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D Okello

Publications and source records attributed to D Okello.

12 recordsLinked to original sources
PubMed2006

Health Research Profile to assess the capacity of low and middle income countries for equity-oriented research.

BACKGROUND: The Commission on Health Research for Development concluded that "for the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped." This project was designed to assess low and middle income country capacity and commitment for equity-oriented research. METHODS: A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe) developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP): 1) Research priorities; 2) Resources (amount spent on research); 3) Production of knowledge (capacity); 4) Packaging of knowledge and 5) Evidence of research impact on policy and equity. We surveyed three countries from each region. RESULTS: Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI) had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process. CONCLUSION: Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external agencies) should invest more in building a certain minimum level of national capacity for equity-oriented research.

Africa↗
PubMed2003

Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda.

SETTING: Kiboga district, a rural area in Central Uganda. OBJECTIVE: To assess the cost and cost-effectiveness of community-based care for new smear-positive pulmonary tuberculosis patients compared with conventional hospital-based care. METHODS: Costs were analysed from the perspective of health services, patients, and community volunteers in 1998 US dollars, using standard methods. Cost-effectiveness was calculated as the cost per patient successfully treated. FINDINGS: The cost per patient treated for new smear-positive patients was dollars 510 with the conventional hospital-based approach to care (dollars 419 for the health system and dollars 91 for patients), and dollars 289 with community-based care (dollars 227 for health services, dollars 53 for patients and dollars 9 for volunteers). Important new costs associated with community-based care included programme supervision (dollars 18 and dollars 9 per patient at central and district levels, respectively) and training (dollars 18 per patient). The cost per patient successfully treated was dollars 911 with the hospital-based strategy and dollars 391 with community-based care, reflecting both lower costs and higher effectiveness (74% vs. 56% successful treatment rate) with community-based care. Length of hospital stay fell from an average of 60 to 19 days. CONCLUSION: There is a strong economic case for the implementation of community-based care in Uganda.

Community Health Services↗
PubMed2002

Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa.

An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.

Adolescent↗
PubMed2001

Natural human immunoglobulin G subclass responses to Plasmodium falciparum serine repeat antigen in Uganda.

Serum samples from Ugandan residents of a malaria-hyperendemic region were tested by enzyme-linked immunosorbent assay for reactivity against recombinant constructs of the 47 (SE47')- and 50 (SE50A)-kDa fragments of Plasmodium falciparum serine repeat antigen (SERA). Immunoglobulin (Ig) G3 and IgG1 were the predominant subclass responses to SE47' and SE50A, respectively. The geometric mean optical density (OD) for IgG3 anti-SE47' was significantly lower in children < 15 years compared with adults > or = 15 years (P < 0.0001). By contrast, the geometric mean IgG1 anti-SE50A was slightly higher in children compared with adults (P < 0.01). The proportion of high responders (ODs > 0.5) to SE47' was significantly lower in children compared with adults (P < 0.001), whereas the proportion of high responders to SE50A was comparable in children and adults (P = 0.07). This first detailed study of SERA in a malaria-hyperendemic region suggests that natural human IgG3 anti-SE47' might be associated with immunity to malaria.

Adolescent↗
PubMed2000

Human IgG subclass antibodies to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)) and predominance of the MAD20 allelic type of MSP1 in Uganda.

OBJECTIVE: To determine the natural human humoral immune responses to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)), a malaria candidate vaccine antigen and to determine the prevalence of MAD20 and K1 alleles of P. falciparum MSP1. DESIGN: Community based cross-sectional study. SETTING: Atopi Parish, Apac District, Uganda, 1995. SUBJECTS: Three hundred and seventy four Ugandans between <1 and 70 years old provided serum samples. MAIN OUTCOME MEASURES: IgG subclass antibodies by ELISA; MAD20 and K1 allelic types of MSP1 by PCR. RESULTS: Both the prevalence and the mean concentration of serum IgG1, and to a lesser extent IgG3, antibodies increased with age. IgG2 or IgG4 antibodies were virtually nonexistent. The cross-reactivity between the 4 sequence variants (E-KNG, E-TSR, Q-KNG and Q-TSR) of MSP1(19) was confirmed; however, a minority of sera preferentially recognised the KNG but not the TSR variants. All 33 P. falciparum isolates from different parts of Uganda carried the E-TSR (Mad20) allelic type and 3 isolates were mixed infections with E-TSR (MAD20) and Q-KNG (K1) allelic types, confirming the rarity of the K1 allele in Uganda. CONCLUSION: There is a robust IgG1 antibody response to the malaria vaccine candidate antigen MSP1(19) which begins at an early age. Future cohort studies are necessary to estblish the impact of these antibodies on clinical immunity to malaria. The MAD20 allelic type of MSP1 id predominant in Ugandan P. falciparum isolates.

Animals↗
PubMed2000

Plasmodium falciparum malariometric indices in Apac district, northern Uganda.

OBJECTIVE: To establish Plasmodium falciparum malariometric indices in a field study site in Apac district, northern Uganda. DESIGN: A community-based cross sectional survey. SETTINGS: Atopi Parish, Apac district, Uganda, 1995. SUBJECTS: One thousand two hundred and thirty four volunteers aged below one and ninety years. MAIN OUTCOME MEASURES: P. falciparum parasitaemia rates and parasite density, splenomegaly, bednet use and chloroquine consumption. INTERVENTIONS: All subjects with P. falciparum positive smears were treated with chloroquine. RESULTS: The population prevalence of parasitaemia was 62.1% with the predominant species being P. falciparum (100%) and P. malariae in the minority (3.5%); P. ovale was not seen. The prevalence of parasitaemia in subjects older than 20 years and in those under ten years was 36% and 85%, respectively. The geometric mean parasite density started to decline by the age of six years. The splenomegaly rate in subjects over the age of 12 years and in those under nine years was 19.8% and 63.1%, respectively. Bednet use and chloroquine consumption was low. Interestingly, the reported use of chloroquine in the week immediately preceding the study was more frequent in children under two years old than in the rest of the population. CONCLUSION: Malaria transmission in Atopi Parish in northern Uganda is hyperendemic and age-related acquired anti-parasite immunity seems to appear by seven years of age.

Adolescent↗
PubMed1994

Stage- and region-dependent chondrogenesis and growth of chick wing-bud mesenchyme in serum-containing and defined tissue culture media.

During development, limb-bud mesenchymal cells carry out complex spatiotemporal-patterns of growth and differentiation. Tissue and organ culture facilitate analysis of environmental influences on these cell behaviors, allowing their partial dissection into exogenous and endogenous components. Two factors that complicate such in vitro analyses are the heterogeneity of the cultured cells and imprecise knowledge of culture medium composition. Limb mesenchyme comprises a heterogenous cell population with important regional differences in cell type. Dividing the limb into subregions helps limit the cellular heterogeneity and using chemically defined, serum-free medium alloys concerns about medium composition. In the present study, mesenchyme from different regions along the anteroposterior and proximodistal axes of stage 21-22 and stage 23-24 chick wing buds was grown in high-density microtiter cultures in chemically defined and in serum-containing medium. Four-day cultures of the various regions were compared in terms of culture morphology and the accumulation of Alcian blue-positive cartilage matrix and DNA. The results demonstrate stage- and region-dependent differences in the in vitro growth, differentiation, and responsiveness of these cells. For example, mesenchyme from the distal anterior region of the wing bud exhibited lower intrinsic chondrogenic capacity and greater responsiveness to serum than other regions. Patterns of in vitro chondrogenesis also suggest that, at the stages examined, distal wing-bud mesenchyme may be less homogeneous than has been believed. A case is made for the suitability of serum-free medium for future in vitro studies of chick limb-bud mesenchyme. The results are considered in relation to the process of limb development and regional expression of pattern-related genes.

Animals↗
PubMed1994

Stage- and region-dependent responses of chick wing-bud mesenchymal cells to retinoic acid in serum-free microcultures.

Retinoic acid (RA) has been shown to affect skeletal patterning in vivo in both developing and regenerating limbs. Regional differences in RA concentrations alone cannot account for the region-specific cell behaviors involved in limb-skeletal morphogenesis. The present study explores a role for regional differences in signal interpretation in RA's effects along the anteroposterior and proximodistal axes of stage 21-22 and 23-24 chick wing-buds. Mesenchymal cells isolated from specific limb regions were grown in chemically defined medium and exposed to 5 or 50 ng/ml of RA for 4 days in high-density microtiter cultures. Previous studies showed that RA's effects on chondrogenesis and growth in such cultures differed depending on the position along the limb's proximodistal axis from which the cells were isolated. The present study is the first to show that such differences in RA-responsiveness also exist along the limb's anteroposterior axis, especially in the distal subridge mesenchyme. The region-dependent relationships between RA's effects on growth and chondrogenesis suggest that RA affects these two behaviors through different mechanisms. The regional differences in the responsiveness of these cells to exogenous RA are discussed with respect to their correspondence to the in vivo patterns of expression of RA-binding proteins, RA-receptors, and other patterning-related genes.

Animals↗
PubMed1994

Low bed occupancy rates in Uganda's peripheral health units: is it a policy problem?

A survey of 71 government and non-governmental health units ranging from hospitals to dispensaries was made to determine the utilisation of available beds in these units. In addition, an assessment of consumer practices on the use of beds was made using qualitative methods. The major finding of the study was the very low bed occupancy rates at the primary health care (PHC) level, ranging from 0.2-42%; compared to very high bed occupancy rates at the hospitals, ranging from 54-153%. Most patients referred themselves directly to the hospitals, travelling very long distances of up to 80 km. The reason for low bed occupancy rates at the primary health care level are multifactorial, including lack of medically trained personnel at this level, sporadic supply of drugs and other medical supplies and a complete breakdown in the transfer and referral system. In order to implement the policy of PHC which government has adopted, there is need to redirect resources to the PHC level and revive the referral system.

Bed Occupancy↗