Biomedical subjects

R Ndyomugyenyi

Publications and source records attributed to R Ndyomugyenyi.

14 recordsLinked to original sources

PubMed2002

Using ivermectin-treatment coverage among schoolchildren monitored by schoolteachers as a proxy of population coverage in areas of Uganda where onchocerciasis is endemic.

In the control of onchocerciasis using mass treatment with ivermectin, coverage needs to be monitored regularly so that communities with poor or insufficient coverage can be identified and timely and appropriate interventions then instituted. The aim of the present study was to assess whether ivermectin-treatment coverage in schoolchildren, as monitored by schoolteachers, could be used as a proxy of population coverage. Although the coverages estimated in schoolchildren were found to be significantly correlated with estimates based on household surveys (P=0.01), there was poor correlation between either school and household-survey coverage and the values recorded in community registers. Although the community-register figures are the ones which the district health services normally use to report treatment coverage, they may be unreliable. Ivermectin-treatment coverage in schoolchildren monitored by schoolteachers could give a good and more accurate approximation of total population coverage. Further, large-scale studies, that take into consideration the cost-effectiveness of the various methods available to validate reported treatment coverage, are recommended.

Adolescent↗

PubMed2002

Monitoring community-directed treatment programmes for sustainability: lessons from the African Programme for Onchocerciasis Control (APOC).

Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P > 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P > 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the 'predictor indicators' of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.

Adolescent↗

PubMed2001

Involvement of women in community-directed treatment with ivermectin for the control of onchocerciasis in Rukungiri district, Uganda: a knowledge, attitude and practice study.

A study of knowledge, attitudes and practice was carried out in the Rukungiri district of Uganda, in order to investigate the involvement of women in community-directed treatment with ivermectin (CDTI), for the control of onchocerciasis. The data analysed came from interviews with 260 adult women (one from each of 260 randomly-selected households in 20 onchocerciasis-endemic communities), community informants, and participatory evaluation meetings (PEM) in eight communities. The women who had been treated with ivermectin in 1999 generally had more knowledge of the benefits of taking ivermectin, were more likely to have attended the relevant health-education sessions and were more involved in community decisions on the method of ivermectin distribution than the women who had not received ivermectin in that year. There were fewer female community-directed health workers (CDHW) than male CDHW in the communities investigated. The reasons for not attending health-education sessions, not participating in community meetings concerning the CDTI, and the reluctance of some women to serve as CDHW were investigated. The most common reasons given were domestic chores, a reluctance to express their views in meetings outside their own kinship group, suspicions that other women might take advantage of them, and a lack of interest. Most of the women interviewed (as well as other community members) felt that there were relatively few women CDHW. The women attributed this to a lack of interaction and trust amongst themselves, which resulted in more men than women being selected as CDHW. The rest of the community members were not against women working as CDHW. It is recommended that communities be encouraged to select women to serve as CDHW in the CDTI, and that the performances of male and female CDHW be compared.

Community Health Workers↗

PubMed2001

Urinary schistosomiasis in schoolchildren in Dar-es-Salaam, Tanzania, and the factors influencing its transmission.

The prevalence of urinary schistosomiasis among the schoolchildren living in Kigogo administrative ward of the Kinondoni district of Dar-es-Salaam city, Tanzania, and the factors influencing the transmission of the causative agent, Schistosoma haematobium, were investigated in a cross-sectional study. The estimate of overall prevalence, based on microscopical examination of a single urine sample/subject, was 47.6%. Compared with the girls, the boys were more likely to be excreting schistosome eggs (54.6% v. 40.8%; P = 0.004) and had, in general, higher intensities of infection (54 v. 38 eggs/10 ml urine; P = 0.001). The children aged 10-14 years had higher prevalences and intensities of infection than those in the younger or older age-group studied. The sensitivity of micro-haematuria as an indicator of infection (compared with the microscopical examination of single urine samples) was 84.3% overall, reaching 92% among the children excreting > or = 50 eggs/10 ml urine. The corresponding positive and negative predictive values were 77% and 84%, respectively. The sensitivity, specificity and positive and negative predictive values of the history of haematuria as an indirect screening technique for S. haematobium were 60.4%, 72.7%, 67% and 67%, respectively. Recreational activities such as bathing, swimming and playing in the water were the most frequent activities attracting children to water bodies and carried the highest risks of infection with S. haematobium. Knowledge about the disease, especially on the symptoms and mode of transmission, was generally good but the methods of prevention were inadequately known. Chemotherapy to control urinary schistosomiasis in schoolchildren is recommended; infected children may be identified on the basis of haematuria, detected using questionnaires or reagent strips. Additional health education, to heighten awareness of the disease and its prevention, would also be beneficial.

Adolescent↗

PubMed2000

In vivo sensitivity of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine among schoolchildren in rural Uganda: a comparison between 1995 and 1998.

Sensitivity of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine was tested among asymptomatic school children in 1995 and 1998 using a modified in vivo test with examination for parasitaemia on day 0, 2 and 7. Sensitivity (S/RI) to chloroquine in 'urban' areas was found in 42% in 1995 and 62% in 1998 with resistance at the RII/RIII level observed in 58 and 38%, respectively (P<0.01). In 'rural' areas, sensitivity to chloroquine was 76% in 1995 and 72% in 1998 (P=0.6) with resistance at the RII/RIII level observed in 24 and 18%, respectively (P=0.4). Sensitivity to sulfadoxine-pyrimethamine was found in 98 and 99% in 1995 and 1998, respectively. The apparent improvement in sensitivity to chloroquine in 'urban' areas might be due to a different school being included in the two studies. It is concluded that the pattern of sensitivity of P. falciparum to chloroquine and sulfadoxine-pyrimethamine has not changed over a period of 2.5 year.

Animals↗

PubMed2000

Chloroquine prophylaxis, iron/folic-acid supplementation or case management of malaria attacks in primigravidae in western Uganda: effects on congenital malaria and infant haemoglobin concentrations.

A randomized, double-blind, placebo-controlled trial, which compared the effects of three interventions (weekly chloroquine prophylaxis, daily iron and weekly folic-acid supplementation, and case management of malaria) on congenital malaria, maternal haemoglobin (Hb) and foetal outcome, was conducted among primigravidae resident in Hoima district, Uganda. Among 473 babies examined at birth or within 7 days of birth, 198 (42%) were parasitaemic, the level of parasitaemia in an infant being strongly correlated with those of placental (P< 0.01) and maternal, peripheral parasitaemia (P < 0.01). However, 33 (17%) of the parasitaemic babies were born to mothers who had placental but not peripheral parasitaemia, 22 (11%) to mothers who had peripheral but not placental parasitaemia, and 12 (6%) to mothers with neither peripheral nor placental parasitaemia. Overall, 163 babies were each examined for malarial parasites at birth and 1 month later. Of the 76 (47%) found to have parasitaemia at birth, 37 (23%) appeared aparasitaemic at the 1-month follow-up but 28 (17%) were still parasitaemic at that time. Among the babies born to the mothers who only received case management of malaria during pregnancy, parasitaemia at birth was associated with infant anaemia at birth (i.e. < 140 g Hb/litre; P = 0.03). Infants found to be parasitaemic at the 1-month follow-up had lower mean concentrations of Hb at that time than their aparasitaemic counterparts (P= 0.03). Parasitaemia at birth was not significantly associated with low birthweight, in any of three intervention groups. The intervention given to the mother had no significant effect on the parasitaemia of her baby, either at birth or at the age of 1 month. Congenital malaria per se may have little influence on birthweight but may have an impact on infant anaemia. In conclusion, congenital parasitaemia was not associated with birthweight, but was related to anaemia at birth in infants born to women who had only received active case management during their pregnancies.

Analysis of Variance↗

PubMed2000

In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control.

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, control of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

Community Health Workers↗

PubMed1999

Anaemia in pregnancy: Plasmodium falciparum infection is an important cause in primigravidae in Hoima district, western Uganda.

Infection with Plasmodium falciparum is a major cause of anaemia in pregnancy, especially in primigravidae. Of 853 primigravidae visiting an antenatal clinic in Hoima district, western Uganda, for the first time, 530 (62.1%) were found to have P. falciparum parasitaemias and 305 (57.5%) of these had at least 1000 parasites/microliter blood. Plasmodium falciparum parasitaemia was significantly associated with anaemia (relative risk = 0.84, with 95% confidence limits = 0.74-0.96; P = 0.01). Malarial parasites were detected in > 80% of the women who had severe anaemia (P = 0.0008) and haemoglobin concentrations decreased with increasing intensity of infection (P = 0.03). Malarial hyper-reactive splenomegaly was associated with high parasite density (P = 0.01) and low haemoglobin level (P < 0.0001). Effective measures aimed at prevention of malaria and anaemia in pregnancy, especially in primigravidae, would significantly reduce anaemia and its deleterious effects on both the mother and the baby.

Adolescent↗

PubMed1998

The burden of onchocerciasis in Uganda.

Onchocerciasis is far more prevalent and far more of a public-health and socio-economic problem in Uganda than it was thought to be a decade ago. It appears that over a million Ugandans have the disease and nearly two million others live in endemic areas. A few years of annual treatment with Mectizan (ivermectin, MSD) have reduced the community microfilarial load (CMFL) in sentinel villages in Uganda by 52%-100%. The greatest reductions (100%) have been in those villages with the lower CMFL pre-treatment. Assessments at intervals of much less than 1 year should help to show how quickly skin cleared by Mectizan is re-invaded by microfilariae and give an idea of how frequently treatment should be given to produce the greatest benefits. It seems likely that it would be best to give Mectizan at intervals of < 1 year and that such frequent treatment only becomes feasible if Mectizan distribution is community-directed.

Filaricides↗

PubMed1998

The use of formal and informal services for antenatal care and malaria treatment in rural Uganda.

The study aimed to analyze reasons for the use or non-use of antenatal care services and malaria treatment among pregnant women living in rural areas in Uganda. Focus group discussions with pregnant women, in-depth interviews with key informants (Traditional Birth Attendants (TBAs) and health workers) and a structured questionnaire administered to pregnant women were used to collect the relevant information. Antenatal care attendance was irregular and few women knew that the purpose of attending antenatal care was to monitor both the growth of the baby and the health status of the woman. Parity significantly influenced antenatal care attendance, but level of education, religion and marital status did not. Fifty-five per cent of the women stated that they had delivered outside the formal health delivery system despite antenatal care attendance. All women in their second pregnancy had delivered their first child in the village, despite TBA training to the contrary. Malaria as perceived by pregnant women is common and multiple health service providers are used for its treatment. About 66% of the mothers reported having suffered from malaria during the current pregnancy; of these more than half had received treatment outside the formal health delivery system. Self-treatment with drugs bought from ordinary shops was commonly reported. Nearly all women (93.3%) knew about the antimalarial drug chloroquine and 83% thought that it was used for the treatment of malaria, not for its prevention. Some women believed that the drug could cause abortion. Health seeking behaviour was influenced by several factors, including the perceived high cost of antenatal care services, of conducting a delivery and treatment, and perceived inadequacy of services provided by the formal health system. Inadequacy of formal health services was perceived by users to be partly due to understaffing and to irregular supply of essential drugs. Intensive health education to pregnant women on the safety of chloroquine use in pregnancy, the importance and the need for regular antenatal care attendance are recommended. In addition, training of more TBAs and continued educational efforts to upgrade their knowledge, regular and adequate supply of essential drugs, and free health services for high-risk groups such as pregnant women are recommended to improve antenatal care services and drug prophylaxis use in pregnancy.

Adult↗

PubMed1998

Onchocerciasis control in Uganda.

In 1990 a community-based programme of onchocerciasis control, involving the use of ivermectin, was introduced in Uganda. The problems confronting it are discussed and suggestions are made for making it sustainable.

Animals↗

PubMed1997

In vivo sensitivity of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine in school children in Hoima district, western Uganda.

In vivo testing of Plasmodium falciparum sensitivity to chloroquine and sulfadoxine-pyrimethamine was carried out among asymptomatic school children from seven schools in four sub-counties in Hoima District in western Uganda. Seven hundred and twenty five children were screened, 487 (67%) had parasitaemia and 307 met the inclusion criteria. Full sensitivity to chloroquine in urban areas was found in 42%. Chloroquine resistance at RII level was observed in 46% (33-58%) and RIII level in 13% (0-24%) In rural areas, however, full sensitivity to chloroquine was found in 76% (70-84%). Resistance at RII and RIII level was found in 18 and 6% respectively. Full sensitivity to sulfadoxine-pyrimethamine was found in 98% and only 2% resistant at RII level. The relatively high proportion of chloroquine resistance at RII and RIII levels in urban areas could be attributed to easy access to chloroquine as well as frequent and probably inadequate use of chloroquine. Chloroquine can still be used as first line antimalarial drug in the area. Sulfadoxine-pyrimethamine should be the second line drug for cases not responding to chloroquine.

Antimalarials↗

PubMedDate not supplied

Chloroquine prophylaxis, iron-folic acid supplementation or case management of malaria attacks in primigravidae in western Uganda: effects on maternal parasitaemia and haemoglobin levels and on birthweight.

The effects of weekly chloroquine prophylaxis, daily iron-weekly folic acid supplementation or passive case management on maternal haemoglobin and parasitaemia and on birthweight were examined in primigravidae in a randomized, double-blind placebo-controlled intervention trial in 1996-98 in Hoima District, western Uganda. Iron-folic acid supplementation significantly increased mean birthweight as compared to case management (P = 0.03). Low birthweight (< 2.5 kg) occurred in 2% of babies of women receiving chloroquine prophylaxis for > or = 8 weeks and in 9% in the case management group (RR = 0.36, 95% CI 0.13-1.00, P = 0.009). Parasitaemia at enrolment significantly correlated with low birthweight in the case management group as compared to the intervention groups (P = 0.02). Women in the case management group who were parasitaemia and had haemoglobin levels < 100 g/L at delivery had babies with lower mean birthweight as compared to babies in the other groups (P = 0.04). Low haemoglobin level at enrolment, irrespective of parasitaemia status, was a predictor of low birthweight in the case management group only (P = 0.04). Chloroquine prophylaxis and iron-folic acid supplementation significantly increased maternal haemoglobin levels during pregnancy as compared to case management (P = 0.01 and 0.007, respectively) and the increase correlated to the duration of the intervention.

Adolescent↗

PubMedDate not supplied

Malaria morbidity, mortality and pregnancy outcome in areas with different levels of malaria transmission in Uganda: a hospital record-based study.

A retrospective hospital record-based study for Uganda was conducted in Hoima district (an area of stable malaria transmission) and in Kabale district (an area of unstable malaria transmission). In-patient and maternity ward registers for January 1997-December 1998 were reviewed and malaria admissions, mortality, abortions, stillbirths and birthweights were recorded. Data were analysed in relation to rainfall patterns. Admissions due to malaria were significantly higher at Hoima compared to Kabale hospital in 1997 (P < 0.0001). However, the situation reversed in 1998 with significantly more malaria cases registered at Kabale compared to Hoima hospital (P < 0.0001). The increase at Kabale hospital in 1998 was attributed to increased and prolonged rains during 1997 (E1 Niño). Pregnancy was a risk factor for admission with malaria at Kabale, but not at Hoima. Anaemia was significantly more common among patients admitted to hospital at Hoima compared to Kabale in 1997 and 1998 (P < 0.0001 and P = 0.02, respectively). The rate of low birthweight (birthweight < 2.5 kg) was significantly higher among primigravidae and multigravidae at Hoima hospital compared to Kabale hospital (P < 0.0001). There were significantly more stillbirths at Kabale compared to Hoima hospital (P < 0.0001). Routine hospital data such as birthweight and number of malaria cases can provide information on the level of malaria transmission useful for the health services to target appropriate malaria interventions and allocate resources to control outbreaks of malaria epidemics.

Adolescent↗