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Editorial: In this issue
James Tumwine
African Health Sciences , 2002,
Abstract: Happy birthday African Health Sciences! Today we celebrate the first birthday of our journal with humility but also with a sense of satisfaction. In our continent where the infant mortality rate for both humans and journals is very high, survival ushers in a sense of satisfaction and increased responsibility for the future. We are particularly grateful to Nelson Sewankambo the dean of Makerere University Faculty of Medicine, Drs Walker and Samba of the WHO for seeing us through this first year. Many thanks also to all our editorial colleagues and referees both in Uganda and abroad for giving us the confidence to publish only vigorously reviewed work. And of course to you our reader who gives us the reason for existing: we thank you very much! Talking of the future: we have in plan to make African Health Science available to our readers on the Internet. That will be a subject of future discussion. Back to this birth-day issue of our journal. We have a selection of very interesting articles both general and specific. Dr. Dan Kaye's article on gestational trophoblastic disease following complete hydatidiform mole1, gives a glimpse of the clinical epidemiology, prevention and treatment of that condition. Although it occurs in just over 3 per 1000 deliveries, hydatidiform mole occurs in women with high fertility and is associated with mortality and protean complications of treatment. This is interesting information since there seems to be strong evidence from the 2001 Uganda Demographic Health Survey results linking high fertility rates and poverty. Underlying our commitment to promoting evidence based practice, we publish Dr. Wabinga's article in which he compares the reliability of Giemsa stain with immunohistochemistry in the demonstration of H.pylori: the germ linked to duodenal ulcer and gastric carcinoma2. Despite the relatively small numbers of patients studied, indications from this study are that Giemsa stain had high positive and negative predictive values with good agreement between the two tests. Given that Giemsa stain is cheap and easily available in most laboratories in the developed countries, recommending its use, as Webbing does, is not altogether out of place. To our old friend: cotrimoxazole! Now ubiquitously used in primary care settings for treatment of acute respiratory infections and for the prevention of Pneumocystis carinii pneumonia in HIV infected children and adults, cotrimoxazole seems destined to stay. Of major concern however is quality control of our products in an environment where sophisticated and time-consuming procedures may not always be possible. Balyejjussa, Adome and Musoke3 have used a rapid method (derivative spectrophotometry) for getting assays of the two components of cotrimoxazole with success. In their article on monitoring the severity of iodine deficiency disorders in Uganda, Bimenya, Olio-Okui and colleagues4 found that the prevalence of goitre has declined with the introduction of iodised salt in th
James Tumwine
African Health Sciences , 2002,
Abstract: African Health Sciences has come a long way since its long anticipated birth in August 2001. You are very much welcome to this first issue of volume 2, of 2002 which contains very interesting papers. The papers include studies of the effect of Ugandan herbal extracts on measles virus1, sugar as a potential for vitamin A fortification2, experience with Directly Observed Therapy (DOT) for TB in South Africa3, the Bwamba virus in Tanzania and Uganda,4 an exploration of an interesting western lifestyle condition now on the rise in Uganda: diverticular disease of the colon5; as well as sexuality in Kenya6. In their paper, Olila, Olwa-Odyek and Opuda Asibo1 tested the claimed efficacy of some plants in the treatment of measles - a disease of public health significance. They performed in vitro antiviral assays of extracts of two medicinal plants using measles virus as the test organism. One of the two plants had antiviral activity in seed extracts and it was established that this was due to the compound skimmianine. Clearly this is an important finding which needs to be followed up with further studies. The paper on sugar2 as a potential for vitamin A fortification is timely in that there is a resurgence of interest in Vitamin A as an important micronutrient with anti-oxidant properties, among others. The use of sugar seems to be widespread in eastern Uganda and therefore, the argues that sugar is a potential vehicle for vitamin A fortification. However, there is need for caution here since the use of sugar has been associated with obesity and dental ill health. No doubt the debate on this issue will continue. Poor patient adherence to prescribed medication is one of the hindrances to effective TB control and is the rationale for DOT advocated by WHO. However this is a labour intensive practice, which over burdened health systems find difficult to implement. Kironde3 and Kahirimbanyis paper in todays African Health Sciences, report on their experience with community involvement in the delivery of TB treatment in the northern Cape Province in South Africa. One third of the TB patients received treatment from lay DOT volunteers who had been trained and supported to administer and record the treatment. Treatment outcomes for new patients supervised in the community were equivalent to those who received treatment from the health units. For patients on re-treatment, community based treatment was superior to self-administered therapy. Clearly, community participation might be a viable way of achieving effectiveness of DOT. In this issue we also bring you the study of the Bwamba virus (genus Bunya virus, family Bunyaviridae) from Uganda and northern Tanzania4. As it causes un identified fevers because of its benign nature, this may be more common than previously believed. The virus was isolated from several sources: mosquitoes obtained during the Oonyong-nyong virus fever out break in Rakai in 1997, and from a refugee in a camp in Ngara in north-eastern Tanzan
In this issue
James Tumwine
African Health Sciences , 2001,
Abstract: I wish to welcome you to our second issue of Africa Health Sciences which is coming out just before Christmas, 2001. While this is a festive season we in the Africa region have not got much to celebrate. It is the first anniversary of Dr. Mathew Lukwiya s tragic death at the hands of Ebola haemorrhagic fever. News from Gabon and the Democratic Republic of the Congo (DRC) is not good. They sighted some cases of haemorrhagic fever feared to be Ebola. The countries bordering the DRC are panicking because, as Ugandas commissioner for communicable diseases says, "; Ebola can travel across boundaries in a matter of hours. Even one thousand kilometers is not far enough. So be prepared!"; In light of this, African Health Sciences brings you an update on Ebola haemorrhagic fever in an article by some of the doctors who experienced the last Ebola outbreak in Gulu, northern Uganda last year, first hand1. They give us a glimpse of the epidemic as it affected children and adolescents, a sector of the population that is usually spared. Their take-home message is that we need to develop strategies to protect children and adolescents from exposure to Ebola patients. One such strategy is health education to children ad adolescents to avoid contact with Ebola patients. In this issue of African Health Sciences we also bring you Dr. Nuru Nakintus results of a comparative study of vaginal misoprostol and intravenous oxytocin for induction of labour in women with intra uterine fetal death2. Dr. Nakintu demonstrates that misporostol is cheaper and more effective than oxytocin in induction of labour in women with intrauterine fetal death. The study has very important implications for Obstetric practice in countries with limited resources such as Uganda. We continue our series on the anti-microbial activities of extracts of several Ugandan medicinal plants with an article by Dr. Olila and colleagues3. In the current article they report results of their study of antibacterial and anti-fungal activities of two Ugandan medicinal plants. One of the plants (W. ugandensis) had antibacterial activity against Escherichia coli and Staphylococcus aureus, as well as anti-fungal activity against Candiada albicans. However Z. cahlybeum had neither antifungal nor antibacterial activities. These are important findings since a large proportion of Africans still relies on the use of herbal remedies. We welcome an article from the United Sates on contraceptive security, information flow and local adaptations to family planning practice in Morocco.4 Chandani and Breton use their Morocco experience tomake a few conclusions: both external and internal funding and technical expertise are critical components of a successful logistics system for supplying customers with the contraceptives they need, when, and where they need them. In this era of escalating numbers of people with tuberculosis, it is essential to revisit methods of diagnosis. Erume and colleagues article5 on rapid detection of My
Editor\'s Choice: Tackling HIV, malaria, tuberculosis and others together
James K Tumwine
African Health Sciences , 2004,
Editor's choice: Post traumatic stress, HIV and malaria: contemporary issues explored in depth
James K Tumwine
African Health Sciences , 2004,
Abstract: No available African Health Sciences Vol.4(2) 2004: 79-79
Human immunodeficiency virus infection and cerebral malaria in children in Uganda: a case-control study
Peace D Imani, Philippa Musoke, Justus Byarugaba, James K Tumwine
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-5
Abstract: We conducted an unmatched case-control study, in which 100 children with cerebral malaria were compared with 132 with uncomplicated malaria and 120 with no malaria. In stratified analyses we estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age.HIV-1 infection was present in 9% of children with cerebral malaria compared to 2.3% in uncomplicated malaria (age-adjusted odds ratio (aOR) 5.94 (95% confidence interval (CI) 1.36-25.94, p = 0.012); and 2.5% in children with no malaria (aOR 3.85 (95% CI0.99-14.93, p = 0.037). The age-adjusted odds of being HIV-positive among children with cerebral malaria compared to the control groups (children with uncomplicated malaria and no malaria) was 4.98 (95% CI 1.54-16.07), p-value = 0.003.HIV-1 infection is associated with clinical presentation of cerebral malaria in children. Clinicians should ensure that children diagnosed with HIV infection are initiated on cotrimoxazole prophylaxis as soon as the diagnosis is made and caretakers counselled on the importance of adherence to the cotrimoxazole towards reducing the risk of acquiring P.falciparum malaria and associated complications such as cerebral malaria. Other malaria preventive measures such as use of insecticide-treated mosquito nets should also be emphasized during counselling sessions.Malaria and Human immunodeficiency virus (HIV)-1 are two of the most common global health challenges today and the two infections commonly overlap in distribution in most countries especially in sub-Saharan Africa[1]. Studies have demonstrated interaction between these two infections with the majority of studies conducted in adults [2-6]. HIV-1 infection has been found to be associated with severe forms of malaria and particularly cerebral malaria in adults but there is still a paucity of information on the interaction between the two infections in children [2,7,8].HIV-1 infected adults have a greater percentage of severe malaria episodes with more frequent hospitaliz
Intimate partner violence and infant morbidity: evidence of an association from a population-based study in eastern Uganda in 2003
Charles AS Karamagi, James K Tumwine, Thorkild Tylleskar, Kristian Heggenhougen
BMC Pediatrics , 2007, DOI: 10.1186/1471-2431-7-34
Abstract: We conducted a population based household survey in Mbale, eastern Uganda in 2003. Participants were 457 women (with 457 infants) who consented to participate in the study. We measured socio-demographics of women and occurrence of intimate partner violence. We measured socio-demographics, immunization, nutritional status, and illness in the previous two weeks of the children.The mean age of the women was 25 years (SD 5.7) while the mean age of the infants was 6 months (SD 3.5). The prevalence of lifetime intimate partner violence was 54% (95% CI 48%–60%). During the previous two weeks, 50% (95% CI 50%–54%) of the children had illness (fever, diarrhoea, cough and fast breathing). Lifetime intimate partner violence was associated with infant illness (OR 1.8, 95% CI 1.2–2.8) and diarrhoea (OR 2.0, 95% CI 1.2–3.4).Our findings suggest that infant illnesses (fever, diarrhoea, cough and fast breathing) are associated with intimate partner violence, and provide insights into previous reports that have shown an association between intimate partner violence and child mortality, suggesting possible underlying mechanisms. Our findings also highlight the importance of intimate partner violence on the health of children, and the need for further research in this area.Intimate partner violence is the most common form of violence against women[1]. Intimate partner violence assumed international recognition initially because of its violation of women's rights. In recent years there has been accumulating evidence of the consequences of intimate partner violence on the health of women including detrimental reproductive health outcomes [2-10]. In Uganda, a hospital-based study reported that 57% of pregnant women experienced intimate partner violence [11].However, the effect of intimate partner violence on children has received limited attention. Violence prior to or during pregnancy has been associated with premature birth, foetal injury and low birth weight[3,9,10,12]. Studies have s
Intimate partner violence against women in eastern Uganda: implications for HIV prevention
Charles AS Karamagi, James K Tumwine, Thorkild Tylleskar, Kristian Heggenhougen
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-284
Abstract: The study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study.During November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1–0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1–0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2–16.2) and the husband having another partner (OR 2.4, 95% CI 1.02–5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5–5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence.Intimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.The World Health Organization defines intimate partner violence against women as "the r
Antenatal HIV testing in rural eastern Uganda in 2003: incomplete rollout of the prevention of mother-to-child transmission of HIV programme?
Charles AS Karamagi, James K Tumwine, Thorkild Tylleskar, Kristian Heggenhougen
BMC International Health and Human Rights , 2006, DOI: 10.1186/1472-698x-6-6
Abstract: The study was a cross sectional household survey of women aged 18 years or more, with children aged one year or less, who resided in Mbale Town or in the surrounding Bungokho County. We also conducted in-depth interviews with six health workers in Mbale Hospital.In 2003, we interviewed 457 women with a median age of 24 years. The prevalence of antenatal HIV testing was 10 percent. The barriers to antenatal HIV testing were unavailability of voluntary counselling and testing services (44%), lack of HIV counselling (42%) and perceived lack of benefits for HIV infected women and their infants. Primipara (OR 2.6, 95% CI 1.2–5.8), urban dwellers (OR 2.7, 95% CI 1.3–5.8), women having been counselled on HIV (OR 6.2, 95% CI 2.9–13.2), and women with husbands being their primary confidant (OR 2.3, 95% CI 1.0–5.5) were independently associated with HIV testing.The major barriers to PMTCT implementation were unavailability of PMTCT services, particularly in rural clinics, and poor antenatal counselling and HIV testing services. We recommend that the focus of the prevention of mother-to-child transmission of HIV programme should shift to the district and sub-district levels, strengthen community mobilization, improve the quality of antenatal voluntary counselling and HIV testing services, use professional and peer counsellors to augment HIV counselling, and ensure follow-up care and support for HIV positive women and their infants.It is estimated that 2.1 million children are infected with HIV worldwide. About 90% of the HIV-infected children are in Africa and over 95% of HIV infections in children below the age of 15 years are due to mother-to-child-transmission[1]. Antenatal voluntary counselling and HIV testing (VCT), followed by the provision of short-course nevirapine prophylaxis is the key intervention advocated in the prevention of mother-to-child-transmission of HIV (PMTCT)[2,3]. VCT acceptance by pregnant women varies greatly and is influenced by several factors inclu
Severe malnutrition with and without HIV-1 infection in hospitalised children in Kampala, Uganda: differences in clinical features, haematological findings and CD4+ cell counts
Hanifa Bachou, Thorkild Tyllesk?r, Robert Downing, James K Tumwine
Nutrition Journal , 2006, DOI: 10.1186/1475-2891-5-27
Abstract: The study was conducted in the paediatric wards of Mulago hospital, which is Uganda's national referral and teaching hospital. We studied 315 severely malnourished children (presence of oedema and/or weight-for-height: z-score < -3) and have presented our findings. At admission, the CD4+ and CD8+ cells were measured by the flow cytometry and HIV serology was confirmed by Enzyme linked Immunoassay for children >18 months of age, and RNA PCR was performed for those ≤18 months. Complete blood count, including differential counts, was determined using a Beckman Coulter counter.Among the 315 children, 119 (38%) were female; the median age of these children was 17 months (Interquartile range 12–24 months), and no difference was observed in the HIV status with regard to gender or age. The children showed a high prevalence of infections: pneumonia (68%), diarrhoea (38%), urinary tract infection (26%) and bacteraemia (18%), with no significant difference with regard to the HIV status (HIV-positive versus HIV-negative children). However, the HIV-positive children were more likely to have persistent diarrhoea than the HIV-uninfected severely malnourished children (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2–3.6). When compared with the HIV-negative children, the HIV-positive children showed a significantly lower median white blood cell count (10700 versus 8700) and lymphocyte count (4033 versus 2687). The CD4+ cell percentages were more likely to be lower in children with non-oedematous malnutrition than in those with oedematous malnutrition even after controlling for the HIV infection.The novel observation of this study is that the CD4+ percentages in both HIV-positive and HIV-negative children without oedema were lower that those in children with oedema. These observations appear to imply that the development of oedema requires a certain degree of immunocompetence, which is an interesting clue to the pathophysiology of oedema in severe malnutrition.Severe malnutrit
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