Master of Medicine in Pediatrics and Child Health

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    Prevalence and Factors Associated with Overweight and Obesity among Adolescents in Selected Secondary Schools in Bushenyi-Ishaka Municipality, Western Uganda
    (Kampala International University, 2021-11) Simon Odoch
    Background: Childhood obesity has become a worldwide epidemic. Several non-communicable diseases are now being found among overweight and obese adolescents. There is lack of data on the burden of overweight and obesity, associated comorbidities in Bushenyi-Ishaka municipality. This study aims to investigate prevalence; factors associated with overweight and obesity among adolescents in selected secondary schools in Bushenyi-Ishaka municipality and determined the proportion of overweight and obese adolescents with hyperglycemia. Methods: A school-based cross-sectional study was conducted. Multistage sampling technique used to randomly recruit 752 study participants aged 12 to 18 years with the use of interviewer administered structured questionnaires. Food Frequency Questionnaire, International Physical Activity Questionnaire and HEADSS assessment tool were adapted to assess dietary, physical activity and sedentary lifestyle, and psychosocial factors, respectively. Weight and height was measured twice and average calculated provided the difference between the two measurements does not vary by more than 0.5kg for weight or 0.5cm for height. Body Mass Index (BMI) was calculated by dividing weight by height in squared meter and interpreted as normal, overweight or obese using International Obesity Task Force BMI cut-off references for a given age and gender. A glucometer was used to measure fasting blood glucose; ≥ 5.6 mmol/L was considered hyperglycemia. Data analyzed using SPSS version 27.0. The prevalence of overweight and obesity were determined as a proportion. Binary logistic regression was used to determine factors associated with overweight and obesity taking a p-value < 0.05 at 95% confidence interval to be statistically significant. Hyperglycemia among overweight and obese adolescents was determined as a proportion. Results: Of the 752 study participants, 563 (74.9%) were from private schools and 189 (25.1%) from public schools. Prevalence of overweight and obesity was 15% with overweight and obesity only being 14.1% and 0.9%, respectively. Out of 113 overweight and obese adolescents, 11 (9.7%) had hyperglycemia. Female gender (aOR = 10.17, 95% CI: 4.52-22.91, p < 0.001), urban residence (aOR 1.70, CI 1.12-2.53, p = 0.013), family history of obesity and overweight (aOR = 2.86, 95% CI: 1.62-5.05, p < 0.001), less than moderate to vigorous physical activity (aOR 2.82, 95% CI: 1.46-5.47, p = 0.002), and, unhealthy diet, (aOR = 2.91 95% CI: 1.53-5.53, p = 0.001) were independently associated with overweight and obesity. In addition, adolescents who received pocket money were more likely to be overweight or obese (aOR = 3.77, 95% CI: 1.47-9.66, p = 0.006). Conclusion: This study found high prevalence of overweight and obesity with one in six adolescents being affected. One in 10 overweight and obese adolescents had hyperglycemia. Adolescents at high risk of obesity should be targeted for healthy lifestyle programs in secondary schools.
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    Prevalence and factors associated with under nutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi District
    (Kampala International University, 2021-10) Kumbowi Kumbakulu Patrick
    Background: HIV-exposed children are vulnerable to undernutrition. Knowledge of feeding practices, prevalence and factors associated with undernutrition among HIV-exposed uninfected children remains the mainstay to elaborate efficient strategies, which can help to reduce the burden of undernutrition among this vulnerable group. Methods: This was a cross sectional, descriptive and analytical study to determine the prevalence, feeding practices and factors associated with undernutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi District, Uganda. The study involved 245 mother-child pairs in four antiretroviral treatment clinics from May to June 2021. Questionnaire interviews were used to obtain socio-demographic, medical, and dietary factors data. A digital weighing scale, stadiometer and mid-upper-arm circumference (MUAC) tape were used to measure body weight, length, and MUAC of participants respectively. Undernutrition was defined by either a length-for-age or a weight-for-length or a weight-for-age below -2 SD of the 2006 World Health Organization growth standards for stunting, wasting and underweight respectively. Data were entered and analyzed using IBM SPSS 27.0 statistics for windows. The prevalence of undernutrition and feeding practices indicators were determined as proportions, whereas binary logistic regression was used to determine factors associated with undernutrition. A p-value <0.05 was considered for statistical significance at multivariable level. Results: Of the 245 participants, 43(17.6%) had undernutrition. The prevalence of stunting, wasting and underweight was 11%, 5.3% and 6.5% respectively. Most study participants 235(95.9%) were initiated on breastfeeding during their first hour of life, and 215(87.8%) were exclusively breastfed for 6 months. However, 93(38%) of study participant did not receive an acceptable meal frequency and 188 (76.7%) did not have an acceptable dietary diversity score during the last 24 hours. The mean dietary diversity score was 2.9±0.4, 2.7±0.8, 2.6±0.5, and 2.6±0.6 for study participants with normal nutritional status, stunting, wasting, and underweight respectively. Only 4(4%) continued breastfeeding after 1 year of age. Among HIV-positive mothers, 108(78.4 %) had ever been advised on feeding practices. Factors that were significantly associated with undernutrition included young age of the mother (aOR=2.51, 95% CI: 1.12-5.62, p=0.024), low birth weight (aOR=2.85, 95% CI: 1.12-7.23, p=0.028), child’s history of illness in the past two weeks (aOR=1.84, 95% CI: 1.04-5.53, p=0.039), maternal viral load of ≥ 1000 copies/μL (aOR=3.4, 95% CI: 1.13-10.19, p=0.029) and maternal undernutrition (aOR=9.35, 95% CI: 1.99-13.69, p=0.001). Conclusion: The prevalence of undernutrition among HIV-exposed uninfected children (6-18 months) in Bushenyi district was relatively low. The study revealed a high exclusive breastfeeding rate in the first 6 months, which may have offered a protective effect. On the other hand, complementary feeding practices were poor with regards to frequency and diversity. This study demonstrates the need for routine nutritional assessment of HIV-exposed uninfected children, especially those presenting with these risk factors
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    Prevalence, predictors and susceptibility patterns of bacterial urinary tract infections among febrile children under-five years of age at Kampala International University Teaching Hospital
    (Kampala International University, 2021-07) Gloria Nakalema
    Background: Accurate and reliable diagnosis of UTI in children is critical because they are usually underdiagnosed or over-diagnosed especially in children under five years of age. Antimicrobial susceptibility results are key to effective intervention. Objective: This study was done to determine the prevalence, predictors, and susceptibility patterns of bacterial urinary tract infections among febrile children aged less than 5 years presenting at Kampala International University Teaching Hospital. Methods: A hospital-based cross-sectional study was conducted in entry points of the pediatric ward of KIU-TH between December 2020 and March 2021. The study enrolled a total of 350 children 2-59 months by consecutive enrolment. Urinalysis and urine culure was done, clinical and demographic data was collected using questionnaires and data analysed using SPSS version 27 with significance at 95% confidence interval. Results: Out of 350 children studied, 97 (27.7%) had a UTI. E.coli was the most commonly isolated uropathogen (56.7%). Isolates had a sensitivity pattern to Imipenem of 93.4%, Ciprofloxacin (85.4%), Amikacin (77.4%) and were extremely resistant to Cotrimoxazole (83.3%), Amoxicillin (80.0%) and Ampicillin (74.4%). Factors that were independently predictive of a UTI were age less than 24 months (p 0.002), male children (p 0.010), undernutrition (p 0.012), diarrhea (p 0.032), vomiting (p 0.005). Children who were wiped back to front after defecation (p 0.021), diapers use (p 0.014). Among the laboratory urinalysis predictors, Children with nitrites and those with more than 5 white blood cells at urine microscopy were 17.875(p <0.001) and 6.505(p<0.001) times more likely to suffer from Urinary tract infection respectively. Conclusion: There is a high intra hospital prevalence of bacterial UTIs among febrile children under five years of age with with E.Coli as the predominant causative organism and there is a high resistance to commonly used antibiotics thus need to review the treatment protocols of UTI.
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    Prevalence and factors associated with glomerular hyperfiltration among children aged 2 to 18 years with sickle cell anemia at Jinja Regional Referral Hospital.
    (Kampala International University, 2023-10) Omar Abdikarim Abdulle
    Introduction: Even though progression in children’s care with SCD have raised, their prolonged-term survival is characterized by long-standing diseases such as long-standing kidney disease. Renal involvement occurs all the time of life of a patient with SCA and contribute greatly reduced life expectancy of patients with sickle cell disease, accounting for 16–18% of mortality. Methods: An analytic and descriptive cross-sectional hospital-based study was conducted among children with Sickle cell anemia. Consecutive enrolment of study participants was done until the sample size of 245 was achieved. The prevalence of glomerular hyperfiltration was analyzed as percentage with its corresponding 95% CI. To determine factors associated with glomerular hyperfiltration, bivariate and multivariate logistic regression were run. The proportion of microalbuminuria among study participants with glomerular hyperfiltration was determined as a fragment of participants with albuminuria and glomerular hyperfiltration over the number of study participants with glomerular hyperfiltration. Results: The prevalence of glomerular hyperfiltration was 28.00%. The independent risk factors for glomerular hyperfiltration were age and severe anemia. Children who were in the age group of 14 – 16 years had 3.91 folds the risk of developing Glomerular Hyperfiltration (aOR 3.91, 95%CI 1.41-37.23, P=0.023) and children who had severe anemia were 9.47 folds the risk of developing Glomerular Hyperfiltration (aOR 9.47, 95%CI 1.57-57.05, P<0.001). This study showed that 23.19% (16/69) of the SCA children with Glomerular Hyperfiltration had Microalbuminuria. Conclusion: This study suggests that a considerable proportion of children in this population experience glomerular hyperfiltration. The results underscore the importance of considering age, and severe anemia in the management and care of these patients. This study suggests that a significant proportion of SCA children with glomerular hyperfiltration may be experiencing early kidney damage or dysfunction, as evidenced by the presence of MA. Recommendations ✓ Regular visiting of sickle cell clinic should be done since Glomerular hyperfiltration starts early age of life. ✓ Anemia Management: Early and effective management of anemia in children with sickle cell anemia is crucial. ✓ Screening for albuminuria should occur annually beginning at 10 years of age in patients with SCA.
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    Incidence and risk factors for early neonatal mortality among term neonates in the Neonatal Unit of Hoima Regional Referral Hospital
    (Kampala International University, 2024-03) Abdirahman Hassan Salad
    Background:The contribution of neonatal deaths to the under-5 deaths continue to increase despite the efforts to reduce under-five mortality. Of all neonatal deaths, about a third occur within the first day after birth, and three-quarters within the first week of life. Neonatal mortality rate is still high in Uganda. There is still a paucity of data on the incidence of early neonatal mortality among term neonates in the NICU of Hoima Regional Referral Hospital (HRRH) and its risk factors. This study aimed to determine the incidence and risk factors for early neonatal mortality among term neonates in the neonatal unit of HRRH. Methods: This was a hospital based prospective cohort study at HRRH in which neonates admitted to the NICU were followed up for 7 days to assess for occurrence of mortality and the day it occurred. Data relating to risk factors was collected at admission. A blood sample was taken for blood investigations. The risk factors were determined using Poisson regression in Stata version 18 for analysis. Results:In this study that enrolled 301 term neonates, most were males 205(68.1%) admitted within 24 hours of life 273 (90.7%) The commonest diagnosis at admission was neonatal sepsis seen among 128(42.5%) of the study participants. In this study, 29 of the term neonates died within 7 days of life representing an incidence rate of 29 deaths per 2,015 person days at risk, equivalent to 0.014 deaths per person day (. At multivariate analysis, the significant risk factors for early neonatal mortality among term neonates were: mother not having formal education (adjusted incidence rare ratio (aIRR) =1.258, 95%CI=1.097-1.444, P=0.001), being resuscitated for >10 minutes (aIRR=1.246, 95%CI=1.059-1.465, P=0.008) and having apnea (aIRR=1.232, 95%CI=1.065-1.425, P=0.005). Conclusion: The early neonatal mortality in this study was high. More still needs to be done to further bring down the early neonatal mortality with focus on neonates born to mothers with no formal education, those resuscitated for >20 minutes and those having apnea.