neurodevelopmental function in HIV-infected African children have been small and have generated conflicting results [6–9]. One report of 26 Congolese HIV-infected school-aged children demonstrated cognitive, language, and motor impairment using the first-edition Kaufman Assessment Battery for Children (KABC), compared with HIV-uninfected exposed and control children [10]. In contrast, Bagenda et al [11] reported no significant impairment among 28 HIV-infected ART-naive Ugandan school children, except in one KABC subscale of hand movements and in the Wide Range Achievement Test - Third Edition of academic achievement. Neither study was able to investigate the degree of impairment in relation to quantitative measures of disease stage such as HIV RNA level or CD4 cell count. As access to HIV testing and care expands throughout Africa, increasing numbers of school-age HIV-infected children are being identified. Many of these children are ineligible for antiretroviral therapy (ART) because of high CD4 cell counts. It is important to know whether these children suffer impairment of their neurocognitive or motor development. In this study, we sought to determine whether HIV-infected ART-naive Ugandan children with CD4 cell measures that were above World Health Organization (WHO) [12] thresholds for ART initiation exhibited neurocognitive or motor deficits compared with HIV-uninfected controls from 2 observational cohorts in Kampala, Uganda [12]. We also examined the associations of WHO clinical stage, CD4 cell count and percentage, and plasma HIV RNA level with neurodevelopmental deficits.

Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

Abstract: The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported. ACTs can be successfully integrated into the HMM strategy.

Utilization of public or private health care providers by febrile children after user fee removal in Uganda.

Abstract: Background Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five.

Improving antimicrobial use among health workers in first-level facilities: results from the Multi-Country Evaluation of the Integrated Management of Childhood Illness strategy

Abstract: Objective The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. Methods Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). Findings Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI. They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. Conclusions IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries.

Childhood Tuberculosis and Malnutrition

Abstract: Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease.