Perceived stigma and school attendance among children and adolescents with epilepsy in South Western Uganda

BackgroundEpilepsy is a neurological disorder that has a high worldwide prevalence with eighty percent of the global burden being in low and middle-income countries. There is a high level of perceived stigma among children and adolescents with epilepsy, which has severe debilitating effects and affects school attendance.ObjectiveTo assess the effect of perceived stigma on school attendance patterns among children and adolescents with epilepsy.MethodsWe conducted a cross sectional study among 191 children and adolescents aged from 6–18 years with epilepsy at one large semi-urban hospital and a small rural health center in SouthWestern Uganda. Epilepsy-related perceived stigma was measured using the adapted Kilifi Stigma Scale of Epilepsy and school attendance patterns were assessed using a piloted investigator-designed questionnaire.ResultsChildren with high-perceived stigma were more likely to have never attended school (13.8%) or started school late (average age 5.7 years) compared to those with low-perceived stigma (average age 4.9 years). Additionally, those with high epilepsy-related perceived stigma repeated classes 2.5 times more compared to those with low-perceived stigma.ConclusionThese preliminary findings suggest correlation between high-perceived stigma and disrupted school attendance patterns among children and adolescents with epilepsy, hence the need to address this social challenge.     

Malaria Trends in Six Outpatient Sites in Uganda, 2008—2011

Objective

To estimate trends in malaria morbidity at six sentinel sites in Uganda.

Introduction

Over the past five years, efforts to control malaria have been intensified in Uganda (1). With the intensification of these efforts, accurate and timely data are needed to monitor impact of the interventions and guide malaria control program planning (2, 3). We present data on trends in malaria burden over four years from six out-patient health facilities located in regions of varying malaria endemicity in Uganda.

Methods

The study utilized data from the on-going malaria sentinel surveillance program involving six level IV outpatient health facilities: Aduku, Nagongera, Walukuba, Kasambya, Kihihi and Kamwezi. Major malaria control interventions between 2008 and 2010 in sub-counties where these sites are located included Indoor residual spraying (IRS) conducted in Aduku; insecticide-treated nets (ITNs) distributed in Nagongera and Kamwezi. There has been no major control intervention(s) in sub-counties where Walukuba, Kasambya and Kihihi are located. Treatment with artemisinin-combination therapies have however been deployed nationally. Patient information; demographics, malaria test results and diagnosis are recorded on a standardized patient record. The test positivity rate (TPR) defined as the number of persons testing positive for malaria divided by the total number of persons tested was calculated by year from 2008 to 2011 for two age categories (< 5 years and > 5 years).

Results

A total of 560,586 patients were seen, of which 25% were <5 years. Over 325,500 patients were suspected to have malaria, with the proportion of these having a confirmatory test done increasing from 62% in 2008 to 98% in 2011. Between 2008 and 2011, the proportion of the <5 years testing positive for malaria significantly decreased from 66% to 34% in Aduku, from 61% to 41% in Nagongera, and from 54% to 24% in Kamwezi. However, significant increases were seen in Kasambya and Kihihi from 41% to 51% and from 28% to 44% respectively. The TPR at Walukuba remained stable (41% to 45%). Similar trends were seen in the > 5 years.

Conclusions

Sentinel site surveillance has been a reliable and timely method/tool for monitoring trends in malaria morbidity thereby informing and guiding the Uganda malaria control program.     

Comparison of Routine Health Management Information System Versus Enhanced Inpatient Malaria Surveillance for Estimating the Burden of Malaria Among Children Admitted to Four Hospitals in Uganda

To prepare for a Phase III dengue vaccine efficacy trial, 20 investigational sites were selected for this observational study to identify dengue infections in a closed cohort (N = 3,000 children 9–16 years of age). Of 255 acute febrile episodes experienced by 235 children, 50 (21.3%) were considered serologically probable dengue, and 18 (7.7%) were considered virologically confirmed (i.e., dengue NS1 antigen positive) dengue cases. Considering the disease-free and at-risk period from study start to onset of symptoms, the overall incidence density of acute febrile episodes was 17.7 per 100 person-years of follow-up, ranging from 15.3 in Colombia to 22.0 in Puerto Rico. This study showed that all sites were capable of capturing and following up acute febrile episodes within a specific timeframe among the established cohort and to detect dengue cases.     

The Effect of Indoor Residual Spraying on Malaria and Anemia in a High-Transmission Area of Northern Uganda

Indoor residual spraying (IRS) with insecticide is now recommended for malaria control in high-transmission settings. However, concerns about insecticide resistance have increased. We conducted a cross-sectional household survey in high-transmission northern Uganda in two districts previously sprayed with pyrethroids before documentation of pyrethroid resistance and at least one round of carbamates and in one contiguous district that was not sprayed. Parasitemia prevalence among children < 5 years of age was lower in the two IRS districts compared with the non-sprayed district: 37.0% and 16.7% versus 49.8%, P < 0.001. Anemia prevalence was also significantly lower in the two IRS districts: 38.8% and 36.8% versus 53.0%, P < 0.001. Multivariable Poisson regression models indicated that a child living in a sprayed district had a 46% and 32% lower risk of parasitemia and anemia, respectively, than a child in a non-sprayed district (P < 0.001). Carefully managed IRS can significantly reduce malaria burden in high-transmission settings.