NRU :: Browsing by Author "Ogwang, Martin D."

Browsing by Author "Ogwang, Martin D."

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African Burkitt Lymphoma: Age-Specific Risk and Correlations with Malaria Biomarkers
(The American journal of tropical medicine and hygiene, 2011) Emmanuel, Benjamin; Kawira, Esther; Ogwang, Martin D.; Wabinga, Henry; Magatti, Josiah; Nkrumah, Francis; Neequaye, Janet; Bhatia, Kishor; Brubaker, Glen; Biggar, Robert J.; Mbulaiteye, Sam M.
African Burkitt lymphoma is an aggressive B-cell, non-Hodgkin lymphoma linked to Plasmodium falciparum malaria. Malaria biomarkers related to onset of African Burkitt lymphoma are unknown. We correlated agespecific patterns of 2,602 cases of African Burkitt lymphoma (60% male, mean ± SD age = 7.1 ± 2.9 years) from Uganda, Ghana, and Tanzania with malaria biomarkers published from these countries. Age-specific patterns of this disease and mean multiplicity of P. falciparum malaria parasites, defined as the average number of distinct genotypes per positive blood sample based on the merozoite surface protein-2 assessed by polymerase chain reaction, were correlated and both peaked between 5 and 9 years. This pattern, which was strong and consistent across regions, contrasted parasite prevalence, which peaked at 2 years and decreased slightly, and geometric mean parasite density, which peaked between 2 and 3 years and decreased sharply. Our findings suggest that concurrent infection with multiple malaria genotypes may be related to onset of African Burkitt lymphoma.
Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda
(Journal of Acquired Immune Deficiency Syndromes, 2018) Spittal, Patricia M.; Malamba, Samuel S.; Ogwang, Martin D.; Musisi, Seggane; Ekwaru, J. Paul; Sewankambo, Nelson K.; Pearce, Margo E.; Jongbloed, Kate; Patel, Sheetal H.; Katamba, Achilles; Blair, Alden H.; Muyinda, Herbert; Schechter, Martin T.
As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence. Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda. Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender. Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, ,0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing $12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner $10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40). Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Traumainformed HIV prevention and culturally safe mental health initiatives are urgently required.
Cango Lyec (Healing the Elephant): HIV incidence in post-conflict Northern Uganda
(EClinicalMedicine, 2020) Katamba, Achilles; Ogwang, Martin D.; Zamar, David S.; Muyinda, Herbert; Oneka, Alex; Atim, Stella; Jongbloed, Kate; Malamba, Samuel S.; Odongping, Tonny; Friedman, Anton J.; Spittal, Patricia M.; Sewankambo, Nelson K.; Schechter, Martin T.
Civil war in Northern Uganda resulted in widespread atrocities, human rights violations, and death, and caused millions to flee to internally displaced persons camps. War-related traumas combined with difficulties accessing HIV prevention and health services has led to extreme HIV-related vulnerability among conflict-affected people who survived the war. Objectives were to (1) determine HIV incidence among conflict-affected people in Northern Uganda and (2) identify vulnerabilities associated with HIV infection. Methods: The Cango Lyec (Healing the Elephant) Project is a prospective cohort involving conflict-affected populations in three districts in Northern Uganda. In 2011, eight randomly selected communities were mapped, and a census was conducted. Consenting participants aged 13 49 years were followed over three rounds of follow-up. Longitudinal data collected included war-related experiences, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV-1 at baseline and each 12-month follow-up. Multivariable Cox proportional hazard models determined factors associated with HIV incidence. Findings: Overall, 1920 baseline HIV-negative participants with at least one follow-up contributed 3877 person-years (py) for analysis. Thirty-nine (23 female, 16 male) participants contracted HIV during follow-up. Age- and gender-standardised HIV incidence rate was 102 per 1000py (95%CI: 72-140). Stratified by sex, the age-adjusted HIV incidence was 110 per 1000py (95%CI: 69-166) among women and 94 per 1000py (95%CI: 53-153) among men. Adjusting for confounders, factors associated with risk of HIV included: having been abducted (HR: 370; 95%CI: 187-734), experiencing 12 war-related traumatic events (HR: 291 95%CI: 128-660), suicide ideation (HR: 283; 95%CI: 100-803), having 2 sexual partners (HR: 468; 95%CI: 136-1605), inconsistent condom use (HR: 675; 95%CI: 249-1829), and self-reported genital ulcers (HR: 439; 95%CI: 204-945). Interpretation: Conflict-affected participants who had experienced abduction and multiple traumas during the war were at greater risk of HIV infection. Trauma-informed HIV prevention and treatment services, and culturally-safe mental health initiatives, are urgent for Northern Uganda
The Cango Lyec Project - Healing the Elephant”: HIV related vulnerabilities of post-conflict affected populations aged 13–49 years living in three Mid-Northern Uganda districts
(BMC Infectious Diseases, 2016) Malamba, Samuel S.; Muyinda, Herbert; Spittal, Patricia M.; Ekwaru, John P.; Kiwanuka, Noah; Ogwang, Martin D.; Odong, Patrick; Kitandwe, Paul K.; Katamba, Achilles; Jongbloed, Kate; Sewankambo, Nelson K.; Kinyanda, Eugene; Blair, Alden; Schechter, Martin T.
The protracted war between the Government of Uganda and the Lord’s Resistance Army in Northern Uganda (1996–2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce. Methods: The ‘Cango Lyec’ Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13–49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline. Results: A total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31–4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06–1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28–2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34–2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive. Conclusions: HIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.
A case-control study of Burkitt lymphoma in East Africa: are local health facilities an appropriate source of representative controls?
(Infectious Agents and Cancer, 2012) Baik, Sonya; Mbaziira, Mike; Williams, Makeda; Ogwang, Martin D.; Kinyera, Tobias; Emmanuel, Benjamin; Ziegler, John L.; Reynolds, Steven J.; Mbulaiteye, Sam M.
We investigated the feasibility and appropriateness of enrolling controls for Burkitt lymphoma (BL) from local health facilities in two regions in Uganda. Methods: BL case data were compiled from two local hospitals with capacity to diagnose and treat BL in Northwest and North-central regions of Uganda during 1997 to 2009. Local health facility data were compiled from children attending four representative local health facilities in the two regions over a two week period in May/June 2010. Age and sex patterns of BL cases and children at local facilities were compared and contrasted using frequency tables. Results: There were 999 BL cases diagnosed in the study area (92% of all BL cases treated at the hospitals): 64% were from North-central and 36% from North-west region. The mean age of BL cases was 7.0 years (standard deviation [SD] 3.0). Boys were younger than girls (6.6 years versus 7.2 years, P = 0.004) and cases from North-central region were younger than cases from North-west region (6.8 years versus 7.3 years, P = 0.014). There were 1012 children recorded at the four local health facilities: 91% at facilities in North-central region and 9% from facilities in North-west region. Daily attendance varied between 1 to 75 children per day. The mean age of children at health facilities was 2.2 years (SD 2.8); it did not differ by sex. Children at North-central region facilities were younger than children at North-west region facilities (1.8 years versus 6.6 years, P < 0.001). Conclusions: While many children attend local health facilities, confirming feasibility of obtaining controls, their mean age is much lower than BL cases. Health facilities may be suitable for obtaining young, but not older, controls.
Incidence and geographic distribution of endemic Burkitt lymphoma in northern Uganda revisited
(International journal of cancer, 2008) Ogwang, Martin D.; Bhatia, Kishor; Biggar, Robert J.; Mbulaiteye, Sam M.
Endemic Burkitt lymphoma (BL) is etiologically associated with Epstein-Barr virus and ecologically linked to Plasmodium falciparum malaria. However, these infections imperfectly correlate with BL epidemiology. To obtain recent epidemiological data, we studied district- and county-specific BL incidence and standardized incidence ratios using data collected from 1997 to 2006 at Lacor Hospital in northern Uganda, where studies were last done more than 30 years ago. Among 500 patients, median age was 6 years (interquartile range 5–8) and male-to-female ratio was 1.8:1. Among those known, most presented with abdominal (56%, M:F 1.4:1) vs. only facial tumors (35%, M:F 3.0:1). Abdominal tumors occurred in older (mean age: 7.0 vs. 6.0 years; p < 0.001) and more frequently in female children (68% vs. 50%; OR 2.2, 95% CI 1.5– 3.5). The age-standardized incidence was 2.4 per 100,000, being 0.6 in 1–4 year olds, 4.1 in 5–9 year olds and 2.8 in 10–14 year olds and varied 3- to 4-fold across districts. The incidence was lower in districts that were far from Lacor and higher in districts that were close to Lacor. Although districts close to Lacor were also more urbanized, the incidence was higher in the nearby perirural areas. We highlight high-BL incidence and geographic variation in neighboring districts in northern Uganda. Although distance from Lacor clearly influenced the patterns, the incidence was lower in municipal than in surrounding rural areas. Jaw tumors were characterized by young age and male gender, but presentation has shifted away from facial to mostly abdominal.
Mean platelet counts are relatively decreased with malaria but relatively increased with endemic Burkitt Lymphoma in Uganda, Tanzania, and Kenya
(British journal of haematology, 2020) Peprah, Sally; Ogwang, Martin D.; Kerchan, Patrick; Reynolds, Steven J.; Tenge, Constance N.; Were, Pamela A.; Kuremu, Robert T.; Wekesa, Walter N.; Masalu, Nestory; Kawira, Esther; Kinyera, Tobias; Otim, Isaac; Legason, Ismail D.; Nabalende, Hadijah; Dhudha, Herry; Mumia, Mediatrix; Ayers, Leona W.; Biggar, Robert J.; Bhatia, Kishor; Goedert, James J.; Mbulaiteye, Sam M.
Platelet counts are decreased in Plasmodium falciparum malaria, which is aetiologically linked with endemic Burkitt lymphoma (eBL). However, the pattern of platelet counts in eBL cases is unknown. We studied platelet counts in 582 eBL cases and 2 248 controls enrolled in a case-control study in Uganda, Tanzania and Kenya (2010–2016). Mean platelet counts in controls or eBL cases with or without malaria-infection in controls versus eBLcases were compared using Student’s t-test. Odds ratios (ORs) and two-sided 95% confidence intervals (95% CIs) were estimated using multiple logistic regression, controlling for age, sex, haemoglobin and white blood cell counts. Platelets were decreased with malaria infection in the controls [263 vs. 339 9 109 platelets/l, P < 0 0001; adjusted OR (aOR) = 3 42, 95% CI: 2 79–4 18] and eBL cases (314 vs. 367 9 109 platelets/ l, P-value = 0 002; aOR = 2 36, 95% CI: 1 49–3 73). Unexpectedly, platelets were elevated in eBL cases versus controls in overall analyses (mean: 353 vs. 307 9 109 platelets/l, P < 0 0001; aOR = 1 41; 95% CI: 1 12–1 77), and when restricted to malaria-positive (mean 314 vs. 263 9 109 platelets/ l, P < 0 0001; OR = 2 26; 95% CI: 1 56–3 27) or malaria-negative (mean 367 vs. 339 9 109 platelets/l, P < 0 001; OR = 1 46; 95% CI: 1 17–1 83) subjects. Platelets were decreased with malaria infection in controls and eBL cases but elevated with eBL.
Plasma magnesium is inversely associated with Epstein-Barr virus load in peripheral blood and Burkitt lymphoma in Uganda
(Cancer epidemiology,, 2018) Juan, Ravell; Otim, Isaac; Nabalende, Hadijah; Legason, Ismail D.; Reynolds, Steven J.; Ogwang, Martin D.; Ndugwa, Christopher M.; Marshall, Vickie; Whitby, Denise; Goedert, James J.; Engels, Eric A.; Bhatia, Kishor; Lenardo, Michael J.; Mbulaiteye, Sam M.
Epstein-Barr virus (EBV) causes endemic Burkitt lymphoma (eBL). EBV control was improved by magnesium (Mg2+) supplementation in XMEN, an X-linked genetic disease associated with Mg2+ deficiency, high circulating EBV levels (viral loads), and EBV-related lymphomas. We, therefore, investigated the relationship between Mg2+ levels and EBV levels and eBL in Uganda. Methods: Plasma Mg2+ was measured in 45 women with low or high circulating EBV levels, 40 pediatric eBL cases, and 79 healthy children. Mg2+ uptake by T-lymphocytes was evaluated in samples from healthy donors. Results: Plasma Mg2+ deficiency (plasma level<1.8 mg/dl) was more likely in women with high- vs. low-EBV levels (76.0% vs. 35%; odds ratio [OR] 11.3, 95% CI 2.14–60.2), controlling for age, and in eBL cases than controls (42.0% vs. 13.9%; OR 3.61, 95% CI 1.32–9.88), controlling for sex, age group, and malaria status. Mg2+ uptake by T-lymphocytes was related to extracellular Mg2+ concentration. Interpretation: Plasma Mg2+ deficiency is associated with high EBV levels and eBL.
Risk factors for Burkitt lymphoma in children in East Africa
(Research Square, 2019) Peprah, Sally; Ogwang, Martin D.; Kerchan, Patrick; Reynolds, Steven J.; Tenge, Constance N.; Were, Pamela A.; Kuremu, Robert T.; Wekesa, Walter N.; Sumb, Peter O.; Masalu, Nestory; Kawira, Esther; Magatti, Josiah; Kinyera, Tobias; Otim, Isaac
Endemic Burkitt lymphoma (eBL), a malignancy of immune B cells, is the most common childhood cancer in sub-Saharan Africa eBL is curable when it's identified early, but it's rapidly fatal without treatment Children in sub-Saharan Africa are over 50 times more likely to develop eBL than children living anywhere else in the world Unfortunately, few studies have examined the risk factors associated with eBL To address that gap, researchers conducted a study of eBL in children in three countries in East Africa They analyzed the relationship between eBL and infections, environmental, and genetic risk factors and focused their conclusions on results observed in at least two countries to minimize false-positives Risk of eBL was associated with low socio-economic status inpatient malaria treatment and living in areas targeted for malaria suppression In addition to exploring eBL risk factors, this study also demonstrates the potential to study cancer risk in East Africa and to detect, treat, or prevent eBL Learn more at emblem.cancer.gov Peprah et al. Risk factors for Burkitt lymphoma in East African children and minors. Int. J. Cancer. (2019)
Thirty-day postoperative outcome of patients with non-traumatic gastroduodenal perforations in southwestern Uganda
(Tropical Doctor, 2020) Okidi, Ronald; Sambo, Vanusa D.; Ogwang, Martin D.; Mutiibwa, David; Benitez, Noralis P.; Bongomin, Felix
We studied our 30-day postoperative outcomes in patients with non-traumatic gastroduodenal perforation (NTGDP) in Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a one-year prospective study of patients who underwent exploratory laparotomy for suspected NTGDP between June 2016 and July 2017. Twenty-nine patients had NTGDP, the male-to-female ratio was 3:1 and median age was 60 years (range¼13–80 years). Most (83%) patients were negative for Helicobacter pylori on histology. One patient had a gastric adenocarcinoma. A total of 26 (90%) patients had Graham’s omentopexy performed. The 30-day mortality rate was 34%. Pyrexia at hospital admission, pre-surgical delay (> 72 h), preoperative shock and peritoneal contamination, were associated with higher mortality rates with preoperative shock being an independent predictor of mortality. H. pylori-negative NTGDP presents a unique challenge in our setting, affecting mainly middle-aged and elderly patients. One-third of our patients did not survive one month.

Browsing by Author "Ogwang, Martin D."

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