Master of Medicine in Pediatrics and Child Health

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http://hdl.handle.net/20.500.12493/14841

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    Prevalence and Factors Associated with Anemia among women with Helminthiasis attending Antenatal Care at Fort Portal Regional Referral Hospital
    (Kampala International University, 2023-05) Dr. Geoffrey Akena
    Anemia is a global public health problem that affects around a quarter of the world's population, especially in developing nations (Dorsamy et al., 2022). Its burden is estimated to be around 40% of pregnant women worldwide (Dorsamy et al., 2022). Compared to women who did not have intestinal worms (16.4%), anemia was more prevalent in pregnant women with intestinal worms (55.6%) (Bolka & Gebremedhin, 2019). Aim: To determine the prevalence and factors associated with anemia among women with helminthiasis attending Antenatal Clinic at Fort Portal Regional Referral Hospital. Method and Materials: This was a hospital-based cross-sectional study conducted from November 2022 to March 2023. A total of 420 pregnant women with helminthiasis attending ANC at Fort portal regional referral hospital were consecutively enrolled. Interviewer-administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistical analysis followed by binary logistic regression were done. All data analyses were conducted using IBM SPSS statistics version 23. Results: we enrolled 420 participants, (The prevalence of anemia among them was 26.2%; with 39.1% having mild anemia, 35.5% had moderate anemia and 25.5% had severe form). The factors that independently associated with anemia among women with helminthiasis at the multivariate stage were women who were students (aOR= 0.167, 95% CI: 0.045-0.627, p=0.008), those who took helminthic medications in ≥3months (aOR= 0.107, 95% CI: 0.013-0.882, p=0.038), those whose source of water was borehole (aOR= 0.598, 95% CI: 0.359-0.995, p=0.048) and those who were at gestational age ranging between 14-27 weeks (aOR= 0.567, 95% CI: 0.351-0.915, p=0.020). Conclusions and recommendations: This study found that the prevalence of anemia among women with helminthiasis at Fort portal regional referral hospital was relatively higher than the regional prevalence. Mild form of anemia remains rampant. Being a student was protective and pregnant women who last took deworming medicines >3 months ago runs risk of suffering from anemia. While taking borehole water was protective and being in a gestational age between 14 and 27 weeks was also protective. Intense health education focusing on iron supplementation and deworming drug prophylaxis adherence to all pregnant women by the health workers.
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    Prevalence and Factors Associated with Bacteremia Among Children Aged Under Five Years Hospitalized with Severe Acute Malnutrition in Jinja Regional Referral Hospital
    (Kampala International University, 2024-03) Dr. Abdirazak Mohamed Omar
    Background Severe acute malnutrition, the most common cause of immunodeficiency worldwide, impacts the host's natural and acquired defense mechanisms. This causes the disease to become more severe, episodes to last longer and opportunistic infections to occur. In addition, the symptoms and signs of infectious diseases are frequently concealed, making early clinical identification and treatment challenging. This study purposed to determine the prevalence, antibiogram and to describe factors associated with bacteremia among under-fives hospitalized with severe acute malnutrition (SAM) in Jinja Regional Referral Hospital (JRRH). Methods This was a hospital based cross sectional-analytical study, in which children under five years admitted with SAM at JRRH were enrolled. A blood sample was taken for culture and sensitivity. Bacteremia was defined as any bacterial growth. The factors associated with bacteremia were determined using binary logistic regression in SPSS version 27. Results In our study, majority of the participants were females 107(61.7%). Fifty percent of the participants were aged ≤ 2 years. The prevalence of bacteremia was 11.5% (95% CI=6.9-16.7%). In the multivariate analysis, age ≤ 2 years (AOR=4.822, 95%CI=1.365-17.037, P=0.015), having a primary care giver not his/her own mother (AOR=8.720, 95%CI=1.896-40.091, P=0.005) and being a referral-in (AOR=10.195, 95%CI=4.097-25.370, P<0.001) were independently associated with presence of bacteremia. The most prevalent organism isolated was Staphylococcus aureus (N=12/20) followed by Klebsiella pneumoniae (N=5/20) and Streptococcus pneumoniae (N=3/20). The highest sensitivity was to Meropenem, Vancomycin, Ceftriaxone, Chloramphenicol and Levofloxacin while the highest levels of resistance were found against Ampicillin and Amoxicillin overall. Conclusion The prevalence of bacteremia was high. Children admitted with severe acute malnutrition should be screened for bacteremia, with the main focus on those below 2 years, those whose primary care taker aren’t their own mothers and those referred-in. We suggest that the routine use of ampicillin and Gentamicin for prophylaxis against bacterial infection among children with SAM should be reviewed in view of the high resistance against both drugs found in our study.
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    Prevalence and factors associated with bacteremia among children with severe malaria Aged 2 to 59 months presenting at Hoima Regional Referral Hospital
    (Kampala International University, 2023-03) Dr. Zawadi Vulwaghe Gift
    Introduction Bacteraemia is the presence of living bacterial organisms in circulating blood. Malaria-bacteraemia co-infection in children has 8.5-fold increased mortality compared to malaria alone. The objective of this study was to determine the prevalence, factors associated with bacteraemia, and the susceptibility patterns of bacterial isolates among children aged 2 to 59 months presenting with severe malaria at Hoima Regional Referral Hospital (HRRH). Methods This was a health facility-based cross-sectional analytical study at HRRH. The children diagnosed with severe malaria were enrolled and for each participant a blood sample was taken to determine the presence of bacteria. For children with bacteraemia, culture and antibiotic susceptibility were performed. Data were analyzed using SPSS 22.0. Results During the study period, 233 children had severe malaria out of which 228 children were enrolled. Of the 228 study participants, majority were males 139(61.0%), aged 2 to 30 months 174(76.3%). Bacterial growth was seen in 49 (21.5%) of the study participants. The factors that were independently associated with bacteraemia were: Not attaining formal education for the care taker (AOR=3.983,CI=1.078-7.720, P=0.038), undernutrition (AOR=6.231,CI=4.175-11.928, P<0.001), hypoglycemia (AOR=5.742, CI=2.157-7.283, P<0.001) and abnormal white cell count (AOR=2.341,CI=1.818-6.694, P=0.013). The most common isolate was salmonella Spp (32.6%), followed by staphylococcus Aureus (28.6%) and Klebsiella SPP (14.3%). All organisms were sensitive to Imipenem. Ampicillin and Benzathine Penicilline demonstrated only intermediate sensitivity to a few organisms. Conclusion The prevalence of bacteremia was high. The commonest bacteria isolated were salmonella Spp, staphylococcus Aureus, and Klebsiella SPP. There was high resistance to the commonly used antibiotics, but Imipenem demonstrated the highest level of sensitivity. Children presenting with severe malaria should be routinely screened for bacteremia paying more attention to those with undernutrition, those with hypoglycaemia and those with deranged white blood cell count.
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    Prevalence and factors associated with glomerular hyperfiltration among children aged 2 to 18 years with sickle cell anemia at Jinja Regional Referral Hospital.
    (Kampala International University, 2023-09) Omar Abdikarim Abdulle
    Introduction: Even though progression in children’s care with SCD have raised, their prolonged-term survival is characterized by long-standing diseases such as long-standing kidney disease. Renal involvement occurs all the time of life of a patient with SCA and contribute greatly reduced life expectancy of patients with sickle cell disease, accounting for 16–18% of mortality. The study aimed at determining the prevalence and factors associated with glomerular hyperfiltration among children aged 2 to 18 years with sickle cell anemia at Jinja Regional Referral Hospital (JRRH). The study also described the proportion of microalbuminuria among SCA children with glomerular hyperfiltration. Methods: An analytic and descriptive cross-sectional hospital-based study was conducted among children with Sickle cell anemia. Consecutive enrolment of study participants was done until the sample size of 245 was achieved. The prevalence of glomerular hyperfiltration was analyzed as percentage with its corresponding 95% CI. To determine factors associated with glomerular hyperfiltration, bivariate and multivariate logistic regression were run. Both unadjusted (crude) odds ratios with their corresponding 95% confidence interval (CI) and adjusted OR with their corresponding 95% CI were reported. The proportion of microalbuminuria among study participants with glomerular hyperfiltration was determined as a fragment of participants with albuminuria and glomerular hyperfiltration over the number of study participants with glomerular hyperfiltration. Results: The prevalence of glomerular hyperfiltration was 28.00%. The independent risk factors for glomerular hyperfiltration were age and severe anemia. Children who were in the age group of 14 – 16 years had 3.91 folds the risk of developing Glomerular Hyperfiltration (aOR 3.91, 95%CI 1.41-37.23, P=0.023) and children who had severe anemia were 9.47 folds the risk of developing Glomerular Hyperfiltration (aOR 9.47, 95%CI 1.57-57.05, P<0.001). Conclusion: This study suggests that a considerable proportion of children in this population experience glomerular hyperfiltration. The results underscore the importance of considering age, and severe anemia in the management and care of these patients. This study suggests that a significant proportion of SCA children with glomerular hyperfiltration may be experiencing early kidney damage or dysfunction, as evidenced by the presence of MA.
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    Prevalence and Factors Associated with Iron Deficiency Anaemia among Children aged 6 – 23 months in Bushenyi- Ishaka Municipality
    (Kampala International University, 2023-05) Dr. Kajoba Dickson
    Background: Iron deficiency anaemia is still a global public health concern with heaviest burden among children 6 to 23 months. This is because of their rapid growth spurt exceeding what breastmilk can supply. Therefore, nutritional supply is a key source of iron to attain required nutrients for better growth and development. Objective: To determine the prevalence, factors associated and value of Mentzer index when compared with RDW plus microcytosis in IDA diagnosis among children aged 6 to 23 months attending selected health facilities in Bushenyi-Ishaka municipality. Methodology: This was a quantitative cross-sectional descriptive study done at Ishaka Adventist Hospital (IAH) and Kampala International University Teaching Hospital (KIUTH) from April to July 2022. Ethical approval obtained at KIU REC (KIU-2021-56) and Participants were enrolled consecutively into the study. Structured questionnaires, 24-hour dietary recall and clinical assessment were used to obtain data. Data analysis was done using the statistical package for social scientists (SPSS) 22nd version. At univariable analysis data was summarised using measures of central tendencies. Bivariable and multivariable analysis was done using logistic regression for associations with significance set at P-value <0.05. Spearman correlation coefficient was calculated to established correlation between Mentzer index and RDW plus microcytosis. Results: A total of 364 participants were enrolled, majority were males 198(54.4%) and born at term 333(91.5%). The modal age was 12-17 months [163(44.8%)] with a mean age of 14.1 months (SD 5.32). The overall prevalence of IDA was 151/364 (41.5%). The factors associated with IDA included male sex (aOR 1.612), current episode of diarrhoea (aOR 1.705), less than the minimum recommended meal frequency (aOR 1.781), no vegetable consumption (aOR2.466) 7 days preceding the study and consuming fruits once(aOR1.972) in 7 days preceding the study. Additionally, Mentzer index had a strong positive significant correlation with RDW plus microcytosis with spearman correlation coefficient of 0.521. Conclusion and recommendation: IDA is highly prevalent with at least four in 10 infants 6-23 months affected. Screening should be recommended in male children with current diarrhoea, poor intake of fruits and vegetables and with poor meal frequency. Mentzer index is a good alternative screening test for IDA.
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    Prevalence, risk factors and early mortality of Acute Kidney Injury among term neonates admitted with perinatal asphyxia in Fort Portal Hospital
    (Kampala International University, 2023-05) Dr. Julitha Isdory Kidazu
    Introduction The failure of the newborn to begin and maintain sufficient respiration after delivery is known as perinatal asphyxia. Acute kidney injury (AKI) is common in asphyxiated newborns and is associated with complications and high mortality, but there is paucity of data about the subject in Uganda. This study was aimed at determining the prevalence, risk factors and early mortality of acute kidney injury among term neonates admitted with perinatal asphyxia in Fort Portal Hospital. Methods This was a hospital-based prospective cohort study at Fort Portal Hospital. A blood sample was taken to measure creatinine at admission and 72 hours letter. The KDIGO criteria was used to diagnose AKI. The participants were followed up to the 7th day after diagnosed. Analysis was done using SPSS version 22 in which the prevalence and mortality were reported using descriptive statistics while the risk factors were determined using binary logistic regression. Results Of the 175 neonates enrolled in this study, majority presented at 48-72hours (68.0%) and were male (73.7%) with an APGAR score of 6 at 5 minutes (60.6%). The prevalence of AKI was 24.6% with majority of the AKI being stage I (60.5%). The factors that were significantly associated with acute kidney injury at multivariate level were less than 4 antenatal care visits (aOR=1.972, CI=1.859-2.266, P=0.001), duration of resuscitation >20 minutes (aOR=2.580, CI=1.167-2.867, P=0.031), and presence of shock (aOR=4.636, CI=3.135-6.041, P=0.003). Mortality of Neonates with AKI was 48.8% which represents 58.3% of the observed death among term neonates with low Apgar score and neonates without AKI was 11.4%. Neonates with AKI were 4.356 times more likely to die (cOR=4.356, p=<0.001). Conclusion The prevalence of acute kidney injury was high. More attention should be put on assessing for AKI among neonates with birth asphyxia. Mothers should be encouraged to attend antenatal care as recommended. Also neonates with birth asphyxia should be monitored for dehydration and shock and promptly managed. Neonates diagnosed with AKI should have management directed to kidney recovery to reduce mortality.
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    Prevalence, Severity and Factors associated with Hypoxic Ischemic Encephalopathy among Term Neonates delivered with Low APGAR Score at Hoima Regional Referral Hospital
    (Kampala International University, 2023-05) Dr. Muhiadin Omar Matan
    Background: Despite neonatal encephalopathy being a significant problem worldwide and one of the major contributors to long-term neurological morbidity and mortality, there are contextual variations in its prevalence, severity, and associated factors, particularly those with low APGAR scores. This study determined the prevalence, severity, and factors associated with hypoxic ischemic-encephalopathy among term neonates delivered with Low APGAR Scores at Hoima Regional Referral Hospital. Method: This was a hospital-based cross-sectional study in the Neonatal Intensive care Unit at HRRH among 126 neonates. They were consecutively enrolled based on the hospital register of NICU between November 2022 and January 2023. Data on socio-demographic, obstetric, and clinical characteristics were collected. Descriptive statistics were presented for all characteristics considered. Prevalence of HIE was presented as a proportion of the neonates with HIE expressed as a percentage. For factors, bivariate and multivariate analyses were conducted. Only factors with p<0.05 at the multivariate stage were considered significant. The severity of HIE was presented as a proportion of the neonates with different categories of HIE among those diagnosed with HIE expressed as a percentage. All analyses were done using IM SPSS 24 Results: Of the 126 neonates with low APGAR enrolled, the prevalence of HIE was 92.1%. The risk of HIE increased significantly for neonates with meconium staining (OR= 10, 95%CI: 1.197-82.498, p= 0.033) and for neonates born to mothers who had prolonged labor, (OR=5,95%CI 1.082-27.745, p= 0.040). Of the 116 neonates with HIE, the majority had mild HIE, 44.0% followed by severe HIE, 28.5%, and moderate HIE, 27.9%. Conclusions: The prevalence of HIE among term-neonates with low APGAR scores in the 5th minute at HRRH was high. Most of the neonates delivered with low APGAR scores in the 5th minute had mild HIE. Prolonged labor and the presence of meconium staining in the amniotic fluid increased the odds of HIE. It is therefore recommended to pay close attention to women with prolonged labor and those whose amniotic fluid is stained with meconium. Early communication between the caring obstetrician and neonatology staff in case risk factors are identified.