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Search Results: 1 - 10 of 401350 matches for " Ingunn M Engebretsen "
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Periodontal status, tooth loss and self-reported periodontal problems effects on oral impacts on daily performances, OIDP, in pregnant women in Uganda: a cross-sectional study
Margaret N Wandera, Ingunn M Engebretsen, Charles M Rwenyonyi, James Tumwine, Anne N ?str?m, the PROMISE-EBF Study Group
Health and Quality of Life Outcomes , 2009, DOI: 10.1186/1477-7525-7-89
Abstract: Pregnant women at about 7 months gestational age who were members of a community based multi-center cluster randomized community trial: PROMISE EBF: Safety and Efficacy of Exclusive Breast feeding in the Era of HIV in Sub-Saharan Africa, were recruited in the district of Mbale, Eastern Uganda between January 2006 and June 2008. A total of 877 women (participation rate 877/886, 98%, mean age 25.6, sd 6.4) completed an interview and 713 (participation rate 713/886, 80.6%, mean age 25.5 sd 6.6) were examined clinically with respect to tooth-loss and according to the Community Periodontal Index, CPI.Seven of the original 8 OIDP items were translated into the local language. Cronbach's alpha was 0.85 and 0.80 in urban and rural areas, respectively. The prevalence of oral impacts was 25% in the urban and 30% in the rural area. Corresponding estimates for CPI>0 were 63% and 68%. Adjusted ORs for having any oral impact were 1.1 (95% CI 0.7-1.7), 1.9 (95% CI 1.2-3.1), 1.7 (1.1-2.7) and 2.0 (0.9-4.4) if having respectively, CPI>0, at least one tooth lost, tooth loss in molars and tooth loss in molar-and anterior regions. The Adjusted ORs for any oral impact if reporting periodontal problems ranged from 2.7(95% CI 1.8-4.2) (bad breath) through 8.6(95% CI 5.6-12.9) (chewing problem) to 22.3 (95% CI 13.3-35.9) (toothache).A substantial proportion of pregnant women experienced oral impacts. The OIDP impacts were most and least substantial regarding functional- and social concerns, respectively. The OIDP varied systematically with tooth loss in the molar region, reported chewing-and periodontal problems. Pregnant women's oral health should be addressed through antenatal care programs in societies with limited access to regular dental care facilities.During pregnancy, hormones alter immuno-responsiveness and inflammatory response mediators. This has been reported to cause oral problems, primarily gingivitis and periodontal infection [1,2]. Pregnancy gingivitis ranges from asymptoma
Timeliness of Childhood Vaccinations in Kampala Uganda: A Community-Based Cross-Sectional Study
Juliet N. Babirye, Ingunn M. S. Engebretsen, Frederick Makumbi, Lars T. Fadnes, Henry Wamani, Thorkild Tylleskar, Fred Nuwaha
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035432
Abstract: Background Child survival is dependent on several factors including high vaccination coverage. Timely receipt of vaccines ensures optimal immune response to the vaccines. Yet timeliness is not usually emphasized in estimating population immunity. In addition to examining timeliness of the recommended Expanded Programme for Immunisation (EPI) vaccines, this paper identifies predictors of untimely vaccination among children aged 10 to 23 months in Kampala. Methods In addition to the household survey interview questions, additional data sources for variables included data collection of child's weight and length. Vaccination dates were obtained from child health cards. Timeliness of vaccinations were assessed with Kaplan–Meier time-to-event analysis for each vaccine based on the following time ranges (lowest–highest target age): BCG (birth–8 weeks), polio 0 (birth–4 weeks), three polio and three pentavalent vaccines (4 weeks–2 months; 8 weeks–4 months; 12 weeks–6 months) and measles vaccine (38 weeks–12 months). Cox regression analysis was used to identify factors associated with vaccination timeliness. Results About half of 821 children received all vaccines within the recommended time ranges (45.6%; 95% CI 39.8–51.2). Timely receipt of vaccinations was lowest for measles (67.5%; 95% CI 60.5–73.8) and highest for BCG vaccine (92.7%: 95% CI 88.1–95.6). For measles, 10.7% (95% CI 6.8–16.4) of the vaccinations were administered earlier than the recommended time. Vaccinations that were not received within the recommended age ranges were associated with increasing number of children per woman (adjusted hazard ratio (AHR); 1.84, 95% CI 1.29–2.64), non-delivery at health facilities (AHR 1.58, 95% CI 1.02–2.46), being unmarried (AHR 1.49, 95% CI 1.15–1.94) or being in the lowest wealth quintile (AHR 1.38, 95% CI 1.11–1.72). Conclusions Strategies to improve vaccination practices among the poorest, single, multiparous women and among mothers who do not deliver at health facilities are necessary to improve timeliness of vaccinations.
Socio-demographic factors related to periodontal status and tooth loss of pregnant women in Mbale district, Uganda
Margaret Wandera, Ingunn MS Engebretsen, Isaac Okullo, James K Tumwine, Anne N ?str?m, the PROMISE-EBF Study Group
BMC Oral Health , 2009, DOI: 10.1186/1472-6831-9-18
Abstract: Mothers were participants of a multicentre cluster-randomized behavioral intervention study (PROMISE-EBF Safety and Efficacy of Exclusive Breast feeding Promotion in the Era of HIV in Sub-Saharan Africa). In Uganda, these were pregnant women resident in Mbale district, recruited into the PROMISE EBF study between January 2006 and June 2008. A total of 886 women were eligible to participate of whom information became available for 877 (participation rate 98.9%, mean age 25.6) women who participated in the recruitment interview and 713 (mean age 25.5) women who got a clinical oral examination. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN).The prevalence of tooth loss was 35.7%, 0.6% presented with pockets shallow pockets (4–5 mm), whereas 3.3% and 63.4% displayed bleeding and calculus, respectively. A total of 32.7% were without any sign of periodontal disease. Binary logistic regression analyses revealed that older women, women from larger households and those presenting with microbial plaque were respectively, 3.4, 1.4 and 2.5 times more likely to have CPI score >0. Rural (OR = 0.9), nulliparous (OR = 0.4) and women who never visited a dentist (OR = 0.04) were less likely, whereas women from larger households (OR = 1.5) were more likely to have lost at least one tooth.The results revealed moderate prevalence of bleeding and tooth loss, high prevalence of calculus, low frequency of pockets 4–5 mm. Disparity in pregnant women's oral health related to parity suggests that education of maternity care providers concerning oral health in pregnancy is warranted.ClinicalTrials.gov Identifier NCT00397150Studies using the Community Periodontal Index of Treatment Need (CPITN) have indicated that the prevalence of severe periodontal disease is low in sub-Saharan Africa [1-3]. However, with very few exceptions the oral hygiene condition has been described as poor with accumulation of plaque and calculus being more widespread wit
Gendered perceptions on infant feeding in Eastern Uganda: continued need for exclusive breastfeeding support
Ingunn MS Engebretsen, Karen M Moland, Jolly Nankunda, Charles A Karamagi, Thorkild Tyllesk?r, James K Tumwine
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-13
Abstract: Eight focus groups with 81 informants provided information for inductive content analysis. Four groups were held by men among men and four groups by women among women in Mbale District, Eastern Uganda.Two study questions emerged: How are the different feeding options understood and accepted? And, what are men's and women's responsibilities related to infant feeding? A mother's commitment to breastfeed and the husband's commitment to provide for the family came out strongly. Not breastfeeding a newborn was seen as dangerous and as unacceptable, except in cases of maternal illness. Men argued that not breastfeeding could entail sanctions by kin or in court. But, in general, both men and women regarded EBF as 'not enough' or even 'harmful.' Among men, not giving supplements to breast milk was associated with poverty and men's failure as providers. Women emphasised lack of time, exhaustion, poverty and hunger as factors for limited breast milk production. Although women had attended antenatal teaching they expressed a need to know more. Most men felt left out from health education.Breastfeeding was the expected way to feed the baby, but even with existing knowledge among mothers, EBF was generally perceived as impossible. ERF was overall negatively sanctioned. Greater culture-sensitivity in programs promoting safer infant feeding in general and in HIV-contexts in particular is urgently needed, and male involvement is imperative.The study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov webcite (NCT00397150).Recent studies suggest a growing awareness of the importance of partner HIV-testing and disclosure during pregnancies [1,2], and involvement of the father in prevention of mother-to-child transmission (PMTCT) programmes [3-6]. But to date, the area of maternal and child care in general and PMTCT in particular, has been characterised by limited inclusion of men in many African settings. HIV positive women are usua
Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health
Tanya Doherty, David Sanders, Debra Jackson, Sonja Swanevelder, Carl Lombard, Wanga Zembe, Mickey Chopra, Ameena Goga, Mark Colvin, Lars T Fadnes, Ingunn MS Engebretsen, Eva-Charlotte Ekstr?m, Thorkild Tyllesk?r, For the PROMISE EBF study group
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-105
Abstract: This is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008 (ClinicalTrials.gov no: NCT00397150). Infant feeding recall of 22 food and fluid items was collected at 3, 6, 12 and 24?weeks postpartum. Women’s experiences of breast health problems were also collected at the same time points. 999 women who ever breastfed were included in the analysis. Univariable and multivariable logistic regression analysis adjusting for site, arm and cluster, was performed to determine predictors of stopping breastfeeding by 12?weeks postpartum.By 12?weeks postpartum, 20% of HIV-negative women and 40% of HIV-positive women had stopped all breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first 3?days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12?weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 – 9.5 and AOR 4.1, 95% CI 1.6 – 10.8, respectively). Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95%CI 1.7 – 5.7) and the mother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI 1.3 – 2.8).Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.South Africa is one of five countries in Southern Africa that is considered to have made no progress between 1990 and 2008 in reducing mortality amongst children younger than five years (Millennium Development Goal 4) [1]. In this period, the under-5
Malaria Parasitaemia among Infants and Its Association with Breastfeeding Peer Counselling and Vitamin A Supplementation: A Secondary Analysis of a Cluster Randomized Trial
Victoria Nankabirwa,Thorkild Tylleskar,Jolly Nankunda,Ingunn Marie S. Engebretsen,Halvor Sommerfelt,James K. Tumwine
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0021862
Abstract: Malaria is the second highest contributor to the disease burden in Africa and there is a need to identify low cost prevention strategies. The objectives of this study were to estimate the prevalence of malaria parasitaemia among infants and to measure the association between peer counselling for exclusive breastfeeding (EBF), vitamin A supplementation, anthropometric status (weight and length) and malaria parasitaemia.
Need to optimise infant feeding counselling: A cross-sectional survey among HIV-positive mothers in Eastern Uganda
Lars T Fadnes, Ingunn MS Engebretsen, Henry Wamani, Jonathan Wangisi, James K Tumwine, Thorkild Tyllesk?r
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-2
Abstract: In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall.Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0–10.2) among the most educated mothers, and 18 months (95% CI 15.0–21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2–10.8] vs. 14 months [95% CI 10.8–17.2] and 8 months [95% CI 5.9–10.1] vs. 17 months [95% CI 15.2–18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother.Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations.Wid
Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall
Ingunn Engebretsen, Henry Wamani, Charles Karamagi, Nulu Semiyaga, James Tumwine, Thorkild Tyllesk?r
BMC Pediatrics , 2007, DOI: 10.1186/1471-2431-7-10
Abstract: A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed.Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively).Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda.The Millennium Development Go
Determinants of infant growth in Eastern Uganda: a community-based cross-sectional study
Ingunn Engebretsen, Thorkild Tyllesk?r, Henry Wamani, Charles Karamagi, James K Tumwine
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-418
Abstract: A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003; 723 mother-infant (0–11 months) pairs were analysed. Infant anthropometric status was assessed using z-scores for weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ). Dependent dichotomous variables were constructed using WLZ < -2 (wasting) and LAZ < -2 (stunting) as cut-off values. A conceptual hierarchical framework was used as the basis for controlling for the explanatory factors in multivariate analysis. Household wealth was assessed using principal components analysis.The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. Diarrhoea during the previous 14 days was associated with wasting in the crude analysis, but no factors were significantly associated with wasting in the adjusted analysis. The adjusted analysis for stunting showed associations with age and gender. Stunting was more prevalent among boys than girls, 58.7% versus 41.3%. Having brothers and/or sisters was a protective factor against stunting (OR 0.4, 95% CI 0.2–0.8), but replacement or mixed feeding was not (OR 2.7, 95% CI 1.0–7.1). Lowest household wealth was the most prominent factor associated with stunting with a more than three-fold increase in odds ratio (OR 3.5, 95% CI 1.6–7.8). This pattern was also seen when the mean LAZ was investigated across household wealth categories: the adjusted mean difference between the top and the bottom wealth categories was 0.58 z-scores, p < 0.001. Those who had received pre-lacteal feeds had lower adjusted mean WLZ than those who had not: difference 0.20 z-scores, p = 0.023.Sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size were associated with growth among Ugandan infants.Child under-nutrition is a leading factor underlying child mortality and morbidity in Sub-Saharan Africa, and contributes to 2.
The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, northern Tanzania
Eli Falnes, Karen Moland, Thorkild Tyllesk?r, Marina de Paoli, Sebalda Leshabari, Ingunn MS Engebretsen
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-551
Abstract: The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics.The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding.Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored.There is increasing awareness of the importance of male partner involvement in prevention of mother-to-child transmission of HIV (PMTCT) programmes [1,2], but little attention has been paid to the role of the mother-in-law [3]. Key interventions in the PMTCT programmes include counselling and testing for HIV at the antenatal clinic, drug treatment and counselling on safer infant feeding practises. The HIV-infected mother is expected to make decisions on these complex and sensitive issues in an autonomous manner. However, it has been shown that these decisions are not taken in a social vacuum [4]. The male partner
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