College of Health Sciences (CHS)

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    Etiology of pruritic papular eruption with HIV infection in Uganda
    (American Medical Association., 200-12-01) Resneck, Jack S ; Beek, Marta Van ; Furmanski, Lisa ; Oyugi, Jessica ; LeBoit, Philip E. ; Katabira, Elly. ; Kambugu, Fred ; Maurer, Toby ; Berger, Tim ; Pletcher, Mark J. ; Machtinger, Edward L.
    Context A frequent cause of human immunodeficiency virus (HIV)–related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. Objective To determine the etiology of PPE occurring in HIV-infected individuals. Design, Setting, and Patients Cross sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. Main Outcome Measures Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. Results Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/μL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P .001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/μL; P=.02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/μL; P=.07) than those without histological evidence of arthropod bites. Conclusions Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients.
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    The prevalence of plasmodium falciparum placental malaria and its association with prenatal sulfadoxime-pyrimethamine prophylaxis among HIV positive mothers in Mulago hospital.
    ( 202-05) Namale, Ssebuliba Leticia
    INTRODUCTION: HIV positive (HIV+) women are more susceptible to malaria infection during pregnancy than their HIV negative (HIV-) counterparts but the actual prevalence of infection in Ugandan pregnant women is not known. HIV infection limits the pregnant woman’s capacity to control P. falciparum parasitaemia with resultant placental malaria. This is the major determinant of its impact on foetal growth and survival. Although prenatal SP prophylaxis seems to be protective to pregnant women in general, there is growing concern that the recommended two doses prenatally may be inadequate in HIV+ mothers was determined. SIGNIFICANCE OF THE STUDY: The study gave an insight into the situation of malaria among the HIV+ pregnant women. The protection of the standard two-dose prenatal SP was not known well established due to the inadequate sample size and therefore a large b-error although these preliminary results seem to suggest that two-dose SP may not be sufficient for the HIV+ mothers. OBJECTIVES: The aim of the study was to determine the prevalence of p. falciparum placental malaria among HIV+ mothers and its association with prenatal SP prophylaxis. METHODOLOGY: This was a hospital based cross-sectional study of HIV+ pregnant women. The participants in this study were recruited at delivery from an ongoing Nevirapine cohort study in Mulago hospital where their HIV status had been determined. The history of prenatal SP prophylaxis was determined by self-report. A specimen of placental blood was collected and examined for malaria parasites using fields stain. The prevalence of placental malaria was determined. Inferences about the protection offered to HIV+ mothers by the standard two-dose prenatal SP prophylaxis were made according to its association with placental malaria. STUDY REQUIREMENTS: Quantitative data was collected using a structured questionnaire. Qualitative data on the practice of SP chemoprophylaxis was collected using key informant interviews of doctors who ran the antenatal clinics. DATA MANAGEMENT AND ANALYSIS: The prevalence of placental malaria among the HIV+ mothers was determined. The analysis also included the calculation of the odds ratio (OR), chi-squared values (X2) and their p-values and confidence intervals (CI). Adjusted ORs were calculated to control for potential confounders. Logistic regression was done to determine the association between the outcome and the variables of interest. Qualitative data was transcribed and analyzed manually. RESULTS: The prevalence of placental malaria was 9.4%. The prevalence of placental malaria among the SP users was 9.5% and among the non-users, 9.2%. The difference between the groups was not significant. The association between prenatal SP prophylaxis and placental malaria was not significant. CONCLUSION: The prevalence of placental malaria among HIV+ mothers in Mulago hospital is high. Placental malaria among HIV+ mothers is not parity specific. These preliminary results suggest that two-dose SP prophylaxis may be inadequate for HIV+ mothers but are not conclusive due to the large type II error resulting from a sample size.
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    The role of self medication in rural areas
    ( 1969) Bowry, D. R.
    The subject matter has been studied firstly with a view to showing whether the people living in the Defined Area of Kasangati Health Centre are treating themselves by traditional or customary methods (taboos and native medicines), or by the modern ways as practised at the Health Centre at Kasangati. Secondly, it was hoped to discover how much people prefer to attend the outpatient dispensary of the Health Centre, or to buy their basic drugs from the village shopping centre at Kasangati or Gayaza for self medication. Thirdly, it was hoped to learn something of the incentives behind the practice of self medication - was it a cost incentive, as the shops were nearer to the homes, or was it a form of malingering, by attendance at overcrowded dispensaries resulting in the loss of working time, or was it something wholly different ? Fourthly, it was hoped to discover whether patients preferred the new to the old ways in prevention and cure, and fifthly, whether there was any interest in the simplest possible subjects of public health importance, e.g. teaching on nutrition to prevent kwashiorkor or the importance of breast feeding to avoid marasmus, maternity and child health services in the avoidance of childhood infections, and so on. The study has shown the usefulness of the health centre in every respect. The people like the use of modern (allopathic) treatment. The gentry follow the instructions given to them about their health problems, for example, nutrition, inmunisation, and sanitation, consequently it is found that the people living in the Area are healthy, cleaner and cautious about their health problems. In short the Health Centre services should be extended as the finances of the government concerned allow.
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    Some observations on birth weights and nutritional changes during pregnancy
    ( 1969) Watts, Theresa E.E.
    It has been the impression of the author while conducting antenatal examinations in various parts of East Africa that many women experience very little weight again compared with the recognised standards from the ‘western’ countries. Several publications have shown that the birth weights of African babies are generally lower than the birth weights of European babies. It would be a great help to be able to predict low birth weight babies in the ante-natal clinic as these babies are at greater risk. No study has yet been published concerning weight changes in pregnancy in East Africa and so the present study was undertaken to determine the weight gain and nutritional status in pregnancy and see if this could be related to the birth weight of the baby.
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    The pathology of chronic pancreatic disease in Uganda
    ( 1970) Owor, Raphael
    Chronic pancreatic disease may be defined pathologically as a condition characterized by loss of pancreatic lobular architecture with replacement of most of the parenchyma by fibrous tissue. These features are accompanied by variable degrees of acinar atrophy and duct dilatation. Intraduct calculi are frequently but not invariably present. This entity must be distinguished from simple fibrosis of the pancreas which may be mild or moderate but does not lead to architectural disorganization. From a general survey of the literature it is apparent that this distinction has not been made by many authors and therefore it is difficult to estimate the frequency of the disease in any one area. However, there is evidence to show that the disease is common in the United States of America, parts of West Europe, South Africa and Australia. In these countries the disease is frequently associated with chronic alcoholism. In comparative study of Autopsy materials in Glasgow and Kampala I find that chronic pancreatic disease is uncommon in Glasgow where acute haemorrhagic pancreatitis is common. In Kampala where “silent” acute interstitial pancreatitis is seen chronic pancreatic disease is common.
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    Immunity to malaria
    ( 1970) Mody, N. J.
    Section I: literature is reviewed and the pattern of the development of immunity in a population exposed to high malarial endemicity is followed. This is followed by a brief discussion of specific aspects of malarial immunity in an immune population. Section II: two major groups of Ugandan populations were included in the present study. First comprised of pregnant females and their newborns, and second of patients with Tropical Splenomegaly Syndrome. A. Pregnant females and their newborns i. Malarial immunity during pregnancy Increased parasitaemia during pregnancy, in a previously immune female was investigated to elucidate if there was any breakdown in humoral defense. Fifty pregnant females were followed during their pregnancy and were compared with a control group of forty non-pregnant females and seventeen males. Concentrations of serum gamma-globulins and immuno-globulins were found to be normal during pregnancy. The levels of malarial fluorescent antibodies and their distribution in IgG, IgA were also normal during pregnancy. A reciprocal relationship between antibody levels and parasitaemia was established. Thus the results of this study indicated no depression of humoral immunity during pregnancy. Evidence is reviewed to support the possibility of a breakdown in cellular immunity during pregnancy, pregnancy, preventing lysis of ingested malaria parasites by macrophoges, probably as a result of the effect of corticosteroids, which are synthesized in increasing amounts during pregnancy. ii. Intra-uterine infections Intra-uterine infections are known to lead to fetal synthesis of IgM and /or IgA leading to elevated levels of IgM and /or IgA in cord blood sera at birth. In this study, elevated levels of IgM and/or IgA were detected in 18.6% of the cord blood sera tested. Intra-uterine infections play an important role in the etiology of congenital malformations and in postnatal morbidity and mortality. It is suggested that “African macroglobulinaemia” may have its origin in the intra-uterine priming and fetal synthesis of IgM as a result of intra-uterine infections. Defining the population of the newborn likely to have had intra-uterine infection will permit further study of etiological agents and postnatal effects of such infections in Uganda population. An attempt was made to study the possibility of malaria as en etiological agent responsible for intra-uterine infections in these neonates. There was no correlation between levels of malaria antibodies in these samples and elevated levels of immunoglobulins, neither could IgM malaria antibodies be demonstrated in cord blood sera. It was, therefore, concluded that malaria may not be one of the etiological agents responsible for intra-uterine infections in our population in Uganda. iii. Fetal Levels of IgG Placental transfer of maternal IgG was demonstrated, beginning early during intra-uterine life and increasing exponentially to attain maternal levels in the fetus term. iv. Congenital Malaria Must be rare in an immune population as amply recorded in literature and supported in the present study, where none of the 88 neonates had parasites in their peripheral blood smear. v. Malarial placental parasitization and birth-weights Many reports have recorded the effect of malaria placental parasitization on birth-weights. In the present study such a relationship was not obvious. Factors known to affect birth-weights, like sex of the newborn, its birth-rank, nutritional state of the mother and placental sufficiency seem not to have been taken into consideration in older studies. In the present study fetal plasma proteins, especially albumin and gamma-globulins have been demonstrated to be related to maturity at birth. Probably the degree of parasitization, rather than just the presence of parasites in placental smears, together with other placental lesions may be more relevant to placental insufficiency leading to lower birth-weights. vi. Malarial antibodies in cord blood sera Fluorescent antibodies were detected in significant titres in cord blood sera of immune mothers, thus at birth the neonate has a passively acquired immunity against malaria. vii. Malarial antibodies in colostrum Fluorescent antibodies were detected in breast milk of immune mothers, and their neonates may be acquiring further protection against malaria as a result of ingesting these antibodies. B. Tropical Splenomegaly Syndrome (a) From the following two studies it was possible to rule out the possibility of a defect in antibody response to antigenic stimuli, leading to exaggerated IgM synthesis, in TSS patients i. Antibody response to E. coli Vi antigen in TSS patients was normal and resulted in the synthesis of both IgG and IgM antibodies. ii. The distribution of malarial antibodies in IgG, IgA and IgM in TSS patients was normal too. (b) 7S IgM, monomeric units were detected in almost 30% of TSS patients. This may be the effect or the cause of increased synthesis of IgM in TSS patients. Presence of 7S IgM monimeric units in test sera is likely to lead to over-estimation of IgM by radial immunodiffusion technique. (c) Immuno fluorescence study on liver biopsies has demonstrated antibody synthesis by hepatic sinusoidal lymphocytic infiltrates and the possibility that Kupffer cells are engaged in ingesting antigen/antibody complex. (d) Long term malarial prophylaxis has been shown to lead to clinical improvement in TSS patients. In the present study malarial prophylaxis has been shown to reduction in concentrations of IgM though the IgG, IgA and MFAT seem not to be affected during the period of observation.
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    Mombasa bar-girls: a study of prostitution and venereal disease in a Kenya seaport
    ( 1970-03) Rutasitara, W.K.
    Africa in particular East Africa is in a rapid process of remolding herself in attempt to catch up with the rest of the developed world. She is undergoing a process of industrialisation which is accompanied by increasing urbanisation. People of different cultures have left rural communities for the urban centres and there they formed societies of different social structures from that of their original homes. Those social groups are of varying patterns and often they are based on certain key points such as common beliefs and practices, common need, work, or recreational places. Like birds of the same feather members of the same social group always flock together. Together with these changes, there has also grown up revolutionary changes in attitudes and behaviour amongst the people. What was a taboo food years back is a favourite dish today. What could have been mentioned in a social group previously, for example, matters relating to sexual reproductive happenings and experiences, are today spoken of without inhibition. Such changes in attitude and behaviour of people in some of the “new communities” have given rise to certain groups which are special problem groups in medicine, public health and sociology. One of these special problem groups is that group of people who are known under a multitude of names such as prostitutes, Bar-maids, Bargirls, “Malaya”, “Mbwa kachoka” etc…..
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    Syphilis in Uganda: (the history, clinical features and cellular immunity
    ( 1971-01) Masawe, Aaron E. John
    The history of syphilis in Uganda, the clinical patterns, and the cellular immune mechanisms among the indigenous subjects with syphilis have been studied. Concerning the history it was shown and discussed that the disease was unknown in this country until the arrival of the Arab Slave Traders in 1848. After 1880 the disease rampaged the country “in epidemic fashion” and necessitated the setting up of the anti-venereal disease campaign that has lived until today and which underlined the foundation of Medical Services and higher medical education in this country. The predisposing factors for the so called syphilis epidemic included: (a) the announcement by Kabaka that venereal diseases were virtuous and every man had to acquire to remain a man, and (b) the religious wars between different religious factions. Of the clinical pattern, it was deducted both from the historical review and from the study that lesions of syphilis amongst the indigenous population are severe and exuberant in the early stages of the disease and somehow puzzling in the late stages.
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    Primary schools' survey: (Kyadondo County, West Buganda, Uganda)
    ( 1973) Ogoye, Omondi Ojure
    Some work has already been done on school health in Uganda. But with the quick pace in scientific research in this field, it’s necessary that field surveys be carried out to focus our attention on the most common problems facing this group of school age children. A field survey was undertaken to review health problems of primary school children in Kyadondo County. The aims were: 1. Evaluation of general health of the children including their immunization status. 2. Inspection of the school facilities for water supply, meals, first aid and sanitation. 3. Evaluation of how health education was carried out. 4. The survey was to be coupled with a BCG immunization campaign
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    Causation and prevention of stillbirths and postnatal deaths: Mulago Hospital, 1970-1971
    ( 1973) Marasha, B. J.
    The object of this study is to summarise causes of stillbirths and postnatal deaths based on a review board meeting of Obstetricians and Paediatricians in Mulago Hospital, so as to try and prevent these causes in future. It is hoped that by combining a concise and simple text with a very liberal use of illustrations, tables and graphs the information in these pages can be easily assimilated. The tabulated characteristics of stillbirths as compared to live births are to try and see whether there were any factors predominant in stillbirths than in live births within Mulago Hospital during 1970 and 1971. The modification of a labour graph is one of those ideas based on personal experience of the author. But although the study was written by a single author, reviews of Physicians on causation of stillbirths and postnatal deaths are hinted to make further recommendations for training of staff for further preventive measures. The justification of this study is a step to tackle this problem.
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    Malnutrition and intestinal worm infestation in rural Kigezi
    (Makerere University, 1973) Kakitahi, J. T.
    A prevalence study was done on a sample of 169 pre-school children in a rural area in Kigezi, about 3½ miles from Kabale. The objective was to find whether there was an association between malnutrition and intestinal worm infestation. Both clinical and anthropometric measurements were used to determine the nutritional status of the sample. Stoll’s Method was used in stool examination. High prevalences of malnutrition and parasite rates were found, but there was no statistically significant association between malnutrition and parasite rates. A follow up study on weight of some of these children showed a gain in weight three months after de-worming. This weight gain was statistically significant
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    Incidence of Australia antigen in Ugandan subjects with sickle cell disease
    ( 1973) Kigonya, E
    Two hundred patients with homozygous S-haemoglobinopathy (HbSS) were assayed for Au-Ag and Au-Ab. Three (1.5%) patients had positive Au-Ag and one (0.5%) was positive for Au-Ag. The results indicate that the incidence of Au-Ag and Au-Ab, in repeatedly transfused patients with HbSS, is not higher than that of the general population. Does the sickle-cell-gene impart some indirect protection to these patients against the existence of the Au-Ag? Incidental findings were the high incidence of hepatomegaly (78.5%) and splenomegaly (6%).
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    D-xylose absorption in Ugandan patients with fever
    ( 1973) Wankya, B. M.
    Using 25gm oral dose D-xylose tolerance test was performed on 19 normal subjects and 24 subjects with fever. In the normal subjects, blood D-xylose levels showed a peak between one and two hours and then declined gradually to resting levels after five hours. The mean blood D-xylose levels were lower in the patients with fever and had a prolongation of absorption when compared to the controls. On the basis of both low 5-hour urine D-xylose and low blood levels at one hour after the oral dose a significant number (50%) of patients suffering from fever due to pulmonary tuberculosis and fever due to acute bacterial infection had evidence of D-xylose mal-absorption. In the probable absence of primary jejunal mucosal disease, the intestinal absorptive, disfunction has been attributed to systemic bacterial infection. The intestinal absorptive disfunction was also present in the two patients with chronic myeloid leukaemia. The effect of chronic myeloid leukaemia and myeleran on the jejunal mucosa is yet unknown and requires elucidation. The possible pathogenesis and consequences of this subclinical mal-absorption are discussed.
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    Malnutrition and intestinal worm infestation in rural Kigezi
    ( 1973) Kakitahi, J. T.
    A prevalence study was done on a sample of 169 pre-school children in a rural area in Kigezi, about 3½ miles from Kabale. The objective was to find whether there was an association between malnutrition and intestinal worm infestation. Both clinical and anthropometric measurements were used to determine the nutritional status of the sample. Stoll’s Method was used in stool examination. High prevalences of malnutrition and parasite rates were found, but there was no statistically significant association between malnutrition and parasite rates. A follow up study on weight of some of these children showed a gain in weight three months after de-worming. This weight gain was statistically significant
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    Some aspects of malaria in Mulago Hospital
    ( 1974) Masembe, Rachel N
    Thirty patients with malaria were studied. Seven had cerebral malaria, ten severe and thirteen non-severe malaria. Age ranged from seven weeks to eight years with equal sex distribution. All were febrile except two infants and convulsions were common especially in the cerebral and severe group. Severe anaemia of less than 5gm. per 100 ml. was confined to the children under 6 months. There was evidence of haemolysis in half the patients of the whole group. Parasite densities were low even in those with cerebral malaria and did not correlate with anaemia. Reasons for these findings are discussed. Thrombocytopenia was not severe and was confined to those with severe malaria. Fibrinogen levels were normal and factor V abnormality was found in only one patient. Prothrombin times serum F.D.P. levels were not done. There is insufficient data to make firm conclusions about presence or absence of IVC in cerebral malaria cases. Further studies are suggested.
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    Cardiovascular findings in patients with Sickle Cell Disease
    ( 1974) Mugerwa, R.D.
    SUMMARY Fifty homozygous sicklers and ten heterozygous sick cell patients selected from the sickle cell clinic cardiac clinic and inpatients on the medical wards of Mulago Hospital from the basis of this dissertation. It starts with a historical review and pathology of sickle cell disease. Cardiovascular alterations in Anaemia with emphasis on physiological and pathological considerations in sickle disease are then discussed. The findings among the patients studied are described dwelling mainly on presenting symptoms, cardiovascular findings notably cardiomegally, murmurs, abnormal heart sounds, electro-cardio graphic and X-ray abnormalities. A discussion of findings with reference to work on the same subject by other writers is presented. Some of the possibilities haemodynamic alterations in sickle cell disease are outlined and a need to for further elaborate studies in this condition is stressed.
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    Plasma rennin activity in the African hypertensives
    ( 1974) Muguma, John
    Early reports, particularly from East Africa, concerning surveys of arterial pressures in Africans showed hypertension as an unusual event in the indigenous population (Donnison, 1929; Vint, 1937). This impression has in the last two decades been gradually dispelled and it is now known that hypertension is at least as common in African population as it is in the Caucasian. (William 1944, Callander 1953, Uys 1956, Schrine 1959, Abrahams and Alele 1960, Shaper and Williams 1961, Binder 1961, Smith 1966, Akinkugbe, 0.0. 1968). The etiology of essential hypertension remains largely unknown, but most workers tend to agree with Sir George Peckering who says that, “Like other measurable characters of the higher animals, arterial pressure is determined by the interaction of nature and nurture, heredity and environment”. For instance hypertension is a very rare event in the Gilbert Islands, and genetic factors have been advanced to explain this curiosity. On the other hand arterial hypertension is rampant in Northern Japan, and the possible explanation, has been too much salt consumed at table.
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    Cardiovascular findings in patients with sickle cell disease
    ( 1974) Mugerwa, R. D.
    Fifty homozygous sicklers and ten heterozygous sickle cell patients selected from the Sickle Cell Clinic, Cardiac Clinic and inpatients on the medical wards of Mulago Hospital form the basis of this dissertation. It starts with a historical review and pathology of sickle cell disease. Cardiovascular alterations in anaemia with emphasis on physiological and pathological considerations in sickle cell disease are discussed. The findings among the patients studied are described dwelling mainly on presenting symptoms, cardiovascular findings notably cardiomegally, murmurs, abnormal heart sounds, electro-cardiographic and x-ray abnormalities. A discussion of findings with reference to work on the same subject by other writers is presented. Some of the possible haemo-dynamic alterations in sickle cell disease are outlined and a need for further elaborate studies in this condition is stressed.
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    The relationship between the haemolytic crises in sickle cell anaemia, and the deficiency of the red cell enzyme glucose-6-phosphate dehydrogenase
    ( 1975-01) Kibuka, musoke ; Mukkaanya, Moses E
    Seventy-two patients with proved haemoglobin SS were studied in respected of their haemoglobin, reticulocyte counts, serum bilirubin and their Glucose-6-phosphate dehydrogenase values in international units per gram of Haemoglobin. Of the whole group 18% were found to be deficient in the enzyme. A retrospective study of these patients was carried out to see if those who were deficient in the enzyme are those who experienced haemolytic crises. Records at the Sickle Cell Clinic did not reveal any well documented case of a haemolytic crisis having occurred in any of these patients, a few had clinical evidence of increased haemolysis. One patient who had evidence of increased haemolysis was discussed in detail and was thought to be Glucose-6-Phosphate Dehydrogenase deficient, and it was suggested that the increased haemolysis was precipitated by ingestion of aspirin. It has been suggested that a detailed study if those patients was Sickle Cell anaemia and Glucose-6-Phopsphate Dehydrogenase deficiency is required to establish the occurrence of haemolytic crises and find the precipitating factors.
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    The epidemiology of tetanus in Busoga
    ( 1975-02) Musoke, G. M.
    During a brief period of 4 weeks in October 1974, a study was conducted about factors associated with the high frequency of TETANUS in Busoga previously reported from analysis of Jinja Hospital records. 36 cases of tetanus admitted in 4 Hospitals due to tetanus in this period were interviewed and followed up in their homes where possible. 289 mothers who delivered in the 4 Hospitals were also interviewed about their antenatal care. The number of cases of tetanus previously admitted to these Hospitals over specified periods was also unveiled by the Hospital records. And all Immunization returns against tetanus from the whole province were analysed. Results showed that the disease morbidity and mortality was higher than the average for other parts of Uganda and comparable developing countries, but the other features characteristic of tetanus i.e. affecting mainly the people in the low socio-economic status especially those involved in cultivation exist as in the rest of the world. And that low education plus lack of basic personal hygiene as illustrated by the high rate of jigger sores as well as other forms of sepsis as predesposing factors to the development of the disease were causing a big problem. The province however, proved to have a good distribution of health units and the staffing position was good compared to the rest of the country and the population especially in the group of expectant mothers is well motivated to utilize these health services. The present immunization programmes, however are not covering a good proportion of the population at risk of catching tetanus.