Browsing by Author "Olupot, Peter Olupot"
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Item The Bacterial and Viral Complexity of Postinfectious Hydrocephalus in Uganda(Science translational medicine, 2020) Paulson, Joseph N.; Williams, Brent L.; Hehnly, Christine; Mishra, Nischay; Sinnar, Shamim A.; Zhang, Lijun; Ssentongo, Paddy; Kabachelor, Edith Mbabazi; Wijetunge, Dona S. S.; Bredow, Benjamin von; Mulondo, Ronnie; Kiwanuka, Julius; Bajunirwe, Francis; Bazira, Joel; Bebell, Lisa M.; Burgoine, Kathy; Couto-Rodriguez, Mara; Ericson, Jessica E.; Erickson, Tim; Ferrari, Matthew; Gladstone, Melissa; Guo, Cheng; Haran, Murali; Hornig, Mady; Isaacs, Albert M.; Kaaya, Brian Nsubuga; Kangere, Sheila M.; Kulkarni, Abhaya V.; Kumbakumba, Elias; Li, Xiaoxiao; Limbrick, David D.; Magombe, Joshua; Morton, Sarah U.; Mugamba, John; Ng, James; Olupot, Peter Olupot; Onen, Justin; Peterson, Mallory R.; Roy, Farrah; Sheldon, Kathryn; Townsend, Reid; Weeks, Andrew D.; Whalen, Andrew J.; Quackenbush, John; Ssenyonga, Peter; Galperin, Michael Y.; Almeida, Mathieu; Atkins, Hannah; Warf, Benjamin C.; Lipkin, W. Ian; Broach, James R.; Schiff, Steven J.Postinfectious hydrocephalus (PIH), often following neonatal sepsis, is the most common cause of pediatric hydrocephalus world-wide, yet the microbial pathogens remain uncharacterized. Characterization of the microbial agents causing PIH would lead to an emphasis shift from surgical palliation of cerebrospinal fluid (CSF) accumulation to prevention. We examined blood and CSF from 100 consecutive cases of PIH and control cases of non-postinfectious hydrocephalus (NPIH) in infants in Uganda. Genomic testing was undertaken for bacterial, fungal, and parasitic DNA, DNA and RNA sequencing for viral identification, and extensive bacterial culture recovery. We uncovered a major contribution to PIH from Paenibacillus, upon a background of frequent cytomegalovirus (CMV) infection. CMV was only found in CSF in PIH cases. A facultatively anaerobic isolate was recovered. Assembly of the genome revealed a strain of P. thiaminolyticus. In mice, this isolate designated strain Mbale, was lethal in contrast with the benign reference strain. These findings point to the value of an unbiased pan-microbial approach to characterize PIH in settings where the organisms remain unknown, and enables a pathway towards more optimal treatment and prevention of the proximate neonatal infections.Item Characterising Childhood Blackwater Fever and Its Clinical Care at Two Tertiary Hospitals in Eastern Uganda(Research Square, 2021) Paasi, George; Ndila, Carolyne; Okiror, William; Namayanja, Cate; Okalebo, Benard Phelan; Abongo, Grace; Alaroker, Florence; Abeso, Julian; Kasoro, Andrew; Okello, Francis; Olupot, Peter OlupotIn eastern Uganda, reports suggest that cases of Blackwater Fever (BWF) are on the rise. We summarise the base-line characteristics and routine care available to patients with BWF presenting at two tertiary hospitals in Eastern Uganda prior to the Phase I/II trial on use of paracetamol for acute kidney injury in children with BWF (PARIST; ISRCTN84974248). This was a retrospective descriptive study for the period January – December 2018 for children admitted with a clinical diagnosis of BWF at Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. Data on sociodemographic and clinical characteristics, routine in-patient care and outcomes were abstracted using a customised study proforma and analysed using STATA. We obtained 9578 admission records during the study period, of which 1241 (13.0%) were admitted with a diagnosis of BWF. The median age was 60 months (IQR 36–90). Male: female ratio was 1.5:1. More cases of BWF 682/1241 (55.0%) were in children > 5 years compared to 559/1241 (45.0%) ≤ 5 years [95%CI (0.41–0.59); P = 0.0002]. The common symptoms included fever 1109/1241 (89.4%), vomiting 599/1241 (48.3%) and abdominal pain 494/1241 (39.8%). Conversely, the common signs recorded were clinical pallor 742/1241 (59.8%), clinical jaundice 369/1241 (29.7%), fever 332/1241 (26.7%) and prostration 231/1241 (18.6%). In addition, abdominal tenderness was documented in 120/1241 (9.7%), splenomegaly in 122/1241 (9.8%) and hepatomegaly in 86/1241 (6.9%). Case records with BWF were more in the second half of the year with a peak in the months of July and September. 510/1241 (41.1%) were treated with antimalarial drugs mainly parenteral Artesunate 501/510 (98.2%). 660/1241(53.2%) of the patients were managed with antibiotics mainly parenteral ceftriaxone 616/660 (93.3%). There were 426/1241 (34.3%) patients who received blood transfusion during admission. Clinicians used steroid treatment in 388/1241 (31.3%), mainly parenteral hydrocortisone 370/388 (95.4%).BWF accounted for 13% paediatric hospital admissions in the region. It was predominant in children > 5 years of age. It typically presents with passing dark urine, fever, abdominal pain, clinical jaundice and pallor. Locally there are no treatment guidelines for BWF. These data provide background data useful for future studies on BWF in the region.Item Characterising Demographics, Knowledge, Practices And Clinical Care Among Patients Attending Sickle Cell Disease Clinics In Eastern Uganda(Wellcome Open Research, 2020) Olupot, Peter Olupot; Wabwire, Ham; Ndila, Carolyne; Adong, Ruth; Ochen, Linus; Amorut, Denis; Abongo, Grace; Okalebo, Charles B.; Akello, Sarah Rachael; Oketcho, Joy B.; Okiror, William; Asio, Sarah; Odiit, Amos; Alaroker, Florence; Nyutu, Gideon; Maitland, Kathryn; Williams, Thomas N.In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial.Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire.Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 49.1% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion.The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial.Item Chronic Viral Hepatitis May Diminish The Gains Of HIV Antiretroviral Therapy In Sub-Saharan Africa(International Journal of Infectious Disease, 2009) Cooper, Curtis L.; Mills, Edward; Wabwire, Ben O.; Ford, Nathan; Olupot, Peter OlupotThere is a heavy burden of HIV–hepatitis B virus (HBV) and HIV–hepatitis C virus (HCV) co-infection in many regions of the developing world. An often unmentioned illness, issues of poverty, socio-economic status, nutrition, access to medical care, and mistrust of Western-style medicine conspire to reduce the opportunity to receive clinical work-up and treatment for chronic viral hepatitis. We discuss key issues specific to the treatment of viral hepatitis and obstacles to success with this endeavor in the context of HIV co-infection in Africa. We predict that provision of viral hepatitis antiviral therapy will become a more pressing issue as more HIV-infected patients receive lifesaving combination antiretroviral therapy only to succumb thereafter from viral hepatitis-induced liver disease. Given the lessons learned from combination antiretroviral rollout in sub-Saharan Africa, establishing expertise and infrastructure for viral hepatitis care and antiviral therapy is relevant. Failure to act now may diminish the milestones and the gains made with antiretroviral therapy in the developing world.Item Clinical And Immunological Outcomes Of A National Paediatric Cohort Receiving Combination Antiretroviral Therapy In Uganda(Aids, 2008) Kiboneka, Andrew; Wangisi, Jonathan; Nabiryo, Christine; Tembe, Juliet; Kusemererwa, Sylvia; Olupot, Peter Olupot; Joffres, Michel; Anema, Aranka; Cooper, Curtis L.; Montaner, Julio S.; Mills, Edward J.We aimed to evaluate clinical and immunological outcomes of paediatric patients receiving combination antiretroviral therapy (cART) enrolled in The AIDS Support Organization (TASO) Uganda national HIV/AIDS programme.Observational study of patients (age <14 years) enrolled in 10 clinics across Uganda for which TASO has data.We extracted patient demographic, immunological and clinical outcomes from the TASO databases regarding age, sex, cART regimen, CD4 cell count and WHO stage at initiation, tuberculosis, mortality and adherence. Outcomes were analysed using Pearson's rank–order correlations, Wilcoxon's rank sum tests, Cox proportional hazard model and survivor functions.Of the total 770 HIV children on cART, median age was 9 years (interquartile range, 5–13 years), and median follow-up time was 377 days (interquartile range, 173–624 days). Seven hundred and fifty-one children (97.5%) initiated nonnucleoside reverse transcriptase inhibitor-based regimens. Three hundred and sixty-five children (47.5%) initiated cART with severe immune suppression (CD4 cell percentage <15). Of the 18 (2.3%) children that died, mortality was associated with lower CD4 cell percentage at initiation (B coefficient −0.144, standard error 0.06, P = 0.02). Of the total, 229 (30%) were single or double orphans and more likely to initiate cART at an older age (mean age, 9.25 vs. 8.35 years, P = 0.02) and have a lower CD4 cell count (median, 268 vs. 422 cells/μl, P ≤ 0.0001) and CD4 cell percentage (median 12.8 vs. 15.5%, P = 0.02) at initiation. Pulmonary tuberculosis was present in 43 (5.6%) patients at initiation and 21 (2.3%) after cART. Almost all patients (94.9%) demonstrated more than 95% adherence.Children on cART in Uganda demonstrate positive clinical outcomes. However, additional support is required to ensure timely cART access among orphans and young children.Item Co-Trimoxazole Or Multivitamin Multimineral Supplement For Post-Discharge Outcomes After Severe Anaemia In African Children: A Randomised Controlled Trial(The Lancet Global Health, 2019) Maitland, Kathryn; Olupot, Peter Olupot; Kiguli, Sarah; Chagaluka, George; Alaroker, Florence; Opoka, Robert O.; Mpoya, Ayub; Walsh, Kevin; Engoru, Charles; Nteziyaremye, Julius; Mallewa, Machpherson; Nakuya, Margaret; Kennedy, Neil; Namayanja, Cate; Kayaga, Julianne; Nabawanuka, Eva; Sennyondo, Tonny; Aromut, Denis; Kumwenda, Felistas; Musika, Cynthia Williams; Thomason, Margaret J.; Bates, Imelda; Hensbroek, Michael Boele von; Evans, Jennifer A .; Uyoga, Sophie; Williams, Thomas N.; Frost, Gary; George, Elizabeth C.; Gibb, Diana M.; Walker, A. Sarah; the TRACT trial groupSevere anaemia is a leading cause of paediatric admission to hospital in Africa; post-discharge outcomes remain poor, with high 6-month mortality (8%) and re-admission (17%). We aimed to investigate post-discharge interventions that might improve outcomes.Within the two-stratum, open-label, multicentre, factorial randomised TRACT trial, children aged 2 months to 12 years with severe anaemia, defined as haemoglobin of less than 6 g/dL, at admission to hospital (three in Uganda, one in Malawi) were randomly assigned, using sequentially numbered envelopes linked to a second non-sequentially numbered set of allocations stratified by centre and severity, to enhanced nutritional supplementation with iron and folate-containing multivitamin multimineral supplements versus iron and folate alone at treatment doses (usual care), and to co-trimoxazole versus no co-trimoxazole. All interventions were administered orally and were given for 3 months after discharge from hospital. Separately reported randomisations investigated transfusion management. The primary outcome was 180-day mortality. All analyses were done in the intention-to-treat population; follow-up was 180 days. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN84086586, and follow-up is complete.From Sept 17, 2014, to May 15, 2017, 3983 eligible children were randomly assigned to treatment, and followed up for 180 days. 164 (4%) were lost to follow-up. 1901 (95%) of 1997 assigned multivitamin multimineral supplement, 1911 (96%) of 1986 assigned iron and folate, and 1922 (96%) of 1994 assigned co-trimoxazole started treatment. By day 180, 166 (8%) children in the multivitamin multimineral supplement group versus 169 (9%) children in the iron and folate group had died (hazard ratio [HR] 0·97, 95% CI 0·79–1·21; p=0·81) and 172 (9%) who received co-trimoxazole versus 163 (8%) who did not receive co-trimoxazole had died (HR 1·07, 95% CI 0·86–1·32; p=0·56). We found no evidence of interactions between these randomisations or with transfusion randomisations (p>0·2). By day 180, 489 (24%) children in the multivitamin multimineral supplement group versus 509 (26%) children in the iron and folate group (HR 0·95, 95% CI 0·84–1·07; p=0·40), and 500 (25%) children in the co-trimoxazole group versus 498 (25%) children in the no co-trimoxazole group (1·01, 0·89–1·15; p=0·85) had had one or more serious adverse events. Most serious adverse events were re-admissions, occurring in 692 (17%) children (175 [4%] with at least two re-admissions).Neither enhanced supplementation with multivitamin multimineral supplement versus iron and folate treatment or co-trimoxazole prophylaxis improved 6-month survival. High rates of hospital re-admission suggest that novel interventions are urgently required for severe anaemia, given the burden it places on overstretched health services in Africa.Item Educational Curricula and Programs in Adolescent Medicine for Health Workers in Low- and Middle- Income Countries: A Scoping Review(Journal of graduate medical education, 2019) Miller, Kathleen K.; Brown, Sarah Jane; Pfeffer, Betsy; Olupot, Peter Olupot; Kitaka, SabrinaAdolescent medicine (AM) has been increasingly recognized as critically important to the health of individuals during their transition to adulthood. On a global scale, AM is often underprioritized and underfunded. In low- and middle-income countries (LMICs), education and AM training is developing, and AM physicians often are from general medicine backgrounds.The objective of our scoping review was to identify existing training curricula and educational tools designed to teach AM skills to health care workers in LMICs.We followed PRISMA guidelines for scoping reviews for article identification and inclusion. Online databases, including MEDLINE, Embase, CINAHL, and Scopus, were used to identify papers. We included studies that took place in a LMIC, were available in English, and described any of the following: published educational curricula in AM, education-based intervention for HCWs that focused on AM, or a training opportunity in AM located in a LMIC.Our review includes 14 publications: 5 published curricula and 9 articles describing educational interventionsor training opportunities in AM in LMICs. Curricula were relatively consistent in the topics included, although they varied in implementation and teaching strategies. The scholarly articles described educational materials and identified a number of innovative strategies for training programs.Our review found existing high-quality AM curricula designed for LMICs. However, there is limited published data on their implementation and utilization. There is a continued need for funding and implementation of education in AM in resource-constrained settings.Item Health implications of small arms and light weapons in eastern Uganda(Medicine, conflict and survival, 2006) Pinto, Andrew D.; Olupot, Peter Olupot; Neufeld, Victor R.Injuries due to small arms and light weapons (SALW) are common in developing countries with ongoing collective violence, or those that exist in a post-conflict state. Uganda has a long history of armed conflict, but little quantitative evidence is available about the extent of the problem of SALW. We performed a review of all injuries due to SALW at Mbale Regional Hospital in eastern Uganda for the six-year period 1998–2003. Using a standardised questionnaire, we recorded information from over 200 cases concerning the characteristics of the victim, the incident, the weapon used and the care received. The majority involved males and occurred in the context of conflict within tribal communities, or armed robberies throughout the region. Each injury is of significant cost to the healthcare system and to the victim. Prevention, through limiting the availability of the ‘vector’ of disease (SALW), is a key part of the solution to this problem.Item Healthcare-Provider Perceptions Of Barriers To Oxygen Therapy For Paediatric Patients In Three Government-Funded Eastern Ugandan Hospitals; A Qualitative Study(BMC health services research, 2019) Dauncey, Jonathan W.; Olupot, Peter Olupot; Maitland, KathrynThis study aimed to assess on-the-ground barriers to the provision of oxygen therapy for paediatric patients in three government-funded Eastern Ugandan district general hospitals (DGHs).Site visits to DGHs during March 2017 involved semi-structured interviews with medical officers, clinical officers, paediatric nurses and non-clinical staff (n = 29). MAXQDA qualitative data software was used to assist with response analysis.The healthcare professionals reported that erratic electricity supplies, few and/or malfunctioning oxygen cylinders and concentrators, limited or no access to pulse oximetry, inadequate staffing and lack of continued professional training were key barriers to the delivery of oxygen therapy. Local populations were reportedly fearful of oxygen therapy and reluctant to consent for oxygen therapy to be administered to their children.According to healthcare providers in three Eastern Ugandan DGHs, numerous barriers exist to oxygen therapy for paediatric patients. Healthcare professionals reported lack of facilities and training to effectively deliver oxygen therapy. Quality improvement work prioritising oxygen therapy in government-funded district general hospitals should focus on oxygen supply and delivery issues on a site-specific level and sensitizing communities to the potential benefits of oxygen.Item Implementing A Hospital Based Injury Surveillance System In Africa: Lessons Learned(Medicine, conflict and survival, 2008) Zavala, Diego E.; Bokongo, Simon; John, I. A.; Senoga, Ismail Mpanga; Mtonga, Robert E.; Mohammed, A. Z.; Anjango, Walter Odhiambo; Olupot, Peter OlupotA multinational injury surveillance pilot project was carried out in five African countries in the first half of 2007 (Democratic Republic of the Congo, Kenya, Nigeria, Uganda and Zambia). Hospitals were selected in each country and a uniform methodology was applied in all sites, including an injury surveillance questionnaire designed by a joint programme of the Pan American Health Organization and the United States Centres for Disease Control and Prevention. A total of 4207 injury cases were registered in all hospitals. More than half of all injury cases were due to road traffic accidents (58.3%) and 40% were due to interpersonal violence. Self-inflicted injuries were minimal (1.2% of all cases). This report provides an assessment of the implementation of the project and a preliminary comparison between the five African countries on the context in which inter-personal injury cases occurred. Strengths and weaknesses of the project as well as opportunities and threats identified by medical personnel are summarized and discussed. A call is made to transform this pilot project into a sustainable public health strategy.Item A Mathematical Model Approach for Prevention and Intervention Measures of the COVID19 Pandemic in Uganda(BMJ, 2020) Mbabazi, Fulgensia Kamugisha; Gavamukulya, Yahaya; Awichi, Richard; Olupot, Peter Olupot; Rwahwire, Samson; Biira, Saphina; Luboobi, Livingstone S.The human–infecting corona virus disease (COVID–19) caused by the novel severe acute respiratory syndrome corona virus 2 (SARS–CoV–2) was declared a global pandemic on March 11th, 2020. Current human deaths due to the infection have raised the threat globally with only 1 African country free of Virus (Lesotho) as of May 6th, 2020. Different countries have adopted different interventions at different stages of the outbreak, with social distancing being the first option while lock down the preferred option for flattening the curve at the peak of the pandemic. Lock down is aimed at adherence to social distancing, preserve the health system and improve survival. We propose a Susceptible–Exposed–Infected–Expected recoveries (SEIR) mathematical model to study the impact of a variety of prevention and control strategies Uganda has applied since the eruption of the pandemic in the country. We analyze the model using available data to find the infection–free, endemic/infection steady states and the basic reproduction number. In addition, a sensitivity analysis done shows that the transmission rate and the rate at which persons acquire the virus, have a positive influence on the basic reproduction number. On other hand the rate of evacuation by rescue ambulance greatly reduces the reproduction number. The results have potential to inform the impact and effect of early strict interventions including lock down in resource limited settings and social distancing.Item Methicillin Resistant Staphylococcus Aureus Nasal Carriage And Associated Factors In A Rural Tertiary Hospital In Eastern Uganda: A Prospective Crosssectional Study(Research Square, 2020) Thembo, Nobert; Masifa, George; Kamugisha, Gerald; Nabitaka, Robinah; Akais, Benjamin; Olupot, Peter Olupot; Muhindo, Rita; Kiyonga, Edward; Ampaire, LucasAsymptomatic carriage of Methicillin-Resistant Staphylococcus aureus (MRSA) can predispose the host to a wide array of infections that can be difficult to treat due to antibiotic resistance. To inform public health strategies, the study sought to describe MRSA nasal carriage frequencies and the associated factors concerning nasal carriage among patients attending Mbale Regional Referral Hospital (MRRH).Nasal swabs were obtained from consented (aged >15years) participants presenting to the hospital for medical care between January and April 2018 [L1] . Direct Culture of swabs was performed on blood agar and then incubated at 37℃ for 24 hours. Identification of S. aureus was done using conventional biochemical tests. Phenotypic screening and confirmation of MRSA was done using cefoxitin disc (30μg) test and MICs on the Phoenix M50 instrument respectively. Patient demographic characteristics and the MRSA nasal carriage risk factors were collected using a pre-tested questionnaire. Overall, majority of the participants were in-patients (138, 63.3%) with the proportions of both females and males among the participants being 154/218 (70.6%) and 64/218 (29.3%) respectively. Mean age for both female and male participants was 40.16 (SD± 17.04) years respectively. S . aureus nasal carriage rate among the participants was 22.9% (50/218), with 57.9% (29/50) of the harboured strains phenotypically expressing methicillin resistance ( mecA mediated). Phenotypic co-expression with i nducible clindamycin resistance and vancomycin resistance was displayed in 45.5% (23/50) and 2% (1/50) of the studied isolates respectively. Colonisation with MRSA did not show any significant relationship with all the studied factors.There was a moderate S. aureus nasal carriage among the participants in Mbale Regional Referral Hospital with a highly noted phenotypic expression of methicillin resistance among the isolated S. aureus strains. The studied factors were not significantly associated with the rate of MRSA nasal carriage. For surveillance purposes to combat future outbreaks, there is a need to do a larger study to better draw generalizable conclusions of carriage in the population.Item Modifying Intestinal Integrity and MicroBiome in Severe Malnutrition with Legume-Based Feeds (MIMBLE 2.0): Protocol For A Phase Ii Refined Feed And Intervention Trial(Wellcome open research, 2018) Walsh, Kevin; Calder, Nuala; Olupot, Peter Olupot; Ssenyondo, Tonny; Okiror, William; Okalebo, Charles Bernard; Muhindo, Rita; Mpoya, Ayub; Holmes, Elaine; Marchesi, Julian; Chenevarin, Gael Delamare de la Villenaise de; Frost, Gary; Maitland, KathrynChanges in intestinal mucosal integrity and gut microbial balance occur in severe acute malnutrition (SAM), resulting in treatment failure and adverse clinical outcomes (gram-negative sepsis, diarrhoea and high case-fatality). Transient lactose intolerance, due to loss of intestinal brush border lactase, also complicates SAM, thus milk based feeds may not be optimal for nutritional rehabilitation. Since the gut epithelial barrier can be supported by short chain fatty acids, derived from microbiota fermentation by particular fermentable carbohydrates, we postulated that an energy-dense nutritional feed comprising of legume-based fermentable carbohydrates, incorporated with lactose-free versions of standard World Health Organization (WHO) F75/F100 nutritional feeds will enhance epithelial barrier function in malnourished children, reduce and promote resolution of diarrhoea and improve overall outcome.We will investigate in an open-label trial in 160 Ugandan children with SAM, defined by mid-upper arm circumference <11.5cm and/or presence of kwashiorkor. Children will be randomised to a lactose-free, chickpea-enriched feed containing 2 kcal/ml, provided in quantities to match usual energy provision (experimental) or WHO standard treatment F75 (0.75 kcal/ml) and F100 (1 kcal/ml) feeds on a 1:1 basis, conducted at Mbale Regional Referral Hospital nutritional rehabilitation unit. The primary outcomes are change in MUAC at day 90 and survival to day 90. Secondary outcomes include: i) moderate to good weight gain (>5 g/kg/day), ii) de novo development of diarrhoea (>3 loose stools/day), iii) time to diarrhoea resolution (if >3 loose stools/day), and iv) time to oedema resolution (if kwashiorkor) and change in intestinal biomarkers (faecal calprotectin).We hypothesize that, if introduced early in the management of malnutrition, such lactose-free, fermentable carbohydrate-based feeds, could safely and cheaply improve global outcome by reducing lactose intolerance-related diarrhoea, improving mucosal integrity and enhancing immunity, and limiting the risk of systemic infection and associated broad-spectrum antibiotic resistance.Item Pharmacokinetics And Pharmacodynamics Of Azithromycin In Severe Malaria Bacterial Co-Infection In African Children (TABS-PKPD): A Protocol For A Phase II Randomised Controlled Trial(Wellcome Open Research, 2021) Olupot, Peter Olupot; Okiror, William; Mnjalla, Hellen; Muhindo, Rita; Uyoga, Sophie; Mpoya, Ayub; Williams, Thomas N.; terHeine, Rob; Burger, David M.; Urban, Britta; Connon, Roisin; George, Elizabeth C.; Gibb, Diana M.; Walker, A. Sarah; Maitland, KathrynAfrican children with severe malaria are susceptible to Gram-negative bacterial co-infection, largely non-typhoidal Salmonellae, leading to a substantially higher rates of in-hospital and post-discharge mortality than those without bacteraemia. Current evidence for treating co-infection is lacking, and there is no consensus on the dosage or length of treatment required. We therefore aimed to establish the appropriate dose of oral dispersible azithromycin as an antimicrobial treatment for children with severe malaria and to investigate whether antibiotics can be targeted to those at greatest risk of bacterial co-infection using clinical criteria alone or in combination with rapid diagnostic biomarker tests. A Phase I/II open-label trial comparing three doses of azithromycin: 10, 15 and 20 mg/kg spanning the lowest to highest mg/kg doses previously demonstrated to be equally effective as parenteral treatment for other salmonellae infection. Children with the highest risk of bacterial infection will receive five days of azithromycin and followed for 90 days. We will generate relevant pharmacokinetic data by sparse sampling during dosing intervals. We will use population pharmacokinetic modelling to determine the optimal azithromycin dose in severe malaria and investigate azithromycin exposure to change in C-reactive protein, a putative marker of sepsis at 72 hours, and microbiological cure (seven-day), alone and as a composite with seven-day survival. We will also evaluate whether a combination of clinical, point-of-care diagnostic tests, and/or biomarkers can accurately identify the sub-group of severe malaria with culture-proven bacteraemia by comparison with a control cohort of children hospitalized with severe malaria at low risk of bacterial co-infection.Item Prevalence of Anaemia and Associated Risk Factors among Children in North-western Uganda: A Cross Sectional Study(BMC hematology, 2017) Legason, Ismail Dragon; Atiku, Alex; Ssenyonga, Ronald; Olupot, Peter Olupot; Barugahare, John BansonDespite the public health significance of anaemia in African children, its broader and often preventable risk factors remain largely under described. This study investigated, for the first time, the prevalence of childhood anaemia and its risk factors in an urban setting in Uganda.A total of 342 children were enrolled. Venous blood samples were collected in EDTA tubes and analyzed using Symex 500i (Symex Corp. Japan). Stool and urine samples were analyzed according to established standard methods. Anthropometric indicators were calculated according to the CDC/WHO 1978 references. Ethical approval was granted.Categorically, the prevalence of anaemia was; 37.2, 33.3 and 11.8% among children aged 1–5 years, 6–11 years and 12–14 years respectively. Overall anaemia prevalence was 34.4%. The risk of anaemia was higher among males than females [(OR = 1.3, 95% CI = 0.8, 2.1), P = .22]. Malaria was associated with a 1.5 times risk of anaemia though not statistically significant in the multivariate analysis (P = .19). Maternal parity <5 (P = .002), and stunting [(OR = 2.5, 95% CI = 1.3, 4.7), P = .004] were positively associated with anaemia. There was a positive correlation between household size and income (Pearson X 2 = 22.96; P = .001), implying that large families were of higher socioeconomic status.This study demonstrates that anaemia is more prevalent in the under-5 age. The risk factors are stunting and low maternal parity. Interventions that address nutritional deficiencies in both pre-school and school children are recommended. Malaria and helminthiasis control measures counter the risk of anaemia. Further studies are required to investigate the association between maternal parity and anaemia found in this study.Item Special Section: A Multinational Injury Surveillance System Pilot Project in Africa(Journal of public health policy, 2008) Zavala, Diego E.; Bokongo, Simon; John, Ime A.; Mpanga, Senoga Ismail; Mtonga, Robert E .; Aminu, Zakari Mohammed; Odhiambo, Walter; Olupot, Peter OlupotThis paper describes the development of a pilot project to test the implementation of an epidemiological surveillance system for intentional (violent) and non-intentional injuries, at emergency departments in selected hospitals in five African countries applying the World Health Organization’s guidelines. We outline obstacles and opportunities encountered during the process. By definition, a surveillance system systematically collects, reviews, and evaluates information to understand the context in which specifiic injuries occur. Implementation in diverse sociocultural environments in Zambia, Uganda, Democratic Republic of the Congo, Nigeria, and Kenya has provided an opportunity to gather reliable data on injuries for comparisons between these countries. Analysis of the detailed information may permit researchers to generate evidence-based recommendations. Addressed to public authorities, and health authorities in particular, they can help address injury incidence in their communities from a public health perspective.Item Upper Gastrointestinal Endoscopy Findings In Mbale Regional Referral Hospital, Eastern Uganda: A 10-Year Retrospective Analysis(African Health Sciences, 2021) Doe, Matthew J.; Bua, Emmanuel; Obbo, John SO; Bisso, Fred; Olupot, Peter OlupotEndoscopy is required for formal diagnosis of many upper gastrointestinal (UGI) conditions including oe- sophageal cancer (OC). There is a paucity of data on endoscopy findings in East Africa as access to testing is challeng- ing for patients. We describe the findings of 10 years of UGI endoscopy in Mbale Regional Referral Hospital (MRRH). Records of patients that underwent UGI endoscopy in MRRH, November 2009 – March 2019 were retrospective- ly analysed. Indication, macroscopic findings, histology and patient demographics were retrieved. Sub-group analyses were performed on those with a histological diagnosis of oesophageal cancer.833 eligible patients received single UGI procedures during the study period. Mean age was 54.8 years, range 16-93 years and 56.9% of patients were male. The main indication was dysphagia (42%) and the most common findings OC (34%) and gastritis (28%). 151 patients had histologically proven OC with a median age of 60 years and a 2:1 male to female ratio. 145/151 (96%) of samples tested revealed squamous cell carcinoma (SCC). Those undergoing endoscopy in MRRH are most commonly male patients presenting in their 5th decade with dysphagia. There is a high proportion of significant findings including gastritis, peptic ulcer disease, and oesophageal cancer.Item Validation Of Triple Pass 24-Hour Dietary Recall In Ugandan Children By Simultaneous Weighed Food Assessment(BMC., 2016) Nightingale, Helen; Walsh, Kevin J.; Olupot, Peter Olupot; Engoru, Charles; Ssenyondo, Tonny; Nteziyaremye, Julius; Amorut, Denis; Nakuya, Margaret; Arimi, Margaret; Frost, Gary; Maitland, KathrynUndernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. In order to do so, the assessment method must be validated in the target population. A triple pass 24 h dietary recall with volumetric portion size estimation has been described but not previously validated in African children. This study aimed to establish the relative validity of 24-h dietary recalls of daily food consumption in healthy African children living in Mbale and Soroti, eastern Uganda compared to simultaneous weighed food records. Methods: Quantitative assessment of daily food consumption by weighed food records followed by two independent assessments using triple pass 24-h dietary recall on the following day. In conjunction with household measures and standard food sizes, volumes of liquid, dry rice, or play dough were used to aid portion size estimation. Inter-assessor agreement, and agreement with weighed food records was conducted primarily by Bland-Altman analysis and secondly by intraclass correlation coefficients and quartile cross-classification. Results: Nineteen healthy children aged 6 months to 12 years were included in the study. Bland-Altman analysis showed 24-h recall only marginally under-estimated energy (mean difference of 149 kJ or 2.8 %; limits of agreement −1618 to 1321 kJ), protein (2.9 g or 9.4 %; −12.6 to 6.7 g), and iron (0.43 mg or 8.3 %; −3.1 to 2.3 mg). Quartile cross-classification was correct in 79 % of cases for energy intake, and 89 % for both protein and iron. The intraclass correlation coefficient between the separate dietary recalls for energy was 0. 801 (95 % CI, 0.429–0.933), indicating acceptable inter-observer agreement. Conclusions: Dietary assessment using 24-h dietary recall with volumetric portion size estimation resulted in similar and acceptable estimates of dietary intake compared with weighed food records and thus is considered a valid method for daily dietary intake assessment of children in communities with similar diets. The method will be utilised in a sub-study of a large randomised controlled trial addressing treatment in severe childhood anaemia.Item Was the “ABC” Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda’s Decline in HIV?(PLoS medicine, 2006) Murphy, Elaine M.; Greene, Margaret E.; Mihailovic, Alexandra; Olupot, Peter OlupotUganda is one of the few African countries where rates of HIV infection have fallen, from about 15 percent in the early 1990s to about five percent in 2001. At the end of 2005, UNAIDS estimated that 6.7 percent of adults were infected with the virus. The reasons behind Uganda's success have been intensely studied in the hope that other countries can emulate the strategies that worked. Some researchers credit the success to the Ugandan government's promotion of “ABC behaviors”—particularly abstinence and fidelity. Uganda receives funds from the United States President's Emergency Plan for AIDS Relief, which promotes the ABC approach with a focus on abstinence-driven public health campaigns. Other researchers question whether the ABC approach was really responsible for the decline in HIV infection. Critics of the ABC approach also argue that by emphasizing abstinence over condom use, the approach leaves women at risk of infection, because in many parts of the world women are not empowered to insist on abstinence or fidelity.