NRU :: Browsing by Author "Kalyango, Joan"

Browsing by Author "Kalyango, Joan"

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An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities
(BMC International Health and Human Rights, 2011) Nankinga, Ziadah; Kutyabami, Paul; Kibuule, Dan; Kalyango, Joan; Groves, Sara; Bollinger, Robert C.; Obua, Celestino
Health research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%), malaria (19%), maternal and child health (14%), tuberculosis (11%), mental health (3%), and others (8%). MakCHS faculty were identified as Principal Investigators (PIs) in only 22 (38%) active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66%) addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors. Conclusions: The research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications
An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities
(BMC International Health and Human Rights, 2011) Nankinga, Ziadah; Kutyabami, Paul; Kibuule, Dan; Kalyango, Joan; Groves, Sara; Bollinger, Robert C.; Obua, Celestino
Health research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods: A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results: A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%), malaria (19%), maternal and child health (14%), tuberculosis (11%), mental health (3%), and others (8%). MakCHS faculty were identified as Principal Investigators (PIs) in only 22 (38%) active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66%) addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors. Conclusions: The research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.
Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital
(BMC Oral Health, 2014) Nanteza, Martina; Tusiime, Jayne B.; Kalyango, Joan; Kasangaki, Arabat
The aim of this study was to determine the prevalence of Human Immune Virus (HIV) related oral lesions and their association with Cluster of Differentiation 4 (CD4+) count among treatment naïve HIV positive patients. Methods: This was a descriptive and analytical cross sectional study. Participants were 346 treatment naïve HIV positive adult patients. These were consecutively recruited from Hoima Regional Referral hospital between March and April 2012. Data collection involved interviews, oral examinations and laboratory analysis. Results: A total of 168(48.6%) participants had oral lesions. The four commonest lesions were oral candidiasis (24.9%, CI = 20.6-29.7%), melanotic hyperpigmentation (17.3%, CI = 13.7-21.7%), kaposi sarcoma (9.3%, CI = 6.6-12.8%) and Oral Hairy Leukoplakia (OHL) (5.5%, CI = 3.5-8.4%). There was significant association between oral candidiasis and immunosuppression measured as CD4+ less than 350 cells/mm3 (OR = 2.69, CI = 1.608-4.502, p < 0.001). Oral candidiasis was the only oral lesion significantly predictive of immunosuppression (OR = 2.56, CI = 1.52-4.30, p < 0.001) with a Positive Predictive Value (PPV) of 48.2%, Negative Predictive Value (NPV) of 74.3%, 38.1% sensitivity and specificity of 81.4%. Conclusion: Oral candidiasis can be considered as a marker for immunesuppression, making routine oral examinations essential in the management of HIV positive patients.
Baseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective study
(BMC Infectious Diseases, 2021) Namugenyi, Juliet; Musaazi, Joseph; Katamba, Achilles; Kalyango, Joan; Sendaula, Emmanuel; Kambugu, Andrew; Fehr, Jan; Castelnouvo, Barbara; Manabe, Yukari C.; Ssengooba, Willy; Sekaggya-Wiltshire, Christine
In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB. Methods: A subset of 138 PLHIV from the ‘SOUTH’ study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity. Results: A total of 81 patients (58.7%) were males, median age 34 (IQR 29 ̶ 40) years, median CD4 cell count of 180 (IQR 68 ̶345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0 ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04 ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03 ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient’s colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74 ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79 ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8. Conclusion: Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.
The effect of AIDS defining conditions on immunological recovery among patients initiating antiretroviral therapy at Joint Clinical Research Centre, Uganda
(AIDS Research and Therapy, 2009) Kigozi, Brian K.; Sumba, Samwel; Mudyope, Peter; Namuddu, Betty; Kalyango, Joan; Karamagi, Charles; Odere, Mathew; Katabira, Elly; Mugyenyi, Peter; Ssali, Francis
Many HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART). Methods: A retrospective cohort of 427 HIV-1 patients who were initiated on ART between January 2002 and December 2006 was studied. Data on ADCs was retrieved from Joint Clinical Research Centre (JCRC) data base and backed up by chart reviews. We employed Kaplan-Meier survival curves to estimate median time to 50 CD4 cells/μl from the baseline value to indicate a good immunological recovery process. Cox proportional hazard models were used at multivariate analysis. Results: The median time to gaining 50 CD4 cells/μl from the baseline value after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p = 0.027). At multivariate analysis after adjusting for age, sex, baseline CD4 count, baseline HIV viral load, total lymphocyte count and adherence level, factors that shortened the median time to immunological recovery after ART initiation were belonging to the non-ADC group (HR = 1.31; 95% CI: 1.03–1.28, p = 0.028), adherence to ART of ≥ 95% (HR = 2.22; 95% CI: 1.57–3.15, p = 0.001) and a total lymphocyte count ≥ 1200 cells/mm3 (HR = 1.84; 95% CI: 1.22–2.78, p = 0.003). A low baseline CD4 count of ≤ 200 cells/μl (HR = 0.52; 95% CI: 0.37–0.77, p = 0.001) was associated with a longer time to immunological recovery. There was no interaction between low CD4 counts and ADC group. Conclusion: Patients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality.
Factors Associated with Utilisation of Couple HIV Counselling and Testing Among HIV‑Positive Adults in Kyoga Fishing Community Uganda, May 2017: Cross Sectional Study
(AIDS and behavior, 2017) Nakiire, Lydia; Kabwama, Steven; Majwala, Robert; Bbale, Joy Kusiima; Makumbi, Issa; Kalyango, Joan; Kihembo, Christine; Masiira, Ben; Bulage, Lilian; Kadobera, Daniel; Ario, Alex Riolexus; Nsubuga, Peter
Couple HIV counseling and testing (CHCT) is key in preventing heterosexual HIV transmission and achievement of 90-90-90 UNAIDS treatment targets by 2020. We conducted secondary data analysis to assess utilization of CHCT and associated factors using logistic regression. 58/134 participants (49%) had ever utilized CHCT. Disclosure of individual HIV results to a partner [aOR = 16; 95% CI: (3.6–67)], residence for > 1 < 5 years [aOR = 0.04; 95% CI (0.005–0.33)], and none mobility [aOR = 3.6; 95% CI (1.1–12)] were significantly associated with CHCT. Age modified relationship between CHCT and disclosure (Likelihood-ratio test LR chi2 = 4.2 (p value = 0.041). Disclosure of individual HIV results with a partner and residence for more than 1 year improved utilization of CHCT; mobility reduced the odds of CHCT. Interventions should target prior discussion of individual HIV results among couples and mobile populations to increase CHCT.
Factors Associated with Utilisation of Couple HIV Counselling and Testing Among HIV‑Positive Adults in Kyoga Fishing Community Uganda, May 2017: Cross Sectional Study
(AIDS and behavior, 2020) Nakiire, Lydia; Kabwama, Steven; Majwala, Robert; Kusiima Bbale, Joy; Makumbi, Issa; Kalyango, Joan; Kihembo, Christine; Masiira, Ben; Bulage, Lilian; Kadobera, Daniel; Riolexus Ario, Alex; Nsubuga, Peter; Wanyenze, Rhoda
Couple HIV counseling and testing (CHCT) is key in preventing heterosexual HIV transmission and achievement of 90-90- 90 UNAIDS treatment targets by 2020. We conducted secondary data analysis to assess utilization of CHCT and associated factors using logistic regression. 58/134 participants (49%) had ever utilized CHCT. Disclosure of individual HIV results to a partner [aOR = 16; 95% CI: (3.6–67)], residence for > 1 < 5 years [aOR = 0.04; 95% CI (0.005–0.33)], and none mobility [aOR = 3.6; 95% CI (1.1–12)] were significantly associated with CHCT. Age modified relationship between CHCT and disclosure (Likelihood-ratio test LR chi2 = 4.2 (p value = 0.041). Disclosure of individual HIV results with a partner and residence for more than 1 year improved utilization of CHCT; mobility reduced the odds of CHCT. Interventions should target prior discussion of individual HIV results among couples and mobile populations to increase CHCT.
Factors Associated with Utilization of Insecticide-Treated Nets in Children Seeking Health Care at a Ugandan Hospital: Perspective of Child Caregivers
(Journal of community health, 2012) Nankinga, Ziadah; Kanaabi Muliira, Joshua; Kalyango, Joan; Nankabirwa, Joaniter; Kiwuwa, Steven; Njama-Meya, Denise; Karamagi, Charles
In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0–12 years seeking health care from a Ugandan hospital using caregiver’s reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age \5 years [37.0, 95% CI 31.81–42.21] as compared to children aged C5 years [22.9, 95% CI 13.77–32.01]. Source of mosquito net (OR = 13.53, 95% CI = 6.47–28.27), formal employment by head of household (OR = 6.00, 95% CI = 1.95–18.48), sharing a bed with parent (s) (OR = 2.61, 95% CI = 1.21–5.63) and number of children below 12 years in a household (OR = 0.80, 95% CI = 0.65–0.99), were significant predictors of utilization. ITN utilization among children was below the set national target. The predictors identified by this study reveal opportunities that can be taken advantage of by malaria control programs to achieve the desired rates of utilization and subsequently malaria prevention in children.
Hepatitis B vaccination status and associated factors among undergraduate students of Makerere University College of Health Sciences
(PLOS ONE, 2019) Wibabara, Yvette; Banura, Cecily; Kalyango, Joan; Karamagi, Charles; Kityamuwesi, Alex; Amia, Winfred Christine; Ocama, Ponsiano
Hepatitis B is a global health problem. Trainees in the health-related fields are exposed to occupational risk of Hepatitis B Virus. In Uganda, there is scarcity of information on vaccination among students in health-care. The objective of this study was to assess hepatitis B vaccination status of the students and factors associated.
Incidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenya
(PLoS ONE, 2014) Inzaule, Seth; Otieno, Juliana; Kalyango, Joan; Nafisa, Lillian; Kabugo, Charles; Nalusiba, Josephine; Kwaro, Daniel; Zeh, Clement; Karamagi, Charles
Limited antiretroviral treatment regimens in resource-limited settings require long-term sustainability of patients on the few available options. We evaluated the incidence and predictors of combined antiretroviral treatment (cART) modifications, in an outpatient cohort of 955 patients who initiated cART between January 2009 and January 2011 in western Kenya. Methods: cART modification was defined as either first time single drug substitution or switch. Incidence rates were determined by Poisson regression and risk factor analysis assessed using multivariate Cox regression modeling. Results: Over a median follow-up period of 10.7 months, 178 (18.7%) patients modified regimens (incidence rate (IR); 18.6 per 100 person years [95% CI: 16.2–21.8]). Toxicity was the most common cited reason (66.3%). In adjusted multivariate Cox piecewise regression model, WHO disease stage III/IV (aHR; 1.82, 95%CI: 1.25–2.66), stavudine (d4T) use (aHR; 2.21 95%CI: 1.49–3.30) and increase in age (aHR; 1.02, 95%CI: 1.0–1.04) were associated with increased risk of treatment modification within the first year post-cART. Zidovudine (AZT) and tenofovir (TDF) use had a reduced risk for modification (aHR; 0.60 95%CI: 0.38–0.96 and aHR; 0.51 95%CI: 0.29–0.91 respectively). Beyond one year of treatment, d4T use (aHR; 2.75, 95% CI: 1.25–6.05), baseline CD4 counts #350 cells/mm3 (aHR; 2.45, 95%CI: 1.14–5.26), increase in age (aHR; 1.05 95%CI: 1.02–1.07) and high baseline weight .60kg aHR; 2.69 95% CI: 1.58–4.59) were associated with risk of cART modification. Conclusions: Early treatment initiation at higher CD4 counts and avoiding d4T use may reduce treatment modification and subsequently improve sustainability of patients on the available limited options.
Level of and Factors Associated with Optimal Uptake of Intermittent Preventive Treatment for Malaria in Pregnancy at Private-Not-For profit Health Facilities in Kasese District
(PLOS Global Public Health, 2024-04-13) Mutoro, Julius; Kafunjo, Justus Barageine; Eric-Kitutu, Freddy; Kalyango, Joan; Mumbere, Iving; Nshakira, Nathan
Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6–56.4). Being married (aPR = 1.35, 95% CI = 1.06–1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09–1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39–0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57–0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.
Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-forprofit health facilities in Kasese district
(PLOS Global Public Health, 2024-04-03) Mutoro, Julius; Kafunjo, Justus Barageine; Kalyango, Joan; Nshakira, Nathan
Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6–56.4). Being married (aPR = 1.35, 95% CI = 1.06–1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09–1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39–0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57–0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.
Loss to follow up after pregnancy among mothers enrolled on the option Bþ program in Uganda
(Public Health in Practice, 2021) Kiirya, Yerusa; Musoke, Philippa; Adobea Odei Obeng-Amoako, Gloria; Kalyango, Joan
Option-Bþ programs in Uganda have reported high levels of loss to follow up (LTFU) after cessation of breastfeeding, and this remains unknown beyond this period. In this study, we assessed the incidence and factors associated with LTFU two to four years after delivery among Option-Bþ mothers. Study design: Retrospective cohort. Methods: We reviewed files of 452 mothers who enrolled on Option-Bþ between January 1st, 2013 and December 31st, 2014 at Kisenyi Health Centre IV in Kampala district. We assessed factors associated with LTFU using Cox proportional hazards regression. We also explored the reasons for LTFU using three focus group discussions, five in-depth and three key informant interviews. Results: Of the 452 mothers, 131(29%) were LTFU after delivery. The incidence of LTFU after delivery was 17/ 1000 person months (95% CI, 14–30/1000) with a median follow up of 32 months. The risk of LTFU was higher among mothers who started ART on the day they tested HIV positive (aHR ¼ 1.66, 95% CI; 1.25–2.20, p-value< 0.001). Reasons for LFTU included transport costs, stigma, poor human resource policies and non-disclosure. Conclusion: LTFU after delivery among Option-Bþ mothers is higher than the global target of 15%. ART initiation on the day a mother tests positive increases the risk of LTFU. The major reasons for LTFU were stigma and nondisclosure. To reduce the risk of LTFU, we recommend approaches that encourage disclosure to sexual partners and ongoing specific support to mothers who are initiated on ART-the day of positive test.
Measurement error of mean sac diameter and crown-rump length among pregnant women at Mulago hospital, Uganda
(BMC Pregnancy and Childbirth, 2018) Ali, Sam; Kusaba Byanyima, Rosemary; Ononge, Sam; Ictho, Jerry; Nyamwiza, Jean; Loro, Emmanuel Lako Ernesto; Mukisa, John; Musewa, Angella; Nalutaaya, Annet; Ssenyonga, Ronald; Kawooya, Ismael; Temper, Benjamin; Katamba, Achilles; Kalyango, Joan; Karamagi, Charles
Ultrasonography is essential in the prenatal diagnosis and care for the pregnant mothers. However, the measurements obtained often contain a small percentage of unavoidable error that may have serious clinical implications if substantial. We therefore evaluated the level of intra and inter-observer error in measuring mean sac diameter (MSD) and crown-rump length (CRL) in women between 6 and 10 weeks’ gestation at Mulago hospital. Methods: This was a cross-sectional study conducted from January to March 2016. We enrolled 56 women with an intrauterine single viable embryo. The women were scanned using a transvaginal (TVS) technique by two observers who were blinded of each other’s measurements. Each observer measured the CRL twice and the MSD once for each woman. Intra-class correlation coefficients (ICCs), 95% limits of agreement (LOA) and technical error of measurement (TEM) were used for analysis. Results: Intra-observer ICCs for CRL measurements were 0.995 and 0.993 while inter-observer ICCs were 0.988 for CRL and 0.955 for MSD measurements. Intra-observer 95% LOA for CRL were ± 2.04 mm and ± 1.66 mm. Inter-observer LOA were ± 2.35 mm for CRL and ± 4.87 mm for MSD. The intra-observer relative TEM for CRL were 4.62% and 3.70% whereas inter-observer relative TEM were 5.88% and 5.93% for CRL and MSD respectively. Conclusions: Intra- and inter-observer error of CRL and MSD measurements among pregnant women at Mulago hospital were acceptable. This implies that at Mulago hospital, the error in pregnancy dating is within acceptable margins of ±3 days in first trimester, and the CRL and MSD cut offs of ≥7 mm and≥ 25 mm respectively are fit for diagnosis of miscarriage on TVS. These findings should be extrapolated to the whole country with caution. Sonographers can achieve acceptable and comparable diagnostic accuracy levels of MSD and CLR measurements with proper training and adherence to practice guidelines.
Pneumococcal Carriage in Children under Five Years in Uganda- Will Present Pneumococcal Conjugate Vaccines Be Appropriate?
(PLoS ONE, 2016) Lindstrand, Ann; Kalyango, Joan; AlfveÂn, Tobias; Darenberg, Jessica; Kadobera, Daniel; Bwanga, Freddie; Peterson, Stefan; Henriques- Normark, Birgitta; KaÈllander, Karin
Pneumonia is the major cause of death in children globally, with more than 900,000 deaths annually in children under five years of age. Streptococcus pneumoniae causes most deaths, most often in the form of community acquired pneumonia. Pneumococcal conjugate vaccines (PCVs) are currently being implemented in many low-income countries. PCVs decrease vaccine-type pneumococcal carriage, a prerequisite for invasive pneumococcal disease, and thereby affects pneumococcal disease and transmission. In Uganda, PCV was launched in 2014, but baseline data is lacking for pneumococcal serotypes in carriage. Objectives To study pneumococcal nasopharyngeal carriage and serotype distribution in children under 5 years of age prior to PCV introduction in Uganda Methods Three cross-sectional pneumococcal carriage surveys were conducted in 2008, 2009 and 2011, comprising respectively 150, 587 and 1024 randomly selected children aged less than five years from the Iganga/Mayuge Health and Demographic Surveillance Site. The caretakers were interviewed about illness history of the child and 1723 nasopharyngeal specimens were collected. From these, 927 isolates of S. pneumoniae were serotyped.
Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda
(BMC infectious diseases, 2017) Amanya, Geofrey; Kizito, Samuel; Nabukenya, Immaculate; Kalyango, Joan; Atuheire, Collins; Nansumba, Hellen; Akena Abwoye, Stephen; Opio, Denis Nixon; Kibuuka, Edrisa; Karamagi, Charles
Hepatitis E is self-limiting, but can cause death in most at risk groups like pregnant women and those with preexisting acute liver disease. In developing countries it presents as epidemic, in 2014 Hepatitis E Virus (HEV) outbreak was reported in Napak district Uganda. The role of factors in this setting that might have propagated this HEV epidemic, including host, agent, and environmental characteristics, were still not clear. This study was therefore conducted to investigate the risk factors, person, place and time characteristics, associated with the hepatitis E virus (HEV) epidemic in Napak district. Methods: Review of line lists data for epidemiological description and matched case control study on neighborhood and age in the ratio of 1:2 were used to assess risk factors for HEV outbreak in Napak. Cluster and random sampling were used to obtain a sample size of 332, (111 cases, 221 controls). Possible interaction and confounding was assessed using conditional logistic regression. Results: Over 1359 cases and 30 deaths were reported during 2013/2014 HEV outbreak. The mean age of patients was 29 ± years, 57.9% of cases were females. Overall case Fatality Ratio was 2.2% in general population but 65.2% in pregnant women. More than 94% of the cases were reported in the sub counties of Napak, 5.7% of cases were reported in the outside neighboring districts. The epidemic peaked in January 2014 and gradually subsided by December 2014. Risk factors found to be associated with HEV included drinking untreated water (OR 6.69, 95% CI 3.15–14.16), eating roadside food (OR 6.11, 95% CI 2.85–13.09), reported not cleaning utensils (OR 3.24, 95% CI 1.55–1.76), and being a hunter (OR 1.14, 95% CI 1.03–12.66). Conclusion: The results of this study suggest that the virus is transmitted by the feco-oral route through contaminated water. They also suggest that active surveillance and appropriate measures targeting community and routine individual health actions are important to prevent transmission and decrease the deaths.
Socioeconomic and nutritional factors associated with age of eruption of third molar tooth among Ugandan adolescents
(Journal of forensic dental sciences, 2019) Mutebi Kutesa, Annet; Ndagire, Barbara; Ssanyu Nabaggala, Grace; Lutalo Mwesigwa, Catherine; Kalyango, Joan; Mugisha Rwenyonyi, Charles
This study aimed to establish the influence of socioeconomic and nutritional factors on the age of eruption of the mandibular third molar among Ugandans aged 10–20 years. Materials and Methods: This was a cross‑sectional study carried out in a dental clinic of Mulago Hospital between January and December 2017. The background information was obtained from the participants using a questionnaire in the form of an oral interview. The anthropometric measurements were obtained using a tape measure and a weighing scale, while dental radiographs were used to determine the eruption stages of the mandibular third molar. Statistical Analysis: The data were analyzed using STATA 13 and summarized using descriptive statistics and multivariate analyses. Statistical significance was inferred at P < 0.05. Results: Participants in the overweight body mass index category were statistically significantly associated with the age of the mandibular third molar eruption (P < 0.05) compared to their normal counterparts. There was no statistically significant association between socioeconomic status and age of eruption of third molar teeth (P > 0.05). Age of eruption was statistically significantly higher among males than females (P > 0.05). Conclusion: The findings of the present study reveal that overweight influences early eruption of the mandibular third molar tooth, although there is no trend between socioeconomic status and the age of eruption of the mandibular third molar.
Treatment Success and associated factors among patients with Pulmonary Tuberculosis attending Kampala Capital City Authority health facilities: A retrospective cohort study
(medRxiv, 2022) Tumusiime, Cathbert; Katamba, Achilles; Nakiyingi, Lydia; Kalyango, Joan
TB treatment success remains low in Uganda at 82%, below the recommended WHO target (≥90%). Consequences of poor treatment outcome include; increased MDR-TB prevalence, treatment costs and death. Kampala Capital City Authority (KCCA) public health facilities are congested which compromises the care given to pulmonary tuberculosis patients (PTB) that affects the treatment success of patients. However, there is scarce information regarding factors that are associated with treatment success among PTB patients in KCCA public health facilities. General Objective: To determine the treatment success and associated factors among patients with pulmonary tuberculosis attending KCCA public health facilities in Kampala between July 2019 and June 2020. Methods: A retrospective cohort study that involved review of records for 772 PTB patients who were enrolled on TB treatment in five KCCA health facilities from July 2019 to June 2020. Data on sociodemographic and clinical factors was abstracted from health facility TB registers. Data was entered in epidata and analyzed using STATA_v14 software. A modified poison regression model with robust standard errors was used in analysis and risk ratios were reported. Results: Treatment success was 87.2% (CI: 84.2%-89.1%), PTB patients who cured accounted for 413 (53.5%) and 260 (33.7%) completed treatment. Factors associated with PTB treatment success were: being classified as a clinically diagnosed PTB patients (aRR= 0.8, CI: 0.53 - 0.94, P value =0.021) and having a positive HIV/AIDS status (aRR= 0.7, CI: 0.43 - 0.88, P value =0.006) reduced treatment success and having a community volunteer as a treatment supporter was associated with increased treatment success (aRR= 1.2, CI: 1.06 - 3.28, P value =0.028). Conclusion: Over 80% of PTB patients in KCCA public health facilities achieve treatment success although this is still below the WHO target. Factors associated with TB treatment success include; being classified as a clinically diagnosed PTB patient, having a positive HIV/AIDS status as factors that reduce treatment success and having a community volunteer as a treatment supporter improves treatment success. Efforts such as consistent follow-ups should be encouraged among clinically diagnosed and HIV/AIDS positive PTB patients. Additionally, community volunteers should be empowered to support PTB patients.

Browsing by Author "Kalyango, Joan"

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