Browsing by Author "Mwaka, Amos Deogratius"

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Anticipated Help Seeking Behaviour and Barriers to Seeking Care for Possible Breast and Cervical Cancer Symptoms in Uganda and South Africa
(National Center for Biotechnology Information (NCBI), 2021-01-14) Moodley, Jennifer; Constant, Deborah; Mwaka, Amos Deogratius; Scott, Emilie Suzanne; Walter, Mary Fiona
Objectives: Breast and cervical cancers are leading causes of cancer morbidity and mortality in sub-Saharan Africa. Most women present with advanced-stage disease and have poor outcomes. This study aimed to describe anticipated help-seeking behaviour for possible breast and cervical cancer symptoms, barriers to accessing health care and factors associated with less timely anticipated help-seeking in urban and rural settings in Uganda and South Africa (SA). Methods: We conducted a cross-sectional community-based survey between August and December 2018. Data were collected from one randomly selected woman per household using the African Women Awareness of Cancer breast and cervical cancer tool. Anticipated help-seeking behaviour was dichotomised into waiting <1week or ≥1 week to seek care. Multivariable analysis identified factors associated with anticipated help-seeking behaviour. Results: One thousand, seven hundred fifty-eight women participated (Uganda 873, SA 885, median age 34, interquartile ranges 26–47). Most would discuss symptoms with someone close to them (87.7% for breast, 83.0% for cervical symptoms). The majority anticipated seeking care from a health facility in <1 week: 86.1% and 88.0%, respectively, for breast and cervical symptoms. 38.7% of women expected to encounter at least 1 barrier when seeking care. Lack of money for transport or clinic costs was the most common barrier (24.6% of participants). For both cancers and in both countries, women who reported more barriers were significantly less likely to anticipate seeking timely care. In SA, rural location was also associated with longer anticipated time to seek care, adjusted prevalence ratio (aPR) 2.92, 95% confidence interval (CI) 1.48–5.76 and aPR 2.42, 95% CI 1.08–5.45 for breast and cervical cancer, respectively. Conclusion: Interventions that improve community level cancer knowledge and highlight the importance of prompt help-seeking for possible symptoms are important to promote timely care seeking. In addition, addressing financial barriers by reducing transport and clinic costs and tackling geographical inequities in access to care could support women in seeking timely care for possible symptoms.
Awareness of Cervical Cancer Risk Factors and Symptoms: Cross-Sectional Community Survey in Post-Conflict Northern Uganda
(John Wiley & Sons, Inc., 2015-06-11) Mwaka, Amos Deogratius; Orach, G. Christopher; Were, M. Edward; Lyratzopoulos, Georgios; Wabinga, Henry; Roland, Martin
Background Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. Objective We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform inter ventions to improve cervical cancer survival. Design Cross-sectional population-based survey. Setting and participants We conducted this study in Gulu, a post-conflict district in Uganda in 2012. The sample included 448 persons aged 18 years and above, selected through a multi-stage stratified cluster sampling process. Data collection methods and analysis We collected data using a pretested structured questionnaire. Logistic regressions were used to determine magnitudes of associations between socio-demographic and outcome variables. Results Most participants (444/448) had heard about cervical cancer. Known risk factors including multiple sexual partners, human papillomavirus infection, and early onset of sexual activity, were recognized by 88%, 82%, and 78% of respondents respectively. 63% of participants believed that prolonged use of family planning pills and injections caused cervical cancer. The majority of participants recognized symptoms of cervical cancer including inter-menstrual bleeding (85%), post-menopausal bleeding (84%), and offensive vaginal discharge (83%). 70% of participants believed that cervical cancer is preventable and 92% believed that it could be cured if diagnosed at an early stage.
Bacteriuria Among Adult Non-Pregnant Women attending Mulago Hospital Assessment Centre in Uganda
(Makerere University, 2011-06-02) Mwaka, Amos Deogratius; Mayanja-Kizza, H; Kigonya, E; Kaddu-Mulindwa, D
Background: Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places. Objectives: To determine the prevalence of UTI, associated uropathogens and their antimicrobial susceptibility. Methods: A cross section study carried out at Mulago hospital outpatients’ department. Midstream urine samples (MSU) were collected from 399 women, who gave informed consent and fulfilled other study criteria. Quantitative culture method, identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique were applied to the isolates. Results: Out of 399 MSU samples, 40 pure significant bacterial growths (>105 colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli, 23 (57.5%), Staphylococcus aureus, 9 (22.5%), Enterococci spp, 6 (15%) and Klebsiella pneumoniae, 2 (5.0%). Overall, sensitivities were: nitrofurantoin (98.3%), cefuroxime (89.3%), and cotrimoxazole (20%) by all uropathogens isolated. Conclusions: Culture positive UTI among adult non-pregnant women are a common problem, occurring in 10% of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT. Recommendations: Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women.
Barriers to Biomedical Care and Use of Traditional Medicines for Treatment of Cervical Cancer: An Exploratory Qualitative Study in Northern Uganda
(John Wiley & Sons, Inc., 2014-06-13) Mwaka, Amos Deogratius; Okello, S.E.; Orach, G.C.
Use of traditional medicines for treatment of cancers has increased worldwide. We used a qualitative approach to explore barriers to biomedical care and reasons for use of traditional medicines for the treatment of cervical cancer in Gulu, northern Uganda. We carried out 24 focus group discussions involving men and women aged 18–59 years. We employed content analyses technique in data analysis. Traditional medicines were used mainly due to barriers to biomedical care for cervical cancer. The barriers included health system factors, for example long distances to health facilities and unavailability of medicines; health workers’ factors, for example negative attitudes towards patients and demands for bribes; individual patient’s factors, for example inability to pay for medical care; and socio-cultural beliefs about superiority of traditional medicines and perceived greater privacy in accessing traditional healers. Barriers to biomedical care and community beliefs in the effectiveness of traditional medicines encourage use of traditional medicines for treatment of cervical cancer but might hinder help-seeking at biomedical facilities. There is need for targeted culturally sensitive awareness campaign to promote effectiveness of modern medicine and to encourage cautious use of traditional medicines in the treatment of cervical cancer.
Cancer Care in Countries in Transition in Africa: The Case of Uganda
(Springer, Cham, 2016) Mwaka, Amos Deogratius; Wabinga, Henry; Garimoi, Orach Christopher
Uganda is a low-income country experiencing epidemiological transition with a double burden of communicable diseases including malaria, tuberculosis, and HIV as well as a rising incidence of noncommunicable diseases including cancers, hypertension, and heart diseases and diabetes. The country has a high population growth rate of 3.5 %. The population of the older people who are more prone to cancers is increasing exponentially and cancers related to lifestyles and old age are on the increase. This is in addition to the high rates of infection-related cancers including cervical cancer (most common cancer among women in Uganda), Kaposi sarcoma, and hepatocellular carcinoma. These infection-related cancers predominantly affect the young economically productive age groups and hence contribute negatively to economic production and poverty eradication. Majority of cancer patients in Uganda are diagnosed with advanced stage cancers and experience poor survival. There are few specialized cancer care facilities and cancer specialists in Uganda. Hospice Africa Uganda contributes immensely to the care of the terminally ill cancer patients while the Kampala Cancer registry provides high quality data on cancer exposures, incidences, and mortality to guide planning, research, and policy on care for cancer.
Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control
(Wolters Kluwer Health, Inc., 2021-01-06) Koo, Monica Minjoung; Unger-Saldaña, Karla; Mwaka, Amos Deogratius; Corbex, Marilys; Ginsburg, Ophira; Walter, M. Fiona; Calanzani, Natalia; Moodley, Jennifer; Rubin, P. Greg; Lyratzopoulos, Georgios
Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site–specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems’ capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.
Current State of Palliative Care in Uganda
(Springer Nature, 2020-10-30) Namukwaya, Elizabeth; Mwaka, Amos Deogratius; Namisango, Eve; Mwesiga, Donald Mark; Downing, Julia
The need for palliative care in Uganda has exponentially increased due to the ageing population, the increased number of non-communicable diseases and the high prevalence of HIV/acquired immune deficiency syndrome (AIDS). The World Health Organisation (WHO) estimates that 1% of the population needs palliative care; therefore, as the current population of Uganda is 40,308,000, an estimated 403,080 people need palliative care. Uganda has made significant progress in palliative care services and research since 1993, when palliative care was introduced. Uganda was the highest-ranking African country and 35th ranking country worldwide in the Quality of Death Index of 2015 out of 80 countries assessed for quality and availability of palliative care services for adult populations in the world. Uganda had the largest number of palliative care services among the countries surveyed in Africa for the recent African Palliative Care Association (APCA) Atlas of 2017. In 2019, 90% of the 112 districts in Uganda had palliative care services. Most palliative care services were developed in the pre-antiretroviral treatment era as a response to the HIV/AIDS epidemic and its complications, including cancer. Most palliative care services offer care mainly for HIV/AIDS and cancer patients, with a few now taking on other illnesses that cause serious health-related suffering. The majority of palliative care services in Uganda are health facility-based. Home-based and community-based services are few and are mainly provided by non-government organisations. The palliative care service matrix for palliative care services in Uganda includes pain and symptom control, social and psychological support, patient and family healthcare education, cancer screening, day care services, food and school education support, provision of antiretroviral therapy, HIV testing, transport assistance and bereavement support. Community and hospital volunteers have played a big role in palliative care in Uganda, which bridge healthcare professionals with the community. This chapter discusses the current state of palliative care services in Uganda. Focus will be on services that offer home-based and community-based palliative care, as most people live in rural areas with little access to health facilities; this is where most people should receive most of their care as the majority of patients prefer to die at home. The five-pillar approach to the integration of palliative care into health systems, as proposed by the World Health Organisation, has been pivotal in the palliative care development in Uganda. Therefore, this chapter will highlight the development and current state of palliative care using these pillars. The challenges faced by palliative care in Uganda will also be discussed.
Do Clinicians in Areas of Declining Malaria Transmission Adhere to Malaria Diagnosis Guidelines? A Cross-Sectional study From Kampala, Uganda
(BioMed Central Ltd, 2021-04-15) Atukunda, Angella; Mwaka, Amos Deogratius; Arinaitwe, Emmanuel; Orishaba, Philip; Kamya, R. Moses; Nankabirwa, I.Joaniter
Background: Uganda’s clinical management guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature≥37.5 °C), and only those with a positive test receive anti-malarial treatment. However, the current practice in areas with declining malaria transmission remains unknown. This study assessed the clinicians’ diagnostic practices, the factors associated with recommending a test, and the risk of missing a malaria case when a test is not recommended in patients presenting with fever in Kampala, an area of declining malaria transmission in Uganda. Methods: Between January and March 2020, 383 participants aged≥12 years and presenting to Kisenyi Health Centre IV in Kampala district with fever were enrolled in the study. A questionnaire was administered during exit interviews, routine diagnostic practices were recorded from participant clinical notes, and a research blood slide was obtained for later reading. Results: Of the enrolled participants, 356 (93%) had a malaria diagnostic test recommended by the clinician. Factors associated with increasing prevalence of having a test recommended included; history of overnight travel (adjusted prevalence ratio [aPR] 1.07, 95% confdence interval [CI] 1.02–1.13, p=0.011), being married (aPR=1.07, 95% CI 1.01–1.13, p=0.022), and having tertiary education (aPR=1.09 95% CI 1.01–1.17, p=0.031). Among the 27 participants where a malaria diagnostic test was not recommended, 4 (14.8%) had a positive study smear. Conclusion: Despite having signifcant declines in malaria transmission in Kampala in the last decade, clinicians at the study health facility highly adhered to the clinical management guidelines, recommending a malaria test in almost all patients presenting with fever. However, a signifcant proportion of malaria cases was missed when a test was not recommended. These results highlight the importance of laboratory testing for malaria in all patients who present with fevers and live in endemic settings even when the transmission has signifcantly declined.
Doxycycline for the Treatment of Nodding Syndrome (DONS); The Study Protocol of a Phase II Randomised Controlled Trial
(Springer Nature, 2019-03-06) Idro, Richard; Anguzu, Ronald; Ogwang, Rodney; Akun, Pamela; Abbo, Catherine; Mwaka, Amos Deogratius; Opar, Bernard; Nakamya, Phyellister; Taylor, Mark; Elliott, Alison; Vincent, Angela; Newton, Charles; Marsh, Kevin
Background Nodding syndrome is a poorly understood neurological disorder of unknown aetiology, affecting several thousand children in Africa. There has been a consistent epidemiological association with infection by the filarial parasite, Onchocerca volvulus and antibodies to leiomodin and DJ-1, cross-reacting with O.volvulus proteins, have been reported. We hypothesized that nodding syndrome is a neuro-inflammatory disorder, induced by antibodies to O.volvulus or its symbiont, Wolbachia, cross-reacting with human neuron proteins and that doxycycline, which kills Onchocerca through effects on Wolbachia, may be used as treatment. Methods This will be a two-arm, double-blind, placebo-controlled, randomised phase II trial of doxycycline 100 mg daily for six weeks in 230 participants. Participants will be patients’ ages≥8 years with nodding syndrome. They will receive standard of care supportive treatment. All will be hospitalised for 1–2 weeks during which time baseline measurements including clinical assessments, EEG, cognitive and laboratory testing will be performed and antiepileptic drug doses rationalised. Participants will then be randomised to either oral doxycycline (Azudox®, Kampala Pharmaceutical Industries) 100 mg daily or placebo. Treatment will be initiated in hospital and continued at home. Participants will be visited at home at 2, 4 and 6 weeks for adherence monitoring. Study outcomes will be assessed at 6, 12, 18 and 24-month visits. Analysis will be by intention to treat. The primary efficacy outcome measure will be the proportion of patients testing positive and the levels or titires of antibodies to host neuron proteins (HNPs) and/or leiomodin at 24 months. Secondary outcome measures will include effect of the intervention on seizure control, inflammatory markers, cognitive function, disease severity and quality of life. Discussion This trial postulates that targeting O.volvulus through drugs which kill Wolbachia can modify the pathogenic processes in nodding syndrome and improve outcomes. Findings from this study are expected to substantially improve the understanding and treatment of nodding syndrome.
The Enigmatic Nodding Syndrome Outbreak in Northern Uganda: An analysis of the Disease Burden and National Response Strategies
(Oxford University Press, 2015-06-27) Mwaka, Amos Deogratius; Kitara, Lagoro David; Orach, Garimoi Christopher
To date, the cause of nodding syndrome (NS) remains unknown; however, efforts continue to establish risk factors and optimal symptomatic treatments. We documented the burden and national response strategies including involvement of key stakeholders in the management of the NS epidemic in order to inform future interventions against epidemics of undetermined aetiology. Data were collected through semi-structured interviews with selected leaders in the affected districts and at the Ministry of Health, and through review of documents. We participated in and analysed the proceedings of the first international scientific conference on NS held in Kampala in August 2012. We then analysed the chronology of the NS notification and the steps undertaken in the response plan. Over 3000 children have been affected by NS in northern Uganda; with an estimated case fatality of 6.7%. The first cases of NS were reported in 1997 in internally displaced people’s camps in Kitgum district; however, response efforts by the Ministry of Health and partners towards understanding the disorder and establish management only commenced in 2009. Key strategies in response to the NS epidemic have included formation of a national and district task forces, development of training manual on NS and training of primary healthcare professionals on case diagnosis and clinical management, establishment of treatment and rehabilitation centres, surveillance and promotion of researches to further inform management of the syndrome.
High prevalence of hepatitis B virus infection among pregnant women attending antenatal care: a cross-sectional study in two hospitals in northern Uganda
(BMJ Publishing Group Ltd, 2014-09-03) Bayo, Pontius; Ochola, Emmanuel; Oleo, Caroline; Mwaka, Amos Deogratius
Objective: To determine the prevalence of the hepatitis B viral (HBV) infection and hepatitis B e antigen (HBeAg) positivity among pregnant women attending antenatal clinics in two referral hospitals in northern Uganda. Design: Cross-sectional observational study. Setting: Two tertiary hospitals in a postconflict region in a low-income country. Participants: Randomly selected 402 pregnant women attending routine antenatal care in two referral hospitals. Five women withdrew consent for personal reasons. Data were analysed for 397 participants. Primary outcome: Hepatitis B surface antigen (HBsAg) positivity. Results: Of 397 pregnant women aged 13–43 years, 96.2% were married or cohabiting. 47 (11.8%) tested positive for HBsAg; of these, 7 (14.9%) were HBeAg positive. The highest HBsAg positivity rate was seen in women aged 20 years or less (20%) compared with those aged above 20 years (8.7%), aOR=2.54 (95% CI 1.31 to 4.90). However, there was no statistically significant difference between women with positive HBsAg and those with negative tests results with respect to median values of liver enzymes, haemoglobin level, absolute neutrophil counts and white cell counts. HIV positivity, scarification and number of sexual partners were not predictive of HBV positivity. Conclusions: One in eight pregnant women attending antenatal care in the two study hospitals has evidence of hepatitis B infection. A significant number of these mothers are HBeAg positive and may be at increased risk of transmitting hepatitis B infection to their unborn babies. We suggest that all pregnant women attending antenatal care be tested for HBV infection; exposed babies need to receive HBV vaccines at birth.
Household Poverty, Schooling, Stigma and Quality of Life in Adolescents With Epilepsy in Rural Uganda
(Elsevier, 2020-11-25) Anguzu, Ronald; Akun, Pamela; Katairo, Thomas; Abbo, Catherine; Ningwa, Albert; Ogwang, Rodney; Mwaka, Amos Deogratius; Marsh, Kevin; Newton, R. Charles; Idro, Richard
Background Epilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL). Methods This was a cross-sectional survey nested within a larger study of ALE compared to age matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10–14 and 15–19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL. Results Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1–4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72). Conclusions ALE in this rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs
Integration of Traditional and Complementary Medicine into Medical School Curricula: A Survey Among Medical Students in Makerere University, Uganda
(BMJ Publishing Group Ltd., 2019-08-14) Mwaka, Amos Deogratius; Tusabe, Gersave; Garimoi, Orach Christopher; Vohra, Sunita; Ibingira, Charles
Objective To describe the disposition and sociodemographic characteristics of medical students associated with inclusion of traditional and complementary medicine in medical school curricula in Uganda. Design A cross-sectional study conducted during May 2017. A pretested questionnaire was used to collect data. Disposition to include principles of traditional and complementary medicine into medical school curricula was determined as proportion and associated factors determined through multivariate logistic regression. Participants and setting Medical students in their second to fifth years at the College of Health Sciences, Makerere University, Uganda. Makerere University is the oldest public university in the East African region. Results 393 of 395 participants responded. About 60% (192/325) of participants recommended inclusion of traditional and complementary medicine principles into medical school curricula in Uganda. The disposition to include traditional and complementary medicine into medical school curricula was not associated with sex, age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI 0.16 to 0.93) year students were significantly less likely to recommend inclusion of traditional and complementary medicine into the medical school curricula. Participants who hold positive attributes and believe in effectiveness of traditional and complementary medicine were statistically significantly more likely to recommend inclusion into the medical school curricula in Uganda. Conclusions Inclusion of principles of traditional and complementary medicine into medical school curricula to increase knowledge, inform practice and research, and moderate attitudes of physicians towards traditional medicine practice is acceptable by medical students at Makerere University. These findings can inform review of medical schools’ curricula in Uganda.
Is Nodding Syndrome an Onchocerca Volvulus-Induced Neuroinflammatory Disorder? Uganda’s Story of Research in Understanding the Disease
(Elsevier, 2016-04) Idro, Richard; Opar, Bernard; Wamala, Joseph; Abbo, Catherine; Onzivua, Sylvester; Mwaka, Amos Deogratius; Kakooza-Mwesige, Angelina; Mbonye, Anthony; Aceng, Ruth Jane
Nodding syndrome is a devastating neurological disorder, mostly affecting children in eastern Africa. An estimated 10 000 children are affected. Uganda, one of the most affected countries, set out to systematically investigate the disease and develop interventions for it. On December 21, 2015, the Ministry of Health held a meeting with community leaders from the affected areas to disseminate the results of the investigations made to date. This article summarizes the presentation and shares the story of studies into this peculiar disease. It also shares the results of preliminary studies on its pathogenesis and puts into perspective an upcoming treatment intervention. Clinical and electrophysiological studies have demonstrated nodding syndrome to be a complex epilepsy disorder. A definitive aetiological agent has not been established, but in agreement with other affected countries, a consistent epidemiological association has been demonstrated with infection by Onchocerca volvulus. Preliminary studies of its pathogenesis suggest that nodding syndrome may be a neuroinflammatory disorder, possibly induced by antibodies to O. volvulus cross-reacting with neuron proteins. Histological examination of post mortem brains has shown some yet to be characterized polarizable material in the majority of specimens. Studies to confirm these observations and a clinical trial are planned for 2016.
Is the Glass Half Full or Half Empty? A Qualitative Exploration on Treatment Practices and Perceived Barriers to Biomedical Care for Patients With Nodding Syndrome in Post-Conflict Northern Uganda
(BioMed Central Ltd, 2015-08-29) Mwaka, Amos Deogratius; Okello, S. Elialilia; Abbo, Catherine; Odwong, Okot Francis; Olango, Willy; Etolu, Wilson John; Oriyabuzu, Rachel; Kitara, Lagoro David; Mutamba, Brian Byamah; Idro, Richard; Opar, Toliva Bernard; Aceng, Ruth Jane; Lukwago, Assuman; Neema, Stella
Background Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations. Methods We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes. Results Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities. Conclusions Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.
Knowledge of Cervical Cancer Risk Factors and Symptoms Among Women in a Refugee Settlement: A Cross-Sectional Study in Northern Uganda
(BioMed Central Ltd, 2020-12-03) Adoch, Winnie; Garimoi, Orach Christopher; Scott, E.Suzanne; Okeny, Goddie Geoffrey; Moodley, Jennifer; Komakech, Henry; Walter, M. Fiona; Mwaka, Amos Deogratius
Background: There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. Methods: We conducted a cross-sectional study. 815 women (aged 18–60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. Results: The majority of participants (53%, n = 433) were young (18–29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3–9). Median knowledge score for symptoms recognition = 7 (IQR: 1–10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38–0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36–0.49 (95%CI: 0.26–0.84) were less likely to be knowledgeable of symptoms of cervical cancer. Conclusion: A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.
Nodding Syndrome (NS) in Northern Uganda: A Probable Metabolic Disorder
(Journal of Advances in Medicine and Medical Research, 2013-07-04) Kitara, Lagoro David; Mwaka, Amos Deogratius; Anywar, Arony Denis; Uwonda, Gilbert; Abwang, Bernard; Kigonya, Edward
Aims: To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10th to 20th June 2012. Methodology: We recruited consecutively 101 children with probable NS in the 2 sub counties in Gulu and Amuru districts. Controls were from the same population but without symptoms of NS and were matched by age, sex and residents. History and physical examinations were conducted; anthropometry, blood samples and skin snips were obtained from cases and controls. Researchers were pediatricians, psychiatrists, nurses, laboratory scientists and epidemiologists. The research proposal was approved by the Ministry of Health and the IRB of Gulu University. Results: There was a statistically significant association between NS with malnutrition (t=0.142; p=0.044), Onchocerciasis (Χ 2 = 152.74, p<0.001; OR 7.025 95% CI 3.891, 12.682) and High Anion Gap (Χ2=146.752, p<0.001; OR 6.313 95%CI 4.027, 9.895). Conclusion: Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.
Nodding Syndrome in Ugandan Children—Clinical Features, Brain Imaging and Complications: A Case Series
(BMJ Publishing Group Ltd, 2013-04-08) Idro, Richard; Opoka, Opika Robert; Aanyu, T Hellen; Kakooza-Mwesige, Angelina; Piloya-Were, Theresa; Namusoke, Hanifa; Musoke, Bonita Sarah; Nalugya, Joyce; Bangirana, Paul; Mwaka, Amos Deogratius; White, Steven; Chong, King; Atai-Omoruto, D Anne; Mworozi, Edison; Nankunda, Jolly; Kiguli, Sarah; Aceng, Ruth Jane; Tumwine, K James
Objectives Nodding syndrome is a devastating neurological disorder of uncertain aetiology affecting children in Africa. There is no diagnostic test, and risk factors and symptoms that would allow early diagnosis are poorly documented. This study aimed to describe the clinical, electrophysiological and brain imaging (MRI) features and complications of nodding syndrome in Ugandan children. Design Case series. Participants 22 children with nodding syndrome brought to Mulago National Referral Hospital for assessment. Outcome measures Clinical features, physical and functional disabilities, EEG and brain MRI findings and a staging system with a progressive development of symptoms and complications. Results The median age of symptom onset was 6 (range 4–10) years and median duration of symptoms was 8.5 (range 2–11) years. 16 of 22 families reported multiple affected children. Physical manifestations and complications included stunting, wasting, lip changes and gross physical deformities. The bone age was delayed by 2 (range 1–6) years. There was peripheral muscle wasting and progressive generalised wasting. Four children had nodding as the only seizure type; 18 in addition had myoclonic, absence and/or generalised tonic–clonic seizures developing 1–3 years after the onset of illness. Psychiatric manifestations included wandering, aggression, depression and disordered perception. Cognitive assessment in three children demonstrated profound impairment. The EEG was abnormal in all, suggesting symptomatic generalised epilepsy in the majority. There were different degrees of cortical and cerebellar atrophy on brain MRI, but no hippocampal changes. Five stages with worsening physical, EEG and brain imaging features were identified: a prodrome, the development of head nodding and cognitive decline, other seizure types, multiple complications and severe disability. Conclusions Nodding syndrome is a neurological disorder that may be characterised as probably symptomatic generalised epilepsy. Clinical manifestations and complications develop in stages which might be useful in defining treatment and rehabilitation. Studies of risk factors, pathogenesis, management and outcome are urgently needed.
Nodding Syndrome: Recent Insights into Etiology, Pathophysiology, and Treatment
(Dove press Ltd, 2018-05-24) Mwaka, Amos Deogratius; Semakula, Roy Jerome; Abbo, Catherine; Idro, Richard
Nodding syndrome is an enigmatic neuropsychiatric and epileptiform disorder associated with psychomotor, mental, and physical growth retardation. The disorder affects otherwise previously normal children aged 3–18 years, with a slight preponderance for the male child. Nodding syndrome has been described in rural regions of some low-income countries in sub-Saharan Africa including northern Uganda, South Sudan, and a mountainous region of southern Tanzania. The cause of the disorder has hitherto eluded scientists. Neuroimaging studies show involvement of the nervous system with associated severe cortical atrophy in the affected children. The affected communities have generated a number of perceived causes including some conspiracy theories related to intentional poisoning of water sources and foods, and causes related to fumes and chemicals from ammunitions used during civil wars in the affected regions. From biomedical perspectives, the treatment of the affected children is geared towards symptoms control and rehabilitation. There is evidence that seizures and behavioral problems including wandering and episodes of aggressions are controllable with anticonvulsants, especially sodium valproate and antipsychotics. No treatments have proven effective in reversing the course of the disorder, and cure remains a distant goal. Community members have used indigenous medicines, cleansing rituals, and prayer interventions, but have not perceived any reasonable improvements. A randomized controlled clinical trial is ongoing in northern Uganda to test the efficacy and effectiveness of doxycycline in the treatment of nodding syndrome. The hypothesis underlying the doxycycline trial underscores the role of antigenic mimicry: that antibodies generated against an antigen of a microorganism that resides inside the black fly-transmitted parasite, Onchocerca volvulus becomes directed against nervous tissue in the brain. This paper reviews some of the recent advances in researches on the etiologies, pathophysiology, and treatment of nodding syndrome.
Perceptions and Beliefs of Lay People From Northern Uganda Regarding Surgery for Diagnosis and Treatment of Cervical Cancer
(John Wiley & Sons, Inc., 2018-05-02) Mwaka, Amos Deogratius; Okello, Sarikiaeli Elialilia; Wabinga, Henry
Objective To explore perceptions and beliefs of people in a rural community in northern Uganda regarding surgery for the diagnosis and treatment of cervical cancer. The aim of the study was to inform interventions to reduce delay and improve timely diagnosis and prompt appropriate treatments for patients with symptoms of cervical cancer. Methods A semi‐structured study guide informed by Kleinman's explanatory model for illness was used to collect data during 24 focus group discussions involving 175 men and women aged 18 to 59 years in Gulu, northern Uganda. Using thematic analysis, themes and subthemes were identified from the data through an iterative process and consensus among the authors. Results Surgery for diagnosis and management of cervical cancer was perceived as (1) appropriate when performed at early stage of cancer and by senior doctors, but (2) a potential catalyst for the spread of cancer and early death; and (3) a challenge to childbearing and motherhood as well as a source of distress to women and families if surgery involved removal of the uterus with subsequent permanent infertility. Conclusions There are some negative perceptions about surgery for cervical cancer that may deter prompt help‐seeking for symptoms. However, targeted messages for public awareness interventions to promote help‐seeking can be built on the positive perceptions and beliefs that surgery could be curative when undertaken for early‐stage cancer and by skilled doctors.