Suchergebnisse

RATIONALE: Failure to convert sputum at two months of treatment among persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) indicates poor response to treatment but data are limited on its assessment. OBJECTIVE: We determined the frequency and factors associated with sputum smear non-conversion at two months among persons with BC-PTB in eastern Uganda. METHODS: We abstracted data of adult persons with BC-PTB, from routinely available records from TB registers at 10 clinics in eastern Uganda. We determined factors that are independently associated with sputum smear non-conversion using logistic regression analysis. We expressed the results as odds ratio (OR) with 95% confidence interval (CI). MEASUREMENTS AND MAIN RESULTS: Of 516 persons with BC-PTB, 81 (15.7%) did not achieve sputum smear conversion at two months of TB treatment. Higher Mycobacteria tuberculosis (MTB) load and treatment at a private-not-for-profit (PNFP) facility compared to government health facility were significantly associated with sputum smear non-conversion. A one unit (+1) increase in MTB load based on ZN stain counts was associated with a 48% increase in the odds of sputum smear non-conversion with adjusted odds ratio (AOR), 1.48 (95% CI, 1.02–2.18). TB treatment at private-not-for-profit health facility was associated with a two-fold increase in the odds of sputum smear non-conversion (AOR, 2.03; 95% CI, 1.01–3.92). CONCLUSIONS: Our study shows that sputum smear non-conversion is common at two months of treatment in this population. It is more likely among patients with higher baseline MTB load and those treated at PNFP facilities. Strategies targeting patients with these risk factors are needed to enhance sputum smear conversion.

Abstract Background Aerodigestive foreign bodies (ADFB) in children are a common emergency in ENT clinics globally. The aim of this study was to determine the prevalence and common types of ADFB's presenting to a referral hospital in South Western Uganda, and to review clinical presentation and factors that influence their occurrence among children under 12 years of age. Methods We conducted a case control study comprising 40 cases and 80 unmatched controls. Consecutive and random sampling were used for the cases and controls respectively. A questionnaire was used to collect data. Clinic records were reviewed to calculate prevalence. Results Prevalence was 6.6 % of all paediatric cases seen in the ENT department that year. The most common symptoms included: history of choking [45 %], sudden cough [72.5 %], stridor [60 %] and failure to swallow [35 %]. The most common location for an airway foreign body was the right main bronchus [40 %] and the upper one third of the oesophagus [32.5 %] for digestive tract foreign bodies. Seeds and coins were most frequently removed. Children from upper level SES had a significantly lower risk of foreign body occurrence [ OR = 0.29, p = 0.02 ] compared to those from a low SES. Also significantly, most cases were referrals from other government health centres [ p = <0.01]. The male to female ratio among cases was 2:1. Children of older mothers were less likely to have an ADFB. Conclusion Prevalence of ADFB's is relatively high. The most common symptoms are a history of choking, cough and failure to swallow. Age under 5 years, male sex, younger maternal age and low socioeconomic status increased odds of ADFBs.

Events such as the Tuskegee syphilis study shaped how the public perceives and trusts medical research globally. However, few studies have examined trust in medical research in developing countries. We tested the hypothesis that levels of trust may be lower among community members compared to hospitalized persons in Uganda. We enrolled 296 participants in rural northern Uganda, and 148(50%) were from the community, 192(65%) were female. Mean level of trust for medical research was higher among hospitalized persons compared to community members (p = 0.0001). Previous research participation (p = 0.03), and willingness to participate in future research (p = 0.001) were positively associated with trust. Medical personnel should engage more with the communities in which they practice fostering trust in medical research.

BackgroundCryptococcal infection is a common opportunistic infection among severely immunosuppressed HIV patients and is associated with high mortality. Positive cryptococcal antigenemia is an independent predictor of cryptococcal meningitis and death in patients with severe immunosuppression. We evaluated the prevalence and factors associated with cryptococcal antigenemia among patients with CD4 counts of 100 cells/mm3 or less in Mulago Hospital, Kampala, Uganda. Screening of a targeted group of HIV patients may enable early detection of cryptococcal infection and intervention before initiating antiretroviral therapy. Factors associated with cryptococcal antigenemia may be used subsequently in resource‐limited settings in screening for cryptococcal infection, and this data may also inform policy for HIV care.MethodsIn this cross‐sectional study, HIV‐infected patients aged 18 years and older with CD4 counts of up to 100 cells/mm3 were enrolled between December 2009 and March 2010. Data on socio‐demographics, physical examinations and laboratory tests were collected. Factors associated with cryptococcal antigenemia were analyzed using multiple logistic regression.ResultsWe enrolled 367 participants and the median CD4 count was 23 (IQR 9‐51) cells/mm3. Sixty‐nine (19%) of the 367 participants had cryptococcal antigenemia. Twenty‐four patients (6.5%) had cryptococcal meningitis on cerebrospinal fluid analysis and three had isolated cryptococcal antigenemia. Factors associated with cryptococcal antigenemia included: low body mass index of 15.4 kg/m2 or less (adjusted odds ratio, AOR = 0.5; 95% CI 0.3‐1.0), a CD4+ T cell count of less than 50 cells/mm3 (AOR = 2.7; 95% CI1.2‐6.1), neck pain (AOR = 2.3; 95% CI 1.2‐4.6), recent diagnosis of HIV infection (AOR = 1.9; 95% CI 1.1‐3.6), and meningeal signs (AOR = 7.9; 95% CI 2.9‐22.1). However, at sub‐analysis of asymptomatic patients, absence of neck pain (AOR = 0.5), photophobia (AOR = 0.5) and meningeal signs (AOR = 0.1) were protective against cryptococcal infection.ConclusionsCryptococcal antigenemia is common among severely immunosuppressed HIV patients in Mulago Hospital, Kampala, Uganda. Independent predictors of positive serum cryptococcal antigenemia were CD4+ T cell counts of less than 50 cells/mm, low body mass index, neck pain, signs of meningeal irritation, and a recent diagnosis of HIV infection. Routine screening of this category of patients may detect cryptococcosis, and hence provide an opportunity for early intervention. Absence of neck pain, photophobia and meningeal signs were protective against cryptococcal infection compared with symptomatic patients.