Browsing by Author "Fabiani, Massimo"

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    Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda
    (Tropical Medicine & International Health, 2006) Fabiani, Massimo; Nattabi, Barbara; Ayella, Emingtone O.; Ogwang, Martin; Declich, Silvia
    To estimate differences in fertility by HIV serostatus and to validate an adjustment method for estimating the HIV prevalence in the general female population using data from an antenatal clinic. methods We used Cox regression models to retrospectively estimate the age-specific relative fertility (RF) of HIV-positive compared to HIV-negative women among 3314 antenatal clinic attenders in northern Uganda. RF and the age distribution of women in the general female population were used to extrapolate the antenatal clinic-based HIV prevalence. This procedure was indirectly validated by comparing the adjusted estimate with those based on standard adjustment factors derived from general female populations in Uganda and Tanzania. results HIV-positive women reported a lower fertility than HIV-negative women [age-adjusted RF ¼ 0.83, 95% confidence interval (CI): 0.75–0.93]. Except for girls aged 15–19 (RF ¼ 0.96, 95% CI: 0.74– 1.24) HIV-positive women in all age groups were less fertile (20–24 year: RF ¼ 0.83, 95% CI: 0.67– 1.01; 25–29 years: RF ¼ 0.79, 95% CI: 0.62–1.00; 30–49 year: RF ¼ 0.79, 95% CI: 0.65–0.96]. Adjusting the antenatal clinic-based HIV prevalence (11.6%) for these differences yields a higher estimate (13.8%) that is lower than those based on standard adjustment factors derived from general female populations (from 14.6% to 17.7%). conclusions The age-specific pattern of differential fertility by HIV serostatus derived from antenatal clinic data is consistent with findings from population-based studies conducted in Africa. However, differences in fertility between HIV positive and HIV-negative clients underestimate those in the general female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.
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    Differences in hospital admissions for males and females in northern Uganda in the period 1992—2004: a consideration of gender and sex differences in health care use
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007) Accorsi, Sandro; Fabiani, Massimo; Nattabi, Barbara; Ferrarese, Nicoletta; Corrado, Bruno; Iris, Robert; Ayella, Emintone O.; Pido, Bongomin; Yoti, Zabulon; Corti, Dominique; Ogwang, Martin; Declich, Silvia
    To inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210 319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992—2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0—14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15—44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (≥45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.
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    Impact of insecurity, the AIDS epidemic, and poverty on population health: disease patterns and trends in Northern Uganda.
    (The American journal of tropical medicine and hygiene, 2001) Accorsi, Sandro; Fabiani, Massimo; Lukwiya, Matthew; Ravera, Maurizio; Ojom, Lawrence; Manenti, Fabio; Anguzu, Patrick; Dente, Maria G.; Declich, Silvia
    A retrospective analysis of the discharge records of 186,131 inpatients admitted to six Ugandan hospitals during 1992–1998 was performed to describe the disease patterns and trends among the population of Northern Uganda. In all hospitals, malaria was the leading cause of admission and the frequency of admissions for malaria showed the greatest increase. Other conditions, such as malnutrition and injuries, mainly increased in the sites affected by civil conflict and massive population displacement. Tuberculosis accounted for the highest burden on hospital services (approximately one-fourth of the total bed-days), though it showed a stable trend over time. A stable trend was also observed for acquired immunodeficiency syndrome (AIDS), which is in contrast to the hypothesis that AIDS patients have displaced other patients in recent years. In conclusion, preventable and/or treatable communicable diseases, mainly those related to poverty and poor hygiene, represent the leading causes of admission and death, reflecting the socioeconomic disruption in Northern Uganda.
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    Using prevalence data from the programme for the prevention of mother-to-child-transmission for HIV-1 surveillance in North Uganda
    (AIDS, 2005) Fabiani, Massimo; Nattabi, Barbara; Ayella, Emingtone O.; Ogwang, Martin; Declich, Silvia
    To validate the use of data from a programme for the prevention of motherto- child transmission (PMTCT) in estimating HIV-1 prevalence in North Uganda. Methods: The study was conducted at St. Mary’s Hospital Lacor. We compared the estimated prevalence for 3580 attendees at the antenatal clinic who were selected for anonymous surveillance to that for 6785 pregnant women who agreed to undergo voluntary counselling and testing (VCT) for enrolment in the PMTCT programme. Logbinomial regression models were used to identify the factors associated with both VCT uptake and HIV-1 infection, which could bias the prevalence estimates based on PMTCT data. Results: In 2001–2003, the age-standardized prevalence was similar (11.1% in the anonymous surveillance group and 10.9% in the VCT group). The estimates were also similar when compared for each year tested. Analogously, no important differences were observed in age-specific prevalence. Of the factors associated with HIV-1 infection, only time of residence at current address [prevalence proportion ratio (PPR) ¼ 1.05; 95% confidence interval (CI), 1.00–1.10], marital status (PPR ¼ 1.05; 95% CI, 1.01–1.10) and partner’s occupation (PPR ¼ 1.05; 95% CI, 1.01–1.10) were associated with VCT uptake, yet the associations were weak. Conclusions: The prevalence estimated based on the VCT data collected as part of the PMTCT programme could be used for HIV-1 surveillance in North Uganda. At the national level, however, it needs to be evaluated whether PMTCT data could replace, or instead be combined with, the data from sentinel surveillance.