Browsing by Author "Kiwanuka, Gertrude N."

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    Alcohol Exposure among Pregnant Women in Sub-Saharan Africa: A Systematic Review
    (Canadian Society of Pharmacology and Therapeutics, 2013) Culley, Celia L.; Ramsey, Tasha D.; Mugyenyi, Godfrey; Kiwanuka, Gertrude N.; Ngonzi, Joseph; MacLeod, Stuart; Koren, Gideon; Grunau, Brian E.; Wiens, Matthew O.
    The prevalence of general alcohol use in many countries of sub-Saharan Africa (SSA) is high. However, research examining alcohol use in among pregnant women within this population is limited. A review of the current status of research examining the prevalence of alcohol exposed pregnancies (AEP) is required to inform future research aiming to decrease this occurrence and its subsequent socio-economic complications. Objective The primary objective was to identify all published papers estimating prevalence and risk-factors of alcohol use among pregnant women in SSA. A secondary objective was to determine changes in alcohol use following pregnancy recognition. Methods PubMed/Medline, Embase, IPA, CINAHL were systematically searched using MeSH terms and keywords from inception date to March 2013. Studies from SSA reporting prevalence of alcohol use among pregnant women were included. Results Twelve studies were identified. Studies varied significantly according to design and study population. Prevalence of alcohol use during pregnancy ranged from 2.2%-87%. The most important risk-factors for alcohol use included tobacco use, partner violence, urban living, and having a male partner who drank alcohol. Only three studies examined changes in alcohol use prior to and following pregnancy recognition with absolute reductions of between 9% and 15%. Conclusions Although the burden of alcohol use during pregnancy is likely a significant problem, limited data currently exist for the majority of SSA countries. Furthermore, significant variation likely exists within various populations. Further research is required to explore alcohol use in pregnancy. Strategies to decrease AEP must be developed and implemented in standard pre-natal care.
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    Dynamics of Plasmodium falciparum alleles in children with normal haemoglobin and with sickle cell trait in western Uganda
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2009) Kiwanuka, Gertrude N.; Joshib, Hema; Isharazaa, William K.; Eschrichc, Klaus
    We describe the diversity of Plasmodium falciparum populations in western Uganda and assess the role that asymptomatic malaria carriers with sickle cell trait (HbAS) may be playing on the Plasmodium population structure. We genotyped P. falciparum in 291 samples using merozoite surface protein (MSP) 1 and 2 loci. Extensive genetic diversity was detected among symptomatic children in Mbarara (20 MSP1 alleles; 31 MSP2 alleles) and Kagando, Kasese (19 MSP1 alleles; 30 MSP2 alleles). Multiplicity of infection (MOI) was significantly higher in Kagando, Kasese than in Mbarara, with 2.7 and 2.1 genotypes/PCR positive sample with MSP2 marker, respectively. Similar strains were circulating in the two sites; however, a few strains specific to individual sites were observed. Prevalence of HbAS was 36% (12/33) among asymptomatic children in Kisinga sub-county, Kasese. In asymptomatic children, MOI was age-dependent and higher in HbAS carriers than HbAA, suggesting that HbAS carriers harbour a wider range of P. falciparum genotypes. Sickle cell trait may influence rapid acquisition of premunition by creating a reservoir of variant parasite strains in the host. The high level of genetic diversity demonstrated here shows that even in areas with low or seasonal transmission, high levels of parasite polymorphism can occur.
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    Evaluation of the Deki Reader™, an automated RDT reader and data management device, in a household survey setting in low malaria endemic southwestern Uganda
    (Malaria Journal, 2017) Oyet, Caesar; Roh, Michelle E.; Kiwanuka, Gertrude N.; Orikiriza, Patrick; Wade, Martina; Parikh, Sunil; Mwanga‑Amumpaire, Juliet; Boum, Yap
    Early diagnosis of suspected malaria cases with a rapid diagnostic test (RDT) has been shown to be an effective malaria control tool used in many resource-constrained settings. However, poor quality control and quality assurance hinder the accurate reporting of malaria diagnoses. Recent use of a portable, battery operated RDT reader (Deki Reader™, Fio Corporation) has shown to have high agreement with visual inspection across diverse health centre settings, however evidence of its feasibility and usability during cross sectional surveys are limited. This study aimed to evaluate the performance of the Deki Reader™ in a cross-sectional survey of children from southwestern Uganda. Methods: A two-stage, stratified cluster sampling survey was conducted between July and October 2014 in three districts of southwestern Uganda, with varying malaria transmission intensities. A total of 566 children aged 6–59 months were included in the analysis. Blood samples were collected and tested for malaria using: the SD Bioline Malaria Ag Pf/Pan RDT and microscopy. Results were compared between visual inspection of the RDT and by the Deki Reader™. Diagnostic performance of both methods were compared to gold-standard microscopy. Results: The sensitivity and specificity of the Deki Reader™ was 94.1% (95% CI 69.2–99.6%) and 95.6% (95% CI 93.4–97.1%), respectively. The overall percent agreement between the Deki Reader™ and visual RDT inspection was 98.9% (95% CI 93.2–99.8), with kappa statistic of 0.92 (95% CI 0.85–0.98). Conclusions: The findings from this study suggest that the Deki Reader™ is comparable to visual inspection and performs well in detecting microscopy-positive Plasmodium falciparum cases in a household survey setting. However, the reader’s performance was highly dependent on ensuring adequate battery life and a work environment free of dirt particles.
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    Genetic diversity in Plasmodium falciparum merozoite surface protein 1 and 2 coding genes and its implications in malaria epidemiology: a review of published studies from 1997–2007
    (Journal of vector borne diseases, 2009) Kiwanuka, Gertrude N.
    A major characteristic of human malaria parasites is their genetic diversity and an increasing number of studies have been reported on the epidemiology of Plasmodium falciparum, mainly focusing on the polymorphism of merozoite surface protein (MSP) 1 and 2 genes. A myriad of information on the genetic diversity and multiplicity of P. falciparum infections has been generated from such studies, and a range of molecular tools for epidemiological studies were produced, creating both optimism and pessimism in regard to the global efforts to control malaria. The objective of this review is to provide current and comprehensive information on the diversity in the gene that encodes the merozoite surface protein (MSP) 1 and 2 of P. falciparum and its implications on the epidemiology of malaria, immunity and development of control measures, and point out some research themes that need to be explored further by utilizing molecular techniques currently at our disposal. Articles published in journals between 1997 and 2007 are herein reviewed.
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    Iron status of pregnant women at first antenatal booking in Mbarara University Teaching Hospital
    (Tropical doctor, 1999) Kiwanuka, Gertrude N.; Isharaza, W. K.; Mahmoud, S.
    An assessment of iron status was made on 96 pregnant women and 29 non-pregnant, non-lactating menstruating women of comparable age group as controls. Anaemia (haemoglobin < 110 g/l) was present in 84.4% of the pregnant women and in 48.3% of the control group. Iron deficiency (serum ferritin < 12.0 pg/l) was present in 51.1% of the pregnant group and 37.9% of the control group. Prevalence of anaemia with iron deficiency was 54.7% in anaemic pregnant women. Serum ferritin correlated significantly with low haemoglobin (P < 0.05). Median serum ferritin declined progressively until 3 1 weeks of gestation. Preliminary studies on their dietetics showed that low animal protein consumption and poor dietary iron bioavailability were associated with anaemia.
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    Malaria morbidity and mortality in Uganda
    (Journal of vector borne diseases, 2003) Kiwanuka, Gertrude N.
    Malaria is the leading cause of morbidity and mortality in Uganda especially in children under five years. Transmission of malaria is perennial though there are seasonal exacerbations. Up to 70 per cent of outpatient cases and over 50 per cent of inpatient admissions in the under fives are malaria cases. It is responsible for a specific death rate among this age group of 37/1000 and 18/1000 live births in high and low malaria endemic areas respectively or a total of 70,000–110,000 child health deaths annually. It is also the major killer of refugees and internally displaced people in Uganda. Malaria cases increased from 1,444,352 in 1995 to 2,923,620 in 1999.
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    Microalbuminuria and Traditional Serum Biomarkers of Nephropathy among Diabetic Patients at Mbarara Regional Referral Hospital in South Western Uganda
    (Journal of diabetes research, 2019) Kiconco, Ritah; Rugera, Simon Peter; Kiwanuka, Gertrude N.
    Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives. To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods. This cross-sectional study involved 140 participants with diabetes mellitus (DM) attending the diabetic clinic of Mbarara Regional Referral Hospital. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Serum creatinine and uric acid and glucose levels were determined by spectrophotometric methods. Results. The overall prevalence of microalbuminuria was 22.9%. Using a simple and multiple linear regression model, serum creatinine (β = 0:010, 95% CI (0.005, 0.014), P = 0:0001) and glucose (β = 0:030, 95% CI (0.011, 0.048), P = 0:0017) levels were significantly associated with microalbuminuria. After adjusting for linearity, family history of DM was the only predictor of microalbuminuria (β = 0:275, 95% CI (0.043, 0.508), P = 0:002). Although microalbuminuria was weakly associated with eGFR (OR = 1:2, 95% CI (0.24, 5.96)), the relationship was not statistically significant (P = 0:824). Conclusion. The prevalence of microalbuminuria in patients with diabetes in this study was high. The study suggests the need to screen for microalbuminuria early to reduce the possible burden of ESRD. When serum creatinine is used as a renal function marker among diabetic patients, it should be combined with microalbuminuria for better assessment of incipient nephropathy