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Biomedical subjects

J K Tumwine

Publications and source records attributed to J K Tumwine.

18 recordsLinked to original sources
PubMed2003

Immediate outcome of babies with low Apgar score in Mulago Hospital, Uganda.

BACKGROUND: Birth asphyxia contributes significantly to perinatal morbidity and mortality especially in resource poor countries. Although the Apgar score has been in use for over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome have not been established in many sub-Saharan countries including Uganda. OBJECTIVE: To determine the prevalence of low Apgar score and establish immediate outcome and possible risk factors for poor outcome in babies with low Apgar score. SETTING: Labour wards, operating theatres and special baby care unit, Mulago Teaching and referral Hospital, Uganda. SUBJECTS: Babies delivered in Mulago Hospital between September and October 1999. Those with low Apgar scores, together with an equal number of babies with normal scores matched for sex as controls, were followed up for 48 hours. MEASUREMENTS: Clinical features, anthropometry, gestational age, oxygen saturation, blood glucose and autopsy of babies who died. MAIN OUTCOME MEASURES: Clinical improvement, death, complications such as HIE, RDS, aspiration pneumonia, hypoglycaemia, hypothermia, hypotension and hypoxaemia. RESULTS: The prevalence of low Apgar score at one and five minutes was 8.4% and 2.8% respectively. Adverse outcome was seen in 57.3% of cases: death in 12.1% and clinical complications in 45.2%. HIE occurred in 21.8%, hypoxaemia in 12.9%, hypoglycaemia in 16.9% and aspiration pneumonia in 4.8%. Maternal factors significantly associated with low Apgar scores included primiparity, abnormal delivery, age and medical diseases during pregnancy, while birth injuries and cord accidents were the baby factors. Poor outcome was associated with birth injury, hypothermia, hypoglycaemia, hypotension, aspiration pneumonia, hypoxaemia and severe birth asphyxia. CONCLUSION: Even though the prevalence of low Apgar was only 8.4%, adverse outcomes associated with it were observed in more than half the patients. Therefore there is need to carefully evaluate and monitor babies with low Apgar scores immediately after birth.

Adolescent↗
PubMed2002

Missed opportunities and caretaker constraints to childhood vaccination in a rural area in Uganda.

BACKGROUND: Despite concerted support to vaccination programmes, coverage remains low. While health service reasons for this are known, there is little information on caretaker constraints to vaccination in Africa. OBJECTIVE: To establish the prevalence of missed vaccination opportunities and caretaker constraints to childhood vaccinations. DESIGN: Cross-sectional descriptive study. SUBJECTS: Caretakers of 408 children aged 12-23 months were interviewed. SETTING: Kiyeyi, a rural area in Eastern Uganda. RESULTS: Complete vaccination coverage by card was 26.7% while by history and card it was 44.6%. Of the 215 eligible children who sought treatment in a health facility where vaccination could be offered, 59.6% missed an opportunity to be vaccinated while 24.4% of the children missed an opportunity during routine vaccination sessions. Reasons for non-completion of vaccination included caretaker 'not bothered', being busy, or ill and fear of rude health workers. While most caretakers were aware of vaccination and its benefits, none knew the immunisation schedule. The major caretaker constraints were low level of formal education, fear of vaccine side effects, and perceived contraindications to vaccinations. CONCLUSION: Promotion of formal education for girls and educating mothers and health workers on the timing of vaccinations, their side effects and management might contribute to higher vaccination coverage.

Adult↗
PubMed2002

Nutrition status of children in Kasese district at the Uganda-Congo border.

OBJECTIVE: To establish the magnitude and risk factors for malnutrition in Kasese district at the Uganda-Congo border. DESIGN: Cross sectional nutrition survey. METHODS: Thirty clusters were selected. The height, weight, and mid upper arm circumference of at least 31 children per cluster were measured. Data on food frequency, prevalence of cough, fever and diarrhoea was also collected. RESULTS: Half of the 932 children (49.8%) were stunted, and 21.9% were severely stunted. While 17.4% of the children were under weight, 1.29% were wasted and 3.7% had MUAC <12.5 cm. Risk factors for stunting included not consuming milk, fathers' low formal education, having no immunisation card, and not breast feeding among 12-23 months old. Risk factors for underweight included fathers' and mothers' low education level, consumption of legumes, and fever or diarrhoea two weeks before the survey. For wasting the risk factors were consumption of vegetables, legumes or starchy foods. Those not consuming high-energy or animal foods including milk were likely to be severely wasted as were those not breast feeding in the 12-23 months age group. Fever or a diarrhoea episode two weeks preceding the survey and living in a female-headed household, were also risk factors for severe wasting. CONCLUSION: Attention to education, poverty alleviation, appropriate feeding practices, prevention and treatment of infections might assist in combating malnutrition in this district.

Acute Disease↗
PubMed2000

Extensive polymorphism in Cryptosporidium parvum identified by multilocus microsatellite analysis.

Restriction fragment length polymorphism and DNA sequence analysis discern two main types of Cryptosporidium parvum. We present a survey of length polymorphism at several microsatellite loci for type 1 and type 2 isolates. A total of 14 microsatellite loci were identified from C. parvum DNA sequences deposited in public databases. All repeats were mono-, di-, and trinucleotide repeats of A, AT, and AAT, reflecting the high AT content of the C. parvum genome. Several of these loci showed significant length polymorphism, with as many as seven alleles identified for a single locus. Differences between alleles ranged from 1 to 27 bp. Karyotype analysis using probes flanking three microsatellites localized each marker to an individual chromosomal band, suggesting that these markers are single copy. In a sample of 19 isolates for which at least three microsatellites were typed, a majority of isolates displayed a unique multilocus fingerprint. Microsatellite analysis of isolates passaged between different host species identified genotypic changes consistent with changes in parasite populations.

Animals↗
PubMed2000

Socio-economic risk factors for severe protein energy malnutrition among children in Mulago Hospital, Kampala.

BACKGROUND: Despite Uganda's recent economic success, malnutrition is still an important public health problem and little information is available on socio-economic risk factors for severe protein energy malnutrition. OBJECTIVE: To determine socio-economic risk factors for severe protein energy malnutrition among children aged 0-60 months. DESIGN: A case control study. SETTING: Mulago Referral and Teaching Hospital, Kampala, Uganda. PATIENTS: Sixty six severely malnourished children (age 0-60 months) were matched, for age and sex, with 66 well nourished controls, and socio-economic, demographic, health facility utilisation and feeding practices were compared between the two groups. RESULTS: Severe protein energy malnutrition was associated with young age of the caretaker (p = 0.005), living in a mud walled house (OR 2.44, CI 1.13-5.32), lack of breast feeding (OR 3.22, CI 1.31-8.02), failure to complete immunisation (OR 3.68, CI 1.53-9.011), no land ownership (OR 4.62, CI 2.09-10.3), and no ownership of livestock (OR 13.65, CI 3.60-60.84), by the caretaker. The level of formal education of the caretaker was not associated with severe malnutrition. CONCLUSION: There seems to be a strong association between severe malnutrition and some indicators of poverty, lack of breastfeeding, and failure to complete immunisation. Programmes aimed at poverty alleviation, promotion of breastfeeding and immunisation, will go a long way in preventing malnutrition.

Case-Control Studies↗
PubMed2000

Joining together to combat poverty.

The International Poverty and Health Network (IPHN) was created in December 1997 following a series of conferences organized by the World Health Organization, with the aim of integrating health into plans to eradicate poverty. Around 1.3 billion people live on less than US$1 per day. Of the 4.4 billion people in developing countries nearly 60% lack access to sanitation, 30% do not have clean water, 20% have no health care, and 20% do not have enough dietary energy and protein. Even among rich nations there are gross socioeconomic inequalities. Many children are robbed of their physical and mental potential through poverty. Expressed in constant 1963 US dollars, an average Croatian family needed the annual income of US$894 to meet the poverty line in 1960 and US$9,027 in 1995. Accordingly, 9-25% of Croatian households were below the poverty line between 1960 and 1995. The increase in the poverty rate after 1991 was compounded by the war that destroyed almost a third of industrial capacity and infrastructure. Dissipation of the communist economy and inadequate privatization have contributed to the increase in unemployment rate, corruption, and other social ills. IPHN invited Croatian Medical Journal to publish this editorial to help push the issue of poverty up political and medical agendas on a global level. We argue that a factor contributing to the failure of most large-scale programs against poverty to date is the excessive emphasis on material and infrastructure assistance at the expense of spiritual, moral, and intellectual development.

Croatia↗
PubMed1998

Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial.

BACKGROUND: Despite ample food supplies, the incidence of childhood underweight and stunting remains high in Uganda. Many factors contribute to this situation, but the role of low zinc intakes has not been adequately explored. OBJECTIVE: Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight, height, and midupper arm circumference (MUAC). DESIGN: The study was randomized, double-blind, placebo-controlled, parallel, and 8 mo long, and incorporated 6 mo of zinc supplementation. Children (n = 153) aged 55.8 +/- 11.2 mo from 3 randomly selected nursery schools of medium, low, and very low socioeconomic status in a suburb of Kampala took part. The intervention comprised 10 mg Zn (as ZnSO4) or placebo daily in freshly prepared fruit juice, Monday to Friday inclusive. RESULTS: Zinc supplementation increased MUAC by the end of the study (P = 0.029) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo (P = 0.019 and P = 0.038, respectively). There was no effect on weight gain of the children from the other schools. Zinc supplementation had no influence on height. Infection rates (of which 82% were recorded as malaria) were lower in the zinc-supplemented group than in control subjects (P = 0.063). CONCLUSIONS: Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries. The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status, but may become so as nutritional status improves.

Anthropometry↗
PubMed1998

Risk factors for early childhood malnutrition in Uganda.

OBJECTIVE: To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <30 months of age in a central Ugandan community, whose main dietary staples are banana (matoki) and maize. METHODS: The study was a cross-sectional survey using stratified multistage random sampling to select households with a child <30 months of age in rural and semi-urban environments. A questionnaire was administered to mothers of 261 infants and toddlers in their home setting. Their health status was assessed by clinical examination and anthropometric measurements (mid-upper arm circumference [MUAC], weight, and supine length). RESULTS: A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23. 8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lack of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cow's milk consumption, low intake of energy from fat, and less well educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had been immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, there was a high prevalence of infection in the week preceding the survey interview, including diarrhea (23.0%), malaria (32.3%), or cough/influenza (72.8%). CONCLUSIONS: This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.

Anthropometry↗
PubMed1996

Maternity waiting shelters and pregnancy outcome: experience from a rural area in Zimbabwe.

Despite efforts to improve prenatal and perinatal health care in developing countries, child-birth remains hazardous for both mother and child. Several measures have been initiated to try to improve maternal and perinatal morbidity and mortality. One such measure is the establishment of maternity waiting shelters at hospitals where mothers can wait so that, when they go into labour or develop antenatal complications, they can transfer to the hospital wards for management and safe delivery. From May 1987 to April 1989, we evaluated pregnancy outcome among 280 women using such a shelter in a remote rural district in Zimbabwe. Perinatal mortality was higher (29.8 per 1000) among 773 non-waiting mothers than among the waiting mothers (25.0 per 1000), although this was not statistically significant (p > 0.05). However, there were significantly more low birthweight babies (11.4%) among the non-waiting mothers than among the waiting mothers (4.3%) (p < 0.01). Fetal deaths were more common than early neonatal deaths, suggesting that maternal factors accounted for most of the perinatal deaths. Poor pregnancy outcome was associated more with primigravidae and grand multigravidae than with those who had had one to four pregnancies. We conclude that maternity waiting shelters can contribute to preventing low birthweight and, to a lesser extent, improve perinatal outcome. There is a need to strengthen health care referral systems and to increase efforts to improve other determinants of perinatal and maternal morbidity and mortality.

Birthing Centers↗
PubMed1992

Zimbabwe's success story in education and health: will it weather economic structural adjustment?

The beginning of the 1980s saw the birth of Zimbabwe as a result of a protracted liberation war. It coincided with global interest in primary health care, the concept of universal primary school education and, unfortunately, moves towards economic stabilization and structural adjustment programmes. Economic structural adjustment was adopted by several sub Saharan African countries with dire consequences for the poor and vulnerable. Zimbabwe's commitment to social justice and to equitable distribution of resources demonstrated a practical move away from the culture of rhetoric so characteristic of many governments and non-governmental organisations and agencies. This commitment has been translated into impressive improvements in health and education. Current evidence shows that education has had a positive impact on health and related areas like contraceptive use, child mortality and the nutrition status of children. Conversely nutrition and health conditions among school children are important determinants of educational outcomes. Hitherto Zimbabwe's economy has been sufficiently strong to avoid excessive dependence on the International Monetary Fund, the World Bank and other foreign financial institutions. Unfortunately, however, the current economic recession together with economic structural adjustment programmes are beginning to have a negative impact on health and education. Will true synergism between health and education weather these structural problems? It seems that the people and government of Zimbabwe have the capacity and resolve to weather such a storm.

Economics↗
PubMed1992

Lung abscess in children in Harare, Zimbabwe.

Despite the rarity of lung abscess in children, 24 patients were treated at Harare Central Hospital during the 10 year period (1979 to 1988). The bacteriology and clinical findings of the 24 patients are presented. Bacteria were isolated from 18 patients. The most frequent isolates were Staphylococcus aureus, group A beta haemolytic streptococci, and Pseudomonas aeroginosa. Most of the abscesses followed measles, empyema or an episode of aspiration. The patients were managed with bronchoscopy, physiotherapy, and appropriate antibiotics, and had a mortality of 25%. Efforts at controlling measles as well as early and appropriate management of empyema are likely to reduce the number of lung abscesses in children.

Causality↗
PubMed1992

Child survival in a rural area in Zimbabwe: are we winning?

Health teams in a rural district in Zimbabwe have been implementing child survival programmes since 1984. A prospective study of the causes of morbidity and mortality in under-five children was done. Community based surveys assessing nutrition status, immunisation coverage and knowledge and use of sugar and salt solution for diarrhoea were carried out. Malnutrition, acute respiratory infections and diarrhoea accounted for 69.7 pc of the 902 under-fives admissions while 33 (67.4 pc) of the hospital deaths were under-fives. The mortality pattern parallelled that of morbidity. Malnutrition was more common in the dry communal areas and on the commercial estates. Full immunisation coverage rates in the 12-23-month-olds increased from 44.3 pc in 1984 to 70 pc in 1989; and up to 69 pc of the mothers correctly prepared and used sugar and salt solution for diarrhoea management. Although there appears to have been little impact on malnutrition, respiratory infections and diarrhoea, the study shows that a lot can be achieved even in a remote rural district given political will, community involvement, and dedicated staff. The maintenance of the current momentum and the introduction of further socio-economic reforms is a big challenge facing the health teams, community members and politicians.

Child, Preschool↗
PubMed1991

Measles control in a rural area in Zimbabwe.

In the rural district of Chimanimani in Zimbabwe, the Expanded Programme on Immunisation (EPI) which started in January 1982 has achieved measles coverage of between 50 and 80% in the 12-23 months age group, from 1984 to 1988, through 65 outreach centres, and 15 static health centres serving 93985 people in 119 villages. Facility based data as well as community based surveys have failed to show serious measles transmission in children under nine months of age, a common observation in high population density urban areas in Africa. Instead there has been a reduction in measles incidence and age distribution of measles has shifted to older children. The lowest measles incidence rate of 0.8 per 100 children occurred in the 0-5 months age group and the highest incidence rate of 4.0 per 100 children in the 48-59 months of age group. Only 7.9% of measles cases occurred in children under nine months of age. The high vaccination coverage rates were made possible by the post-independence government commitment, community involvement and dedicated staff. Our observations support the current one-dose 9 months minimum age measles vaccination policy for the low density rural areas in the developing countries.

Age Factors↗
PubMed1990

Acute renal failure and dermal necrosis due to bee stings: report of a case in a child.

Although several cases of reactions to bee venom including acute renal failure have been reported, the literature from Africa is scanty and that concerning children virtually non-existent. We report a child who was stung by over 1,000 bees and developed acute renal failure and extensive scalp necrosis. The pathogenesis of these complications is discussed and the importance of their public awareness stressed.

Acute Kidney Injury↗
PubMed1989

Measles in Chimanimani Zimbabwe.

A mini outbreak of measles in Chimanimani District in Zimbabwe where the measles immunisation coverage is about 79% is reported. Although many of the cases occurred in susceptible non-immunised children of the vaPostori (Apostolic) religious sects, a large number was in teenagers and adults. The importance of health education in increasing community participation in immunisation is emphasised. There is need to chart out a strategy to deal with a projected pool of persons susceptible to measles as our coverage rates continue to increase.

Adolescent↗
PubMed1989

Tropical ulcers in a remote area in Zimbabwe.

There is a dearth of literature on tropical ulcers in the rural areas in the tropics and subtropics. Results of a study of 1680 tropical ulcer patients attending an out patient department of a clinic in a rural district in Zimbabwe over a 14 months period are presented. The ulcers were more common during the wet humid months with 63 percent of the ulcers falling in the 5-14 year age group. There was a male predominance over the female with a ratio of 1.4:1. Culture and sensitivity results of isolates from 8 patients are discussed and the need for further studies on the possible causative organism(s) stressed. Implications of such outbreaks on the already over-burdened health care system are stressed; and the need for the intensification of health education in the prevention of this disease highlighted.

Adolescent↗