Browsing by Author "Kudamba, Ali"

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    Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management
    (International journal of hepatology, 2022) Mukasa Kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Drago Kato, Charles; Wampande, Eddie; Kajumbula, Henry; Kateete, David; Walusansa, Abdul; Kudamba, Ali; Edgar, Kigozi; Ashaba Katabazi, Fred; Namaganda, Maria Magdalene; Ssenku, Jamilu E.; Sendagire, Hakim
    Hepatitis B virus (HBV) is the leading cause of liver-related diseases. In Uganda, there is a regional disparity in the HBV burden. Our study was aimed at establishing the circulating genotypes in a low and a high endemic region to give plausible explanations for the differences in regional burden and guide the future management of the disease. Methods. A total of 200 HBsAg-seropositive subjects were recruited into the study by convenience sampling. The HBsAg Rapid Test Strip (Healgen Scientific Limited Liability Company, Houston, TX77047- USA) was used to screen for HBsAg while the Roche machine (Roche, Basel Switzerland/Abbot Technologies (USA)) was used to determine the viral load. The Chemistry Analyzer B120 (Mindray, China) was used for chemistry analysis. For HBV genotyping, total DNA was extracted from whole blood using the QIAamp® DNA extraction kit. Nested PCR amplification was performed using Platinum Taq DNA Polymerase (Invitrogen Corporation, USA) to amplify the 400 bp HBV polymerase gene. Purification of nested PCR products was performed using Purelink PCR product purification kit (Life Technologies, USA). Automated DNA sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit on 3130 Genetic Analyzer (Applied Biosystems, USA). The NCBI HBV genotyping tool (https://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi) was used for determination of genotype for each HBV sequence. Pearson’s chi-square, multinomial logistic regression, and Mann–Whitney U tests were used for the analysis. All the analyses were done using SPSS version 26.0 and MedCalc software version 19.1.3 at 95% CI. A p < 0:05 was considered statistically significant. Results. Majority of our study subjects were female (64.5%), youth (51.0%), and married (62.0%). Overall, genotype A was the most prevalent (46%). Genotype D and the recombinant genotype D/E were proportionately more distributed in the high endemic (38.2%) and low endemic (36.5%) regions, respectively. Genotype D was significantly more prevalent in the high endemic region and among the elderly (p < 0:05). Genotype D was significantly associated with elevated viral load and direct bilirubin (p < 0:05). The recombinant genotype D/E was significantly associated with elevated viral load (p < 0:05). Similarly, genotype A was significantly associated with elevated AST and GGT, lowered viral load, and normal direct bilirubin levels (p < 0:05). Conclusion. There is disproportionate distribution of genotypes A and D and the recombinant genotype D/E in the low and high endemic regions of Uganda. This probably could explain the differences in endemicity of HBV in our country signifying the need for regional specific HBV management and control strategies.
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    Malaria Prevalence and Risk Factors in University Communities of Eastern Uganda: a case of Islamic University in Uganda
    (Research Square, 2021) Elmi Warsame, Abdishakur; Ssenku, Jamilu Edrisa; Alemu Okurut, Shaban; Luwaga Mpagi, Joseph; Iramiot, Jacob Stanley; Kudamba, Ali; Nkambo, Mujibu; Namuli, Aidah; Nakizito, Joweria; Gidudu, George; Nabuuma, Hawa; Mukasa Kafeero, Hussein; Nachuha, Sarah; Walusansa, Abdul
    Malaria remains the world’s leading vector-born cause of mortality and morbidity, and Eastern Uganda contains some of the country’s highest prevalence rates. Though academic societies, such as universities, may be prone to high malaria transmission, the extent of the burden and risk factors in university communities of Eastern Uganda are poorly understood. The aim in this study was to examine malaria prevalence, preventive strategies, and risk factors, among University communities in Eastern Uganda; to inform targeted malaria eradication efforts in academic settings. Methods: A mixed methods approach was applied. A case study of Islamic University in Uganda (IUIU), located in Eastern Uganda, was selected. A retrospective approach was used to determine malaria prevalence in IUIU from August to December 2019. Stratified random sampling was used to select IUIU community members; these were subjected to semi-structured questionnaires and Key informant Interviews (KII) to examine the preventive approaches and risk factors. An observational survey was also conducted to identify barriers to malaria prevention. Data was analyzed using descriptive statistics, graphs, Chisquare, and pictures; with STATA version-15.0. Results: The study involved 255 respondents (204, 80% students, 51, 20% staff); 130, 51% were males, 125, 49% were females. Malaria prevalence was; 12.9%, 11.7% and 12.7% for students, staff, and the general study population respectively. Lowest prevalence was registered in November (8.3% for students, 0% for staff), and the highest in December (18.4% for students, 6.7% for staff). Overall malaria prevalence in IUIU was significantly greater than Uganda’s national prevalence (χ2=182.009; p<0.0001; 95%CI). The commonest intervention was, sleeping under insecticide-treated mosquito-nets (96%), and the rarest was usage of medicinal herbs (15%). Though 41 (17.5%) of respondents who used mosquito-nets never suffered malaria, usage of mosquito-nets was not significantly associated with absence of malaria infection (p = 0.83). The same applied for other interventions except timely testing and treatment (p = 0.02). Most frequently mentioned risk factors were; improper use of mosquito nets (214, 84%), inappropriate depositing of garbage (196, 77%), and “staying out late” (133, 52%). Key barriers to malaria prevention observed were; usage of damaged bed nets (38, 19% of 198), clogged trenches with liquid wastes, and perforated wire meshes in ventilators. Conclusion: The overall prevalence of malaria in IUIU community was 12.7%; and was significantly higher than Uganda’s national prevalence (7%). Usage of insecticide-treated bed-nets was the commonest intervention, but showed no statistically significant association with malaria non-prevalence. Awareness programs should be enhanced to address inappropriate use of malaria control methods/tools, because the widespread adoption of these interventions alone did not effectively curb the burden.
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    Perceived Risk and Knowledge of COVID-2019 Community Transmission among Local Council Leaders in Rural Districts of Eastern Uganda
    (Research Square, 2020) Walusansa, Abdul; Iramiot, Jacob Stanley; Kudamba, Ali; Alemu Okurut, Shaban; Mpagi, Joseph; Namuli, Aidah; Nabuuma, Hawa; Wasige, Godfrey; Kafeero, Hussein M.; Ssenku, Jamil
    Corona virus disease (COVID-19) is one of the topmost global hindrances to human existence. Rural settings have been reported to be more vulnerable in some parts of the world. In Uganda, local council (LC) leaders in rural districts are among the immediate personnel mandated to support compliance with preventive guidelines, and to identify and report/deliver COVID-19 cases to health units. We examined the potential risk of COVID-19 transmission, knowledge levels, perceptions & opinions of LC leaders in selected districts in Eastern Uganda, to support the design of risk-based COVID-19 control measures in rural settings, to protect lives better. Methods: A convenience sample was taken from village council leaders in the selected districts. Pretested questionnaires and in-depth interviews were used to assess the knowledge levels, perceptions, and opinions of respondents about COVID-19. An observational survey was also conducted to examine the barriers that might deter effective control of COVID-19, with reference to health guidelines set by the Ugandan government and the World Health Organization. Data was analyzed using HyperRESEARCH 2.8 software, and STATA version-15.0. Results and discussion: Eighty percent of local council leaders reported that they were formally engaged in the fight against COVID-19 in their communities, and the common means of engagement were; dissemination of COVID-19 information by word of mouth, regulation of public events, and monitoring of visitors that come from distant places. All clients reported having received some information about this pandemic, but there was generally low knowledge on some vital aspects: 70% of the respondents did not know the meaning of COVID-19; 100% were uninformed on these common symptoms; headache, sore throat, nausea, and loss of taste & smell; 10% did not know if willingness to conform to health guidelines may affect COVID-19 prevention, and they believed that domestic animals are viable vectors. Radio was the commonest source of COVID-19 information, but it was confounded by poor quality of radio-signals. Most respondents were of the view that in the communities they lead; inaccessibility to authentic health information, financial constraints, and belief that COVID-19 is a fallacy, were some of the leading obstacles to the fight against the pandemic. Low awareness and misconceptions on COVID-19 could be explained by; technological challenges, low literacy levels, and dissemination of wrong information about this pandemic. From the observational survey, the major factors which might intensify the risk of COVID- 19 spread were: scarcity of requirements for hand hygiene, face protection, violation of health guidelines & directives, porous borders, terrain, and use of potentially polluted open water sources. Conclusion and recommendations: Rural communities in Eastern Uganda are vulnerable to the drastic spread of COVID-19, due to challenges related to: low awareness of COVID-19, reluctance in complying with preventive guidelines, finance, technology, terrain, porous borders, illiteracy and scarcity of protective wear and hygiene resources. Awareness creation, material aid, execution of preventive rules, and more research on COVID-19 are warranted.
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    Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020
    (Archives of Public Health, 2021) Mukasa Kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Kudamba, Ali; Walusansa, Abdul; Sendagire, Hakim
    The epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region. Methods: We examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I2 statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg’s tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and subgroup analysis at 95% CI. P < 0.05 was considered significant for all analyses. Results: The prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg’s test showed no evidence of publication bias for overall meta-analysis (p > 0.05). Conclusion: The burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.