Showing papers by "Mulago Hospital published in 2009"
TL;DR: This home-based HIV-care strategy is as effective as is a clinic-based strategy, and therefore could enable improved and equitable access to HIV treatment, especially in areas with poor infrastructure and access to clinic care.
237 citations
TL;DR: About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed.
Abstract: In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4–12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates. HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART). Eligible subjects were given information and counselling in 3 visits done over 4–6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression. 4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26%) did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28%) had died, 189 (30%) reported that they were on ART with a different provider, 158 (25%) were alive but said they were not on ART and 109 (17%) were lost to follow-up. Death rates (95% CI) per 100 person-years were 34 (22, 55) (n.18) within one month and 37 (29, 48) (n.33) within 3 months. 70/158 (44%) subjects seen at follow-up said they had not started ART because they could not afford transport. About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.
169 citations
TL;DR: To investigate the effect of adult medical male circumcision on female sexual satisfaction, a large number of women were surveyed and found to be sexually satisfied with their circumcisions.
Abstract: OBJECTIVE To investigate the effect of adult medical male circumcision on female sexual satisfaction. SUBJECTS AND METHODS We investigated self-reported sexual satisfaction among 455 women partners of men circumcised in a randomized trial of male circumcision for the prevention of human immunodeficiency virus in Rakai, Uganda. Women aged 15-49 years were interviewed about their sexual satisfaction before and after their partners were circumcised. We analysed female-reported changes in sexual satisfaction using chi-square or Fisher's exact tests. RESULTS Only 2.9% (13/455) of women reported less sexual satisfaction after their partners were circumcised; 57.3% (255/455) reported no change in sexual satisfaction and 39.8% (177/455) reported an improvement in sexual satisfaction after their partner's circumcision. There were no statistically significant differences in sexual satisfaction before and after partner's circumcision by age, religion and education status. CONCLUSION The overwhelming majority of women (97.1%) report either no change or improved sexual satisfaction after their male partner was circumcised. These findings suggest that male circumcision has no deleterious effect on female sexual satisfaction.
64 citations
TL;DR: To assess the number of procedures required to achieve optimal competency in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention.
Abstract: Objective
To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention.
36 citations
TL;DR: HCT for hospitalised children and their caretakers in Mulago teaching hospital in Uganda was introduced to assess its feasibility and to identify opportunities for HIV diagnosis and appropriate treatment.
Abstract: Summary objectives Early diagnosis of HIV-infected children remains a major challenge in Africa. Children who are hospitalised represent an opportunity for HIV diagnosis and appropriate treatment. We introduced HIV Counselling and Testing (HCT) for hospitalised children and their caretakers in Mulago teaching hospital in Uganda to assess its feasibility. methods We analysed routine program data for children and caretakers who were tested between February 2005 and February 2008 to assess the proportion of children and caretakers who were HIVinfected. We also assessed the level of immune suppression (CD4 percentage) in a subset of HIV infected children tested between January 2007 and December 2007. results Caretakers agreed to HIV testing for 8990 (92.8%) of the 9687 children who were offered HIV testing. Among the caretakers, 89.8% agreed to be tested. At the time of hospitalization, 41.3% of the caretakers had previously tested for HIV. Although 313 parents (mothers and fathers) reported that they had previously tested HIV positive, only 113 (36.3%) of these had tested their children prior to hospitalization. Overall HIV prevalence among caretakers was 16.7%. HIV prevalence among children was 12.4%, highest on the nutrition ward (30.8%). Of those children who underwent CD4 counts, 56.4% had a CD4 percentage of <20%. conclusion HCT for hospitalized children and their caretakers identified a significant number of HIV infected children and caretakers. More than half of the children had advanced HIV disease. More intensive efforts are needed to ensure earlier diagnosis and linkage to care for HIV infected children.
34 citations
TL;DR: The major causes of severe visual impairment and blindness overall have not changed appreciably since 1995, and there are important differences among countries, however, and using overall estimates for planning may be misleading.
Abstract: Purpose: To determine the causes of severe visual impairment and blindness in children attending schools for the blind in Kenya, Malawi, Uganda, and Tanzania and to compare the findings with those of a 1994 study. Methods: Children attending schools for the blind or annexes in 4 eastern African countries were examined. The major anatomical site of and underlying etiology of severe visual impairment and blindness was recorded using the standardized World Health Organization (WHO) reporting form. Results: A total of 1062 children aged below 16 years were examined of whom 701 (65.2%) had severe visual impairment or blindness. The major anatomical sites of visual loss overall (% and 95% CI) were cornea scar/phthisis bulbi (19%,16.1–21.9), whole globe lesions (15.7%,13.0–18.4), retina (15.4 %, 12.7–18.1), lens related disorders (13.1%, 10.7–15.5), and optic nerve disorders (12.3%, 9.9–14.7). Corneal scar/phthisis was not distributed equally among the countries and was highest in Malawi, similar to findings in ...
30 citations
TL;DR: It is demonstrated that for a Ugandan population with high prevalences of tuberculosis and human immunodeficiency virus infection, acid-fast microscopy is highly sensitive and specific when performed by trained technologists in a carefully controlled manner using established techniques.
Abstract: Laboratories in low-income countries report that acid-fast microscopy is insensitive and nonspecific. We demonstrate that for a Ugandan population with high prevalences of tuberculosis and human immunodeficiency virus infection, acid-fast microscopy is highly sensitive (93.1%) and specific (100%) when performed by trained technologists in a carefully controlled manner using established techniques.
29 citations
TL;DR: The number of children in the schools who receive cataract surgery has increased greatly since 1995 and the high rate of amblyopia highlights the critical need for programs to find children earlier and to ensure adequate follow-up after surgery.
28 citations
TL;DR: PCR targeting the secA1 gene was highly sensitive and specific for identifying M. tuberculosis in sputum samples, independent of smear or HIV infection status, and oral washes showed promise as an easily obtained respiratory specimen for tuberculosis diagnosis.
Abstract: Background Nucleic acid amplification tests are sensitive and specific for identifying Mycobacterium tuberculosis in sputum smear-positive populations, but they are less sensitive in sputum smear-negative populations. Few studies have assessed their performance among patients infected with HIV, and no studies have assessed their performance with oral wash specimens, which may be easier to obtain than sputum samples. Methods We performed a prospective study involving 127 adults from 2 populations who were undergoing evaluation for respiratory complaints at Mulago Hospital in Kampala, Uganda. We obtained and tested sputum samples for Mycobacterium tuberculosis, and we simultaneously obtained oral wash specimens to test for M. tuberculosis DNA by polymerase chain reaction (PCR) amplification of a novel locus, the secA1 gene. A positive mycobacterial culture of sputum was used to define cases of tuberculosis; we calculated the sensitivity and specificity of the PCR assay with sputum or oral wash specimens in reference to the standard of sputum culture results. Results Tuberculosis (75 [59%] of 127 patients) and HIV infection (58 [46%] of 126 patients) were both common in the study population. PCR of sputum samples was highly sensitive (sensitivity, 99%; 95% confidence interval, 93%-100%) and specific (specificity, 88%; 95% confidence interval, 77%-96%) for detection of pulmonary tuberculosis and performed well among HIV-infected patients and among patients with negative sputum smear results. PCR of oral wash specimens was less sensitive (sensitivity, 73%; 95% confidence interval, 62%-83%) but also detected a substantial proportion of tuberculosis cases. Conclusions PCR targeting the secA1 gene was highly sensitive and specific for identifying M. tuberculosis in sputum samples, independent of smear or HIV infection status. Oral washes showed promise as an easily obtained respiratory specimen for tuberculosis diagnosis. PCR of sputum for detection of the secA1 gene could be a rapid, effective diagnostic tool for tuberculosis referral centers.
28 citations
TL;DR: The extent of inappropriate enrolment of visually impaired children in special schools and annexes for the blind in four African countries is documented and the reasons are multiple and to rectify the situation will require advocacy and cooperation between ministries of health and education.
Abstract: Background: Many visually impaired children can learn to read print with appropriate training and simple visual aids. This may allow them to attend normal schools and to be integrated into society, which has lifelong benefits. Yet, in Africa, many visually impaired children are enrolled in special schools and taught only Braille. The purpose of this analysis was to document the extent of inappropriate enrolment of visually impaired children in special schools and annexes for the blind in four African countries. Methods: Schools were selected through a population-proportional-to-size method so that they would represent all children attending special schools in Kenya, Malawi, Tanzania and Uganda. Children were examined by ophthalmologists trained in standardised methods to determine visual acuity and the cause of decreased acuity. Results: Of 1062 children examined in special schools and annexes for the blind, 361 (34%, 95% CI 31.2, 36.8) had visual acuity ≥6/60; the most common cause of visual imp...
22 citations
TL;DR: Some aspects of pathogenesis and options for the treatment and prevention of TB IRIS are discussed, which are accompanied by an increase in immune responses to Mycobacterium tuberculosis.
Abstract: The TB immune reconstitution inflammatory syndrome (IRIS) is a relatively frequent complication in HIV–TB-coinfected patients after they start highly active antiretroviral therapy (HAART). There are two forms of TB IRIS: the ‘paradoxical’ type (clinical worsening of a patient on TB treatment) and the ‘unmasking’ type (undiagnosed TB becoming apparent after starting HAART). Their pathogeneses are not fully understood, although, as the name suggests, IRIS following initiation of HAART is accompanied by an increase in immune responses to Mycobacterium tuberculosis. The diagnosis of TB IRIS is mainly clinical; so far there are no laboratory tests able to diagnose or predict TB IRIS. Risk factors for TB IRIS include a low CD4+ lymphocyte count, disseminated TB infection at HAART initiation and a short interval between TB treatment and HAART initiation. TB IRIS complicates the treatment and care for HIV–TB-coinfected patients. In this paper, we discuss some aspects of pathogenesis and options for the treatment ...
01 Apr 2009
01 Apr 2009
Journal Article•
TL;DR: Knee arthrodesis is a suitable option for managing severe deformities in children and young adults as it results in a stable and painless limb and eliminates the use of walking aids.
Abstract: Background: Delay in the treatment of septic or tuberculous arthritis of the knee often results in a painful and stiff joint, mainly in a position of flexion. Often limb shortening is also present. A clinical study was undertaken to see what the long-term results of a one-stage procedure is, whereby an external fixator is used to achieve fusion of the knee and limb equalisation simultaneously by means of distraction of the callus at the arthrodesis site. Method: Seven children, with a mean age of 13.5 years at presentation, were included in this study. Four children had septic arthritis and three had tuberculosis. All children had the same procedure. The deformity was corrected and an Orthofix device applied. After seven days, distraction of the arthrodesis site was started and continued until the desired length was obtained. Screw replacement was necessary in five cases due to pin-track infection. Results: A stable, painless, well-aligned limb was obtained in all the patients and they were able to walk unsupported. Complete correction of limb length discrepancy was obtained in five patients and partial correction in the remaining two cases. Conclusion: Knee arthrodesis is a suitable option for managing severe deformities in children and young adults as it results in a stable and painless limb and eliminates the use of walking aids. In cases where leg length discrepancy is also present, the fusion can be achieved simultaneously with the equalisation process. Our experience has shown that this is a worthwhile clinical procedure which can result in a marked improvement in the quality of the life of these children.