Browsing by Author "Ndibazza, Juliet"

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Anthelminthic treatment during pregnancy is associated with increased risk of infantile eczema: randomised-controlled trial results
(John Wiley & Sons A/S, 2011) Mpairwe, Harriet; Webb, Emily L; Muhangi, Lawrence; Ndibazza, Juliet; Akishule, Denise; Nampijja, Margaret; Ngom-wegi, Sophy; Tumusime, Josephine; Jones, Frances M; Fitzsimmons, Colin; Dunne, David W.; Muwanga, Moses; Rodrigues, Laura C.; Elliott, Alison M
Background: Allergy is commoner in developed than in developing countries. Chronic worm infections show inverse associations with allergy, and prenatal exposures may be critical to allergy risk. Objective: To determine whether anthelminthic treatment during pregnancy increases the risk of allergy in infancy. Methods: A randomised, double-blind, placebo-controlled trial on treatment in pregnancy with albendazole versus placebo and praziquantel versus placebo was conducted in Uganda, with a 2 · 2 factorial design; 2507 women were enrolled; infants’ allergy events were recorded prospectively. The main outcome was doctor-diagnosed infantile eczema Results: Worms were detected in 68% of women before treatment. Doctor-diagnosed infantile eczema incidence was 10.4/100 infant years. Maternal albendazole treatment was associated with a significantly increased risk of eczema [Cox HR (95% CI), p: 1.82 (1.26–2.64), 0.002]; this effect was slightly stronger among infants whose mothers had no albendazole-susceptible worms than among infants whose mothers had such worms, although this difference was not statistically significant. Praziquantel showed no effect overall but was associated with increased risk among infants of mothers with Schistosoma mansoni [2.65 (1.16–6.08), interaction p = 0.02]. In a sample of infants, skin prick test reactivity and allergen-specific IgE were both associated with doctor-diagnosed eczema, indicating atopic aetiology. Albendazole was also strongly associated with reported recurrent wheeze [1.58 (1.13–2.22), 0.008]; praziquantel showed no effect. Conclusions: The detrimental effects of treatment suggest that exposure to maternal worm infections in utero may protect against eczema and wheeze in infancy. The results for albendazole are also consistent with a direct drug effect. Further studies are required to investigate mechanisms of these effects, possible benefits of worms or worm products in primary prevention of allergy, and the possibility that routine deworming during pregnancy may promote allergic disease in the offspring.
Assessing the external validity of a randomized controlled trial of anthelminthics in mothers and their children in Entebbe, Uganda
(BioMed Central, 2014) Millard, James D; Muhangi, Lawrence; Sewankambo, Moses; Ndibazza, Juliet; Elliott, Alison M; Webb, Emily L
The ‘external validity’ of randomized controlled trials is an important measure of quality, but is often not formally assessed. Trials concerning mass drug administration for helminth control are likely to guide public health policy and careful interpretation of their context is needed. We aimed to determine how representative participants in one such trial were of their community. We explore implications for trial interpretation and resulting public health recommendations. Methods: The trial assessed was the Entebbe Mother and Baby Study (EMaBS), a trial of anthelminthic treatment during pregnancy and early childhood. In a novel approach for assessing external validity, we conducted a two-stage cluster sample community survey within the trial catchment area and compared characteristics of potentially-eligible community children with characteristics of children participating in the trial. Results: A total of 173 children aged three to five-years-old were surveyed from 480 households. Of children surveyed, we estimated that mothers of 60% would have been eligible for recruitment, and of these, 31% had actually been enrolled. Children surveyed were compared to 199 trial children in the same age group reviewed at annual trial visits during the same time period. There were significant differences in ethnicity between the trial participants and the community children, and in socioeconomic status, with those in the trial having, on average, more educated parents and higher maternal employment. Trial children were less likely to have barefoot exposure and more likely to use insecticide-treated bed nets. There were no significant differences in numbers of reported illness events over the last year. Conclusions: The trial had not enrolled all eligible participants, and those enrolled were of higher socioeconomic status, and had lower risk of exposure to the parasitic infections targeted by the trial interventions. It is possible the trial may have underestimated the absolute effects of anthelminthic treatment during pregnancy and early childhood, although the fact that there were no differences in reported incidence of common infectious diseases (one of the primary outcomes of EMaBS) between the two groups provides reassurance. Concurrent community surveys may be an effective way to test the external validity of trials. EMaBS Trial registration: ISRCTN32849447, registered 22 July 2005
Association between malaria exposure and Kaposi’s sarcoma-associated herpes virus seropositivity in Uganda
(John Wiley & Sons Ltd., 2015) Nalwoga, Angela; Cose, Stephen; Wakeham, Katie; Miley, Wendell; Ndibazza, Juliet; Drakeley, Christopher; Elliott, Alison M; Whitby, Denise; Newton, Robert
Objective: Unlike other herpes viruses, Kaposi’s sarcoma-associated herpes virus (KSHV) is not ubiquitous worldwide and is most prevalent in sub-Saharan Africa. The reasons for this are unclear. As part of a wider investigation of factors that facilitate transmission in Uganda, a high prevalence country, we examined the association between antimalaria antibodies and seropositivity against KSHV. methods Antibodies against P. falciparum merozoite surface protein (PfMSP)-1, P. falciparum apical membrane antigen (PfAMA)-1 and KSHV antigens (ORF73 and K8.1) were measured in samples from 1164 mothers and 1227 children. results Kaposi’s sarcoma-associated herpes virus seroprevalence was 69% among mothers and 15% children. Among mothers, KSHV seroprevalence increased with malaria antibody titres: from 60% to 82% and from 54% to 77%, comparing those with the lowest and highest titres for PfMSP-1 and PfAMA-1, respectively (P < 0.0001). Among children, only antibodies to PfAMA-1 were significantly associated with KSHV seropositivity, (P < 0.0001). In both mothers and children, anti-ORF73 antibodies were more strongly associated with malaria antibodies than anti-K8.1 antibodies. Conclusion: The association between malaria exposure and KSHV seropositivity suggests that malaria is a cofactor for KSHV infection or reactivation.
Associations Between Maternal Helminth and Malaria Infections in Pregnancy and Clinical Malaria in the Offspring: A Birth Cohort in Entebbe, Uganda
(Oxford University Press on behalf of the Infectious Diseases Society of America, 2013) Ndibazza, Juliet; Webb, Emily L; Lule, Swaib; Mpairwe, Harriet; Akello, Miriam; Oduru, Gloria; Kizza, Moses; Akurut, Helen; Muhangi, Lawrence; Magnussen, Pascal; Vennervald, Birgitte J.; Elliott, Alison M
Helminth and malaria coinfections are common in the tropics. We investigated the hypothesis that prenatal exposure to these parasites might influence susceptibility to malaria in childhood. Methods. In a birth cohort of 2345 mother–child pairs in Uganda, maternal helminth and malaria infection status was determined during pregnancy, and childhood malaria episodes were recorded from birth to age 5 years. We examined associations between maternal infections and malaria in the offspring. Results. Common maternal infections were hookworm (45%), Mansonella perstans (21%), Schistosoma mansoni (18%), and Plasmodium falciparum (11%). At age 5 years, 69% of the children were still under follow-up. The incidence of malaria was 34 episodes per 100 child-years, and the mean prevalence of asymptomatic malaria at annual visits was 5.4%. Maternal hookworm and M. perstans infections were associated with an increased rate of childhood clinical malaria (adjusted hazard ratio [aHR], 1.24, 95% confidence interval [CI], 1.10–1.41; aHR, 1.20, 95% CI, 1.05–1.38, respectively). S. mansoni infection had no consistent association with childhood malaria. Conclusions. This is the first report of an association between helminth infections in pregnancy and malaria in the offspring and indicates that helminth infections in pregnancy may increase the burden of childhood malaria morbidity.
A Description of Congenital Anomalies Among Infants in Entebbe, Uganda
(Wiley-Liss, Inc., 2011) Ndibazza, Juliet; Lule, Swaib; Nampijja, Margaret; Mpairwe, Harriet; Oduru, Gloria; Kiggundu, Molly; Akello, Miriam; Muhangi, Lawrence; Elliott, Alison M
Background: Data on congenital anomalies from developing countries of the sub-Saharan region are scarce. However, it is important to have comprehensive and reliable data on the description and prevalence of congenital anomalies to allow surveillance and the implementation of appropriate public health strategies for prevention and management. In this study, we describe the profile of congenital anomalies seen in a birth cohort in Entebbe, Uganda. Methods: Congenital anomalies were defined as any structural defect present at birth. Pregnant women were recruited to the cohort between 2003 and 2005. Defects present at birth were recorded by the midwife at delivery and by physicians at the routine six-week postnatal visit and at illness-related visits until 1 year of life. The anomalies were classified by organ system according to the 10th version of the World Health Organization International Classification of Diseases (ICD-10). Results: There were 180 infants with a congenital anomaly among 2365 births. The most commonly affected systems were the musculoskeletal (42.7 per 1000 births) and skin (16.1 per 1000 births). The prevalence of major anomalies was 20.3 per 1000 births; 1.7 per 1000 births for cardiac anomalies and 1.3 per 1000 births for neural system anomalies. Forty (22%) of the congenital anomalies were identified at birth, 131 (73%) at the 6-week postnatal visit, and nine (5%) at illness-related visits. CONCLUSION: Congenital anomalies are common in developing countries. Establishment of comprehensive databases for surveillance would be helpful for surveillance of effects of new exposures, for prevention, management, and health care planning. Birth Defects Research (Part A) 91:857–861, 2011. _ 2011 Wiley-Liss, Inc.
Effect of Praziquantel Treatment during Pregnancy on Cytokine Responses to Schistosome Antigens: Results of a Randomized, Placebo-Controlled Trial
(Infectious Diseases Society of America, 2008) Tweyongyere, Robert; Mawa, Patrice A; Ngom-wegi, Sophy; Ndibazza, Juliet; Duong, Trinh; Vennervald, Birgitte J.; Dunne, David W; Katunguka-Rwakishaya, Eli; Elliott, Alison M.
Praziquantel treatment of schistosomiasis boosts antischistosome responses, with type 2 helper T cell bias that may contribute to immunologically mediated killing and to protection against reinfection. Praziquantel treatment during pregnancy was recommended in 2002, but the immunological effects of the treatment had not been investigated. A cohort of 387 Schistosoma mansoni–infected women were recruited from a larger trial of deworming during pregnancy. Women were randomized to receive either praziquantel or placebo during pregnancy. Six weeks after delivery, all women received praziquantel. Cytokine responses to S. mansoni worm and egg antigens were measured in whole blood culture before and 6 weeks after each treatment. Schistosome-specific cytokine responses were suppressed during pregnancy. Praziquantel treatment during pregnancy caused significant boosts in interferon-_ (IFN-_), interleukin (IL)–2, IL-4, IL-5, IL-13, and IL-10 responses to schistosome worm antigen and in IFN-_, IL-5, and IL-13 responses to schistosome egg antigen, but these boosts were not as substantial as those seen for women treated after delivery. Pregnancy suppresses a potentially beneficial boost in cytokine responses associated with praziquantel treatment. Further studies are needed on the long-term effects that treatment of schistosomiasis during pregnancy have on morbidity and resistance to reinfection among treated women and their offspring. International Standard Randomized Controlled Trial Number for the parent study: ISRCTN32849447.
Effect of Single-Dose Anthelmintic Treatment During Pregnancy on an Infant’s Response to Immunisation and on Susceptibility to Infectious Diseases in Infancy: a Randomised, Double-Blind, Placebo-Controlled Trial
(2011) Ndibazza, Juliet; Maw, Patrice A.; Webb, Emily L.; Kizito, Dennison; Namatovu, Alice; Kyosiimire-Lugemwa, Jacqueline; Nanteza, Bridget; Nampijja, Margaret; Muhangi, Lawrence; Woodburn, Patrick W.; Akurut, Hellen; Mpairwe, Harriet; Akello, Miriam; Lyadda, Nancy; Bukusuba, Joseph; Kihembo, Macklyn; Kizza, Moses; Kizindo, Robert; Nabulime, Juliet; Ameke, Christine; Namujju, Proscovia B.; Tweyongyere, Robert; Muwanga, Moses; Whitworth, James A. G.; Elliot, Alison M.
Helminth infections aff ect the human immune response. We investigated whether prenatal exposure to and treatment of maternal helminth infections aff ects development of an infant’s immune response toimmunisations and unrelated infections.Methods In this randomised, doubleblind, placebo-controlled trial, we enrolled 2507 women in the second or third trimester of pregnancy who were planning to deliver in Entebbe General Hospital, Entebbe, Uganda. With a computer-generated random number sequence in blocks of 100, we assigned patients to 440 mg albendazole and 40 mg/kg praziquantel (n=628), 440 mg albendazole and a praziquantel-matching placebo (n=625), 40 mg/kg praziquantel and an albendazole-matching placebo (n=626), or an albendazole-matching placebo and praziquantel-matching placebo (n=628). All participants and hospital staff were masked to allocation. Primary outcomes were immune response at age 1 year to BCG, tetanus, and measles immunisation; incidence of infectious diseases during infancy; and vertical HIV transmission. Analysis was by intention-to-treat. This trial is registered, number ISRCTN32849447.Findings Data were available at delivery for 2356 women, with 2345 livebirths; 2115 (90%) of liveborn infants remained in follow-up at 1 year of age. Neither albendazole nor praziquantel treatments aff ected infant response to BCG, tetanus, or measles immunisation. However, in infants of mothers with hookworm infection, albendazole treatment reduced interleukin-5 (geometric mean ratio 0·50, 95% CI 0·30–0·81, interaction p=0·02) and interleukin13 (0·52, 0·34–0·82, 0·0005) response to tetanus toxoid. The rate per 100 person-years of malaria was 40·9 (95% CI 38·3–43·7), of diarrhoea was 134·1 (129·2–139·2), and of pneumonia was 22·3 (20·4–24·4). We noted no eff ect on infectious disease incidence for albendazole treatment (malaria [hazard ratio 0·95, 95% CI 0·79–1.14], diarrhoea [1·06, 0·96–1·16], pneumonia [1·11, 0·90–1·38]) or praziquantel treatment (malaria [1·00, 0·84–1·20], diarrhoea [1·07, 0·98–1·18], pneumonia [1·00, 0·80–1·24]). In HIV-exposed infants, 39 (18%) were infected at 6 weeks; vertical transmission was not associated with albendazole (odds ratio 0·70, 95% CI 0·35–1·42) or praziquantel (0·60, 0·29–1·23) treatment.Interpretation These results do not accord with the recently advocated policy of routine antenatal anthelmintic treatment, and the value of such a policy may need to be reviewed.
Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial
(Infectious Diseases Society of America, 2010) Ndibazza, Juliet; Muhangi, L; Akishule, D.; Kiggundu, M; Ameke, C; Oweka, J; Kizindo, R.; Duong, T.; Kleinschmidt, I.; Muwanga, M.; Elliott, A. M.
Helminth infections during pregnancy may be associated with adverse outcomes, including maternal anemia, low birth weight, and perinatal mortality. Deworming during pregnancy has therefore been strongly advocated, but its benefits have not been rigorously evaluated. Methods. In Entebbe, Uganda, 2507 pregnant women were recruited to a randomized, double-blind, placebocontrolled trial investigating albendazole and praziquantel in a 2_2 factorial design [ISRCTN32849447]. Hematinics and sulphadoxine-pyrimethamine for presumptive treatment of malaria were provided routinely. Maternal and perinatal outcomes were recorded. Analyses were by intention to treat. Results. At enrollment, 68% of women had helminths, 45% had hookworm, 18% had Schistosoma mansoni infection; 40% were anemic (hemoglobin level, !11.2 g/dL). At delivery, 35% were anaemic; there was no overall effect of albendazole (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.79–1.15) or praziquantel (OR, 1.00; 95% CI, 0.83–1.21) on maternal anemia, but there was a suggestion of benefit of albendazole among women with moderate to heavy hookworm (OR, 0.45; 95% CI, 0.21–0.98; Pp.15 for interaction). There was no effect of either anthelminthic treatment on mean birth weight (difference in mean associated with albendazole:_0.00 kg; 95% CI, _0.05 to 0.04 kg; difference in mean associated with praziquantel: _0.01 kg; 95% CI, _0.05 to 0.04 kg) or on proportion of low birth weight. Anthelminthic use during pregnancy showed no effect on perinatal mortality or congenital anomalies. Conclusions. In our study area, where helminth prevalence was high but infection intensity was low, there was no overall effect of anthelminthic use during pregnancy on maternal anemia, birth weight, perinatal mortality, or congenital anomalies. The possible benefit of albendazole against anemia in pregnant women with heavy hookworm infection warrants further investigation.
Effects of Maternal and Infant Co-infections, and of Maternal Immunization, on the Infant Response to BCG and Tetanus Immunization
(2012) Ndibazza, Juliet; Muwanga, Moses; Whitworth, James A. G.; Elliotta, Alison M.; Mawaa, Patrice A.; Webb, Emily L.; Nampijja, Margaret; Lyadda, Nancy; Bukusuba, Joseph; Kizza, Moses; Namujju, Proscovia B.; Nabulime, Juliet
Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigatedfactors that might influence responses to BCG and tetanus immunisation. Whole blood assay responsesto crude culture filtrate proteins ofMycobacterium tuberculosis(cCFP)) and tetanus toxoid (TT) wereexamined among 1506 and 1433 one-year-olds, respectively. MaternalMansonella perstansinfection wasassociated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gammainterferon (IFN-), IL-5 and IL-13 responses; other maternal helminth infections showed little effect.Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternalBCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-, IL-5 andIL-13 to TT were reduced in HIVexposed-uninfected infants; infant malaria and HIV were associatedwith lower IFN-, IL-5 and IL13 responses to both immunogens. We conclude that maternal helminthinfections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation oninfant responses to vaccines should be explored. Prevention of infant malaria and HIV could contributeto effectiveness of immunisation programmes.
Factors associated with perceived work-life balance among health workers in Gulu District, Northern Uganda: a health facility-based cross-sectional study
(Springer Link, 2024-01-23) Obina, Wilfred Felicity; Ndibazza, Juliet; Kabanda, Richard; Musana, Jonathan; Nanyingi, Miisa
Work-life balance (WLB) plays a significant role in improving career satisfaction and reducing burnout. While health workers’ productivity is considered a key factor in client care, there is limited effort put into examining how health workers perceive the balance of their jobs with family and other societal responsibilities (PWLB), especially in low-income countries where the number of health workers in active patient care is low. The purpose of this study was to assess factors associated with perceived work-life balance (PWLB) among health workers in the rural district of Gulu, Northern Uganda. A health facility-based cross-sectional analytical study was conducted. A simple random sampling technique was used to select 384 study participants from the three main hospitals in Gulu District. Data were collected from health workers using a self-administered semi-structured questionnaire and analyzed using STATA version 15. Factors associated with PWLB were determined at a multivariable level using a modified Poisson regression with robust variance with a 95% confidence level and 5% statistical significance. Adjusted prevalent ratios (APR) were used to report the Factors associated with PWLB. Only 157/384 (40.9%) of the health workers reported a positive perceived work-life balance. Multivariable modified Poisson regression analysis showed positive statistical association with PWLB of a laboratory worker(APR=1.74, 95% CI: 1.10–2.75); a midwife(APR=1.82, 95% CI:1.13–2.93) or a nurse (APR=2.19, 95% CI=1.45– 3.30); working in the inpatient department (APR=1.97, 95% CI: 1.31–2.96) or laboratory (APR=2.09, 95%CI: 1.34–3.28); and having a flexible work schedule (APR=28.32, 95%CI:14.52–55.22); feeling satisfied at work (APR=1.58; 95% CI:1.17–2.10), and belonging to an association in the community (APR=32.71, 95% Cl:11.91–89.88). On the other hand, employment tenure of 1–4 years (APR=0.63,95% CI:0.40–0.99) was negatively associated with perceived work-life balance. Only four in every 10 health workers experienced a positive perceived work-life balance. The type of profession, duty station, flexibility in work schedule, satisfaction with work, and availability of social support systems
Factors associated with perceived worklife balance among health workers in Gulu District, Northern Uganda: a health facility based cross-sectional study
(Springer Link, 2024-01-23) Obina, Wilfred Felicity; Ndibazza, Juliet; Kabanda, Richard; Musana, Jonathan; Nanyingi, Miisa
Work-life balance (WLB) plays a significant role in improving career satisfaction and reducing burnout. While health workers’ productivity is considered a key factor in client care, there is limited effort put into examining how health workers perceive the balance of their jobs with family and other societal responsibilities (PWLB), especially in low-income countries where the number of health workers in active patient care is low. The purpose of this study was to assess factors associated with perceived work-life balance (PWLB) among health workers in the rural district of Gulu, Northern Uganda. A health facility-based cross-sectional analytical study was conducted. A simple random sampling technique was used to select 384 study participants from the three main hospitals in Gulu District. Data were collected from health workers using a self-administered semi-structured questionnaire and analyzed using STATA version 15. Factors associated with PWLB were determined at a multivariable level using a modified Poisson regression with robust variance with a 95% confidence level and 5% statistical significance. Adjusted prevalent ratios (APR) were used to report the Factors associated with PWLB. Only 157/384 (40.9%) of the health workers reported a positive perceived work-life balance. Multivariable modified Poisson regression analysis showed positive statistical association with PWLB of a laboratory worker(APR=1.74, 95% CI: 1.10–2.75); a midwife(APR=1.82, 95% CI:1.13–2.93) or a nurse (APR=2.19, 95% CI=1.45– 3.30); working in the inpatient department (APR=1.97, 95% CI: 1.31–2.96) or laboratory (APR=2.09, 95%CI: 1.34–3.28); and having a flexible work schedule (APR=28.32, 95%CI:14.52–55.22); feeling satisfied at work (APR=1.58; 95% CI:1.17–2.10), and belonging to an association in the community (APR=32.71, 95% Cl:11.91–89.88). On the other hand, employment tenure of 1–4 years (APR=0.63,95% CI:0.40–0.99) was negatively associated with perceived work-life balance. Only four in every 10 health workers experienced a positive perceived work-life balance. The type of profession, duty station, flexibility in work schedule, satisfaction with work, and availability of social support systems, were independent determinants of perceived WLB. Therefore, nurturing a system of reviews of the scheduling of health workers, allowing internal staff rotation, and fostering support systems around the health workers could be beneficial for WLB.
Impact of Anthelminthic Treatment in Pregnancy and Childhood on Immunisations, Infections and Eczema in Childhood: A Randomised Controlled Trial
(Uganda Martyrs University, 2012) Ndibazza, Juliet; Mpairwe, Harriet; Webb, Emily L.; Mawa, Patrice A.; Nampijja, Margaret; Muhang, Lawrence; Kihembo, Macklyn; Lule, Swaib A.; Rutebarika, Diana; Apule, Barbara; Akello, Florence; Akurut, Hellen; Oduru, Gloria; Naniima, Peter; Kizito, Dennison; Kizza, Moses; Kizindo, Robert; Tweyongere, Robert; Alcock, Katherine J.; Muwanga, Moses; Elliott, Alison M.
Background: Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects. A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda[ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly singledose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome. Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries.By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control wherehelminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct.
The impact of helminths on the response to immunization and on the incidence of infection and disease in childhood in Uganda: design of a randomized, double-blind, placebo-controlled, factorial trial of deworming interventions delivered in pregnancy and early childhood [ISRCTN32849447]
(Society for Clinical Trials, 2007) Elliott, Alison M; Kizza, Moses; Quigley, Maria A; Ndibazza, Juliet; Nampijja, Margaret; Muhangi, Lawrence; Morison, Linda; Namujju, Proscovia B; Muwanga, Moses; Kabatereine, Narcis; Whitworth, James AG
Helminths have profound effects on the immune response, allowing long-term survival of parasites with minimal damage to the host. Some of these effects “spill-over”, altering responses to non-helminth antigens or allergens. It is suggested that this may lead to impaired responses to immunizations and infections, while conferring benefits against inflammatory responses in allergic and autoimmune disease. These effects might develop in utero, through exposure to maternal helminth infections, or through direct exposure in later life. Purpose To determine the effects of helminths and their treatment in pregnancy and in young children on immunological and disease outcomes in childhood. Methods The trial has three randomized, double-blind, placebo-controlled interventions at two times, in two people: a pregnant woman and her child. Pregnant women are randomized to albendazole or placebo and praziquantel or placebo. At age 15 months their children are randomized to three-monthly albendazole or placebo, to continue to age five years. The proposed designation for this sequence of interventions is a 2 _ 2(_2) factorial design. Children are immunized with BCG and against polio, Diphtheria, tetanus, Pertussis, Haemophilus, hepatitis B and measles. Primary immunological outcomes are responses to BCG antigens and tetanus toxoid in whole blood cytokine assays and antibody assays at one, three and five years of age. Primary disease outcomes are incidence of malaria, pneumonia, diarrhoea, tuberculosis, measles, vertical HIV transmission, and atopic disease episodes, measured at clinic visits and twice-monthly home visits. Effects on anaemia, growth and intellectual development are also assessed. Conclusion This trial, with a novel design comprising related interventions in pregnant women and their offspring, is the first to examine effects of helminths and their treatment in pregnancy and early childhood on immunological, infectious disease and allergic disease outcomes. The results will enhance understanding of both detrimental and beneficial effects of helminth infection and inform policy.
Maternal hookworm modifies risk factors for childhood eczema: results from a birth cohort in Uganda
(Pediatric Allergy and Immunology, 2014) Mpairwe, Harriet; Ndibazza, Juliet; Webb, Emily L; Nampijja, Margaret; Muhangi, Lawrence; Apule, Barbara; Lule, Swaib; Akurut, Helen; Kizito, Dennison; Kakande, Mohammed; Jones, Frances M; Fitzsimmons, Colin M.; Muwanga, Moses; Rodrigues, Laura C.; Dunne, David W; Elliott, Alison M
Background: Worms may protect against allergy. Early-life worm exposure may be critical, but this has not been fully investigated. Objectives: To investigate whether worms in pregnancy and in early childhood are associated with childhood eczema incidence. Methods: The Entebbe Mother and Baby Study, an anthelminthic treatment trial, enrolled pregnant women between 2003 and 2005 in Uganda. Mothers were investigated for worms during pregnancy and children annually. Eczema was doctor-diagnosed from birth to age five years. A planned observational analysis was conducted within the trial cohort to investigate associations between worms and eczema. Results: Data for 2345 live-born children were analysed. Hookworm was the most prevalent maternal worm (45%). Childhood worms were less prevalent. Eczema incidence was 4.68/100 person-years. Maternal hookworm was associated with reduced eczema incidence [adjusted hazard ratio (95% confidence interval), p-value: 0.71(0.51–0.99), 0.04] and modified effects of known risk factors for eczema: Dermatophagoides-specific IgE in children was positively associated with eczema incidence if the mother had no hookworm [2.72(1.11–6.63), 0.03], but not if the mother had hookworm [0.41(0.10–1.69), 0.22], interaction p-value = 0.03. Similar interactions were seen for maternal history of eczema {[2.87(1.31–6.27, 0.008) vs. [0.73(0.23–2.30), 0.60], interaction p-value = 0.05}, female gender {[1.82(1.22–2.73), 0.004 vs. [0.96 (0.60–1.53), 0.87], interaction p-value = 0.04} and allergen-specific IgE. Childhood Trichuris trichiura and hookworm were inversely associated with eczema. Conclusions: Maternal hookworm modifies effects of known risk factors for eczema. Mechanisms by which early-life worm exposures influence allergy need investigation. Worms or worm products, and intervention during pregnancy have potential for primary prevention of allergy.
Maternal Recall of Birthweight and Birth Size in Entebbe, Uganda
(2012) Ndibazza, Juliet; Lule, Swaib A.; Webb, Emily L.; Nampijja, Margaret; Muhangi, Lawrence; Akello, Florence; Kakande, Muhammed; Kizindo, Robert; Elliott, Alison M.
To assess the reliability of maternally recalled birthweight and size in Entebbe, Uganda.methodsThe study population comprised 404 mothers, who were participants in the Entebbe Motherand Baby Study (EMaBS). Mothers were recruited to EMaBS during antenatal care, maternal charac-teristics were recorded during pregnancy, and birthweight was recorded at delivery. Four to seven yearsafter delivery, mothers were asked to recall the child’s birthweight and size. Their responses werecompared with the birthweight recorded in the EMaBS database.resultsOf 404 interviewed mothers, 303 (75%) were able to give an estimate of birthweight and for265 of these EMaBS data on recorded birthweights were available. Women who were educated andwhose children had low birth order were more likely to be able to give an estimate: 37 (14%) recalled theexact recorded birthweight; a further 52 (20%) were accurate to within 0.1 kg of the recordedweight. On average, mothers overestimated birthweight by 0.06 kg (95% CI: 0.00–0.13 kg,P= 0.04).Recalled and recorded birthweights showed moderate agreement with an intraclass correlation coefficient of0.64. Four hundered mothers gave an estimate of birth size: the sensitivity and specificity of recalled birth sizefor classifying low birthweight were 76% (95% CI: 50–93%) and 70% (95% CI: 65–75%), respectively.conclusionsMothers’ recall of birthweight was not precise but in absence of other data, recall ofbirthweight and size may have some value in epidemiological studies in these settings.
Parasite infection is associated with Kaposi’s sarcoma associated herpesvirus (KSHV) in Ugandan women
(BioMed Central, 2011) Wakeham, Katie; Webb, Emily L; Sebina, Ismail; Muhangi, Lawrence; Miley, Wendell; Johnson, W Thomas; Ndibazza, Juliet; Elliott, Alison M; Whitby, Denise; Newton, Robert
Background: Immune modulation by parasites may influence susceptibility to bacteria and viruses. We examined the association between current parasite infections, HIV and syphilis (measured in blood or stool samples using standard methods) and antibodies against Kaposi’s sarcoma herpesvirus (KSHV), measured by ELISA, in 1915 stored plasma samples from pregnant women in Entebbe, Uganda. Results: Seroprevalence of KSHV was higher in women with malaria parasitaemia (73% vs 60% p = 0.01), hookworm (67% vs 56% p = 0.001) and Mansonella perstans (69% vs 59% p = 0.05); seroprevalence increased with increasing intensity of hookworm infection (p < 0.001[trend]). No associations were found for HIV, five other parasites or active syphilis. These effects were not explained by socioeconomic status or education. Conclusions: Specific parasite infections are associated with presence of antibodies against KSHV, perhaps mediated via their effect on immune function.
Participation in Clinical Research Could Modify Background Risk for Trial Outcome Measures
(2014) Ndibazza, Juliet; Abaasa, Andrew M.; Asiki, Gershim; Levin, Jonathan; Bahemuka, Ubaldo; Ruzagira, Eugene; Kibengo, Freddie M.; Mulondo, Jerry; Price, Matthew A.; Fast, Pat; Kamali, Anatoli
Data on HIV incidence and retention are needed to inform study design of efficacy trials. However, the selection criteria and interventions during an actual clinical trial could reduce HIV incidence and thus affect the statistical power. Weinvestigated the effect of inclusion and participation in a simulated vaccine efficacy trial (SiVET) on HIV and pregnancy incidence in a fisherfolk cohort in SW Uganda. High-risk vounteers aged 18–49 years from fishing communities 30-40 km from the MRC/UVRI research centre were recruited in HIV open cohort. High risk was defined as history of multiple sex partners, unprotected sex, STI presence and absence from home for ‡ 2 days in the preceding 3 months. Consenting volunteers with at least 3 months of follow-up, no contraindications for hepatitis B vaccine and willing to use contraception were administered a licensed Hepatitis B vaccine at 0, 1 and 6 months to mimic a candidate vaccine. The cohort was followed quarterly for a year. HIV incidence, pregnancy and retention rates were compared. Results: Of 853 (55% men) individuals screened from Jan 2012-Feb 2014, 575 (60% men, mean age 28) were enrolled into the open cohort, 282 (73% men) of whom enrolled into the SiVET between July, 2012-Feb 2013. In both groups there was reduction of risky behaviours, (p < 0.05). A total of 13 HIV incident cases occurred in 93.0 PYO [brackets 95% CI]; incidence 13.9/100 PYO [8.1-24.1] and 10 cases in 311.6 PYO; incidence 3.2 [1.7-6.0] in the open cohort and SiVET respectively. A total of 26 pregnancies were observed in 42.7 Women Years of Observation(WYO); incidence 60.9 [41.5-89.5], and 4 pregnancies (71.4WYO); incidence 5.6 [2.1-14.8] in the open cohort and SiVET respectively.
Plasmodium falciparum parasitaemia and clinical malaria among school children living in a high transmission setting in western Kenya
(BioMed Central, 2016) Kepha, Stella; Nikolay, Birgit; Nuwaha, Fred; Mwandawiro, Charles S.; Nankabirwa, Joaniter; Ndibazza, Juliet; Cano, Jorge; Matoke‑Muhia, Damaris; Pullan, Rachel L.; Allen, Elizabeth; Halliday, Katherine E.; Brooker, Simon J.
Background: Malaria among school children is increasingly receiving attention, yet the burden of malaria in this age group is poorly defined. This study presents data on malaria morbidity among school children in Bungoma county, western Kenya. Method: This study investigated the burden and risk factors of Plasmodium falciparum infection, clinical malaria, and anaemia among 2346 school children aged 5–15 years, who were enrolled in an individually randomized trial evaluating the effect of anthelmintic treatment on the risks of malaria. At baseline, children were assessed for anaemia and nutritional status and information on household characteristics was collected. Children were followed-up for 13 months to assess the incidence of clinical malaria by active detection, and P. falciparum infection and density evaluated using repeated cross-sectional surveys over 15 months. Results: On average prevalence of P. falciparum infection was 42 % and ranged between 32 and 48 % during the five cross-sectional surveys. Plasmodium falciparum prevalence was significantly higher among boys than girls. The overall incidence of clinical malaria was 0.26 episodes per person year (95 % confidence interval, 0.24–0.29) and was significantly higher among girls (0.23 versus 0.31, episodes per person years). Both infection prevalence and clinical disease varied by season. In multivariable analysis, P. falciparum infection was associated with being male, lower socioeconomic status and stunting. The risk of clinical malaria was associated with being female. Conclusion: These findings show that the burden of P. falciparum parasitaemia, clinical malaria and anaemia among school children is not insignificant, and suggest that malaria control programmes should be expanded to include this age group.
Prevalence and factors associated with sexual and reproductive health literacy among youth living with HIV in Uganda: a cross-sectional study
(Springer Link, 2023-08-07) Mugabi, Benedicto; Nanyingi, Miisa; Kabanda, Richard; Ndibazza; Ndibazza, Juliet; Elyanu, Peter; Asiimwe, John Baptist; Nazziwa, Gorret; Habaasa, Gilbert; Kekitiinwa, Adeodata
Adequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodefciency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda. Through a cross-sectional survey, YLHIV receiving routine HIV care services at Baylor-Uganda HIV Clinic were interviewed using an adapted European Health Literacy Survey (HLS-EU). Using simple random sampling, eligible youth who received HIV care services between August and November 2019 were enrolled in the study. SRHL scores were computed using the HLS-EU index method; and individuals whose scores ranged from 34 to 50 were considered health literate. We used descriptive statistics to determine the prevalence. Potential associated personal and environmental factors (p<0.05) were identifed by performing two-step inferential statistics, bivariate analysis and binary logistic regression. Odds ratios were calculated to estimate the likelihood of youth being health literate on sexual and reproductive health (SRH) issues in comparison with the reference categories, and 95% confdence intervals were determined to establish whether the relationships were statistically signifcant. Of the 267 YLHIV interviewed at Baylor-Uganda HIV Clinic, 167 (62.5%) were female with a mean age of 18.9 years (SD± 2.8), and the majority (242; 90.6%) were vertically infected with HIV. Only 52 (19.5%) were health literate on SRH issues. At the multivariate level, YLHIV who never had difculty accessing SRH information were 0.391 times less likely to be health literate on SRH issues than their counterparts with challenges in accessing SRH information (Adjusted Odds Ratio [AOR] = 0.391, 95% CI =0.178 to 0.860; p= 0.019). YLHIV who did not fnd it easy to access SRH care service points were 2.929 times more likely to be literate in SRH than those who found it easy to access such services (Adjusted Odds Ratio [AOR] = 2.929, 95% CI =1.241 to 6.917; p=0.014). Additionally, YLHIV who did not listen to radio health talks were 2.406 times more likely to be health literate on SRH issues than those who did (AOR = 2.406, 95% CI =1.133 to 5.112; p=0.022). SRHL is an unmet need among YLHIV; only 19.5% were health literate on SRH issues. This could complicate the achievement of the UNAIDS sustainable development goal (SDG) of an HIV/AIDS-free generation by 2030 because low health literacy (HL) skills can afect the efcacy of almost all HIV disease prevention and health promotion eforts. Inaccessible SRH care service points and not listening to radio health talks were positively associated with SRHL, while having access to SRH information was negatively associated with SRHL.
Risk Factors for Helminth, Malaria, and HIV Infection in Pregnancy in Entebbe, Uganda
(Uganda Martyrs University, 2009) Ndibazza, Juliet; Bazanya, Proscovia Namujju; Kizza, Moses; Ameke, Christine; Omoding, Nicolas Emojong; Booth, Mark; Elliott, Alison Mary; Woodburn, Patrick William; Muhangi, Lawrence; Hillier, Stephen
factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy. The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression. Results: There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus) showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities. Conclusions: Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection.