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Okot C, Laker F, Apio PO, Madraa G, Kibone W, Pebalo Pebolo F, Bongomin F. Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda: A Community-Based Survey. Adolesc Health Med Ther 2023; 14:115-124. [PMID: 37577045 PMCID: PMC10417689 DOI: 10.2147/ahmt.s414275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. We determined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13-17 years in Agago district, Uganda. Methods We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13-17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semi-structured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. Results A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7-100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5-71.9, p=0.02). Conclusion The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.
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Affiliation(s)
- Christopher Okot
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Florence Laker
- Department of Public Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Pamela Okwir Apio
- Makerere Lung Institute, School of Medicine, Makerere University, Kampala, Uganda
| | - Grace Madraa
- Department of Rural Development and Agri-Business, Faculty of Agriculture, Gulu University, Gulu, Uganda
| | - Winnie Kibone
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Olal E, Mukunya D, Oloya JN, Baguma S, Okot C, Alema NO, Acullu D, Ochula DO, Atim PO, Odong PO, Okot GS, Pebolo FP, Oyat FWD, Ikoona EN, Aloyo J, Kitara DL. Prevalence and Factors Associated With Compliance With COVID-19 Presidential Lockdown Measures: A Cross-Sectional Study. Inquiry 2023; 60:469580231201258. [PMID: 37803931 PMCID: PMC10559722 DOI: 10.1177/00469580231201258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is one of the most severe global health uncertainties to date. Although significant global effort has been put into implementing COVID-19 pandemic control measures such as lockdowns, travel restrictions, and hygiene precautions, the transmission is expected to resurface once these efforts are discontinued. We aimed to determine the prevalence and factors associated with compliance with presidential 53-day lockdown measures in June-July 2021 in northern Uganda. In this cross-sectional study, 587 adult participants (≥18 years old) from northern Uganda were selected using a systematic sampling method. Data collection involved interviewer-administered questionnaires with an internal validity of Cronbach's α = .72. Socio-demographic characteristics of participants were described, and multivariable modified Poisson regressions were performed to assess prevalence ratios between dependent and selected independent variables, with respective P values at 95% confidence intervals. All analyses were conducted using Stata 17.0. Participants' compliance with the presidential lockdown directives was high at 88%(95% CI: 85%-90%). Compliance with the presidential directives was more likely among participants who agreed to the lockdown measures [adjusted Prevalence Ratio, aPR = 1.28 (95% CI: 1.10-1.49; P = .001)] compared to those who did not, and more likely among those who were afraid of death from COVID-19 [aPR = 1.08 (95% CI: 1.01-1.15; P = .023)] than those who did not. However, compliance was less likely among males [aPR = 0.91 (95% CI: 0.86-0.97; P = .002)] compared to females, those aged 35 to 44 years [aPR = 0.87 (95% CI: 0.79-0.97; P = .013)] compared to those less 25 years; and unmarried [aPR = 0.89 (95% CI: 0.82-0.97; P = .011)] compared to the married. Compliance with the COVID-19 presidential lockdown measures in northern Uganda was high. The factors associated with compliance were the fear of death and agreement with presidential lockdown measures. However, compliance was less likely among males, unmarried persons, and persons aged 35 to 44. The authors recommend more community engagements, participation, sensitization, mobilization, and simultaneous application of multiple public health approaches to improve compliance and control of COVID-19.
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Affiliation(s)
- Emmanuel Olal
- Yotkom Medical Centre, Kitgum, Uganda
- Uganda Medical Association, Gulu City, Uganda
| | - David Mukunya
- Busitema University, Mbale, Uganda
- Nikao Medical Center, Kampala, Uganda
| | - Johnson Nyeko Oloya
- Uganda Medical Association, Gulu City, Uganda
- Moroto Regional Referral Hospital, Moroto, Uganda
| | - Steven Baguma
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | - Christopher Okot
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | | | - Denis Acullu
- Uganda Medical Association, Gulu City, Uganda
- Aga Khan Hospital, Mombasa, Kenya
| | - Denish Omoya Ochula
- Uganda Medical Association, Gulu City, Uganda
- Lamwo District Local Government, District Health Office, Padibe, Uganda
| | - Pamela Okot Atim
- Uganda Medical Association, Gulu City, Uganda
- St. Joseph’s Hospital, Kitgum District, Uganda
| | - Patrick Olwedo Odong
- Uganda Medical Association, Gulu City, Uganda
- Amuru District Local Government, District Health Office, Amuru, Uganda
| | - Godfrey Smart Okot
- Uganda Medical Association, Gulu City, Uganda
- Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | | | | | | | - Judith Aloyo
- Uganda Medical Association, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association, Gulu City, Uganda
- Gulu University, Gulu City, Uganda
- Gulu Centre for Advanced Medical Diagnostics, Research, Trainings, and Innovations (GRUDI BIONTECH), Gulu, Uganda
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Spencer P, Okot C, Palmer V, Valdes Angues R, Mazumder R. Nodding syndrome: A key role for sources of nutrition? eNeurologicalSci 2022; 27:100401. [PMID: 35480298 PMCID: PMC9035392 DOI: 10.1016/j.ensci.2022.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 12/16/2022] Open
Abstract
Nodding Syndrome (NS) has occurred among severely food-stressed communities in northern Uganda and several other East African populations that, with their forced physical displacement, have resorted to nutritional support from available wild plants and fungi, some of which have neurotoxic potential. Among the latter is an agaric mushroom with an unknown content of hydrazine-generating agaritine, namely Agaricus bingensis, the unusually wide consumption of which may relate to the low serum levels of vitamin B6 in Ugandan NS subjects relative to controls. Hydrazine-related compounds induce patterns of DNA damage that promote neuropathological changes (tauopathy) reminiscent of those associated with established NS. While the cause of this childhood brain disease is unknown, we encourage increased attention to the role of malnutrition and B6 hypovitaminosis in the etiology of this devastating brain disease. Idiopathic epileptic encephalopathy with tauopathy (Nodding syndrome) impacts East African children Associated factors include nematode infection, food insecurity, and food use of wild plants and fungi Food use of hydrazinic fungi induces B6 hypovitaminosis, which may be marked in Nodding syndrome Vitamin B6 deficiency promotes tau phosphorylation in mouse models of human tauopathy Hydrazine generates carbon free radicals associated with DNA-damage and neurodegenerative disease Increased research attention to nutritional practices associated with Nodding syndrome is merited.
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Affiliation(s)
- P.S. Spencer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
- Corresponding author at: Oregon Health & Science University (Neurology), S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
| | | | - V.S. Palmer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - R. Valdes Angues
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - R. Mazumder
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, USA
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Baguma S, Okot C, Alema NO, Apiyo P, Layet P, Acullu D, Oloya JN, Ochula D, Atim P, Olwedo PO, Okot SG, Oyat FWD, Oola J, Ikoona EN, Aloyo J, Kitara DL. Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital: A Retrospective Study. Front Public Health 2022; 10:841906. [PMID: 35480594 PMCID: PMC9035511 DOI: 10.3389/fpubh.2022.841906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. As of December 2021, there is inadequate data on the outcome of hospitalized patients suffering from COVID-19 in Africa. This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods This was a single-center, retrospective cohort study in patients hospitalized with confirmed SARS-CoV-2 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, co-morbidities, duration of hospital stay, and treatments were analyzed, and factors associated with the odds of mortality were determined. Results Of the 664 patients treated, 661 (99.5%) were unvaccinated, 632 (95.2%) recovered and 32 (4.8%) died. Mortality was highest in diabetics 11 (34.4%), cardiovascular diseases 12 (37.5%), hypertensives 10 (31.3%), females 18 (56.3%), ≥50-year-olds 19 (59.4%), no formal education 14 (43.8%), peasant farmers 12 (37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32 (100.0%), oxygen saturation (SpO2) at admission <80 4 (12.5%), general body aches and pains 31 (96.9%), tiredness 30 (93.8%) and loss of speech and movements 11 (34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR = 0.220, 95%CI: 0.059–0.827; p = 0.030; Diabetes mellitus AOR = 9.014, 95%CI: 1.726–47.067; p = 0.010; Ages of 50 years and above AOR = 2.725, 95%CI: 1.187–6.258; p = 0.018; tiredness AOR = 0.059, 95%CI: 0.009–0.371; p < 0.001; general body aches and pains AOR = 0.066, 95%CI: 0.007–0.605; p = 0.020; loss of speech and movement AOR = 0.134, 95%CI: 0.270–0.660; p = 0.010 and other co-morbidities AOR = 6.860, 95%CI: 1.309–35.957; p = 0.020. Conclusion The overall Gulu Regional Hospital mortality was 32/664 (4.8%). Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “additional social protection” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.
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Affiliation(s)
- Steven Baguma
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Christopher Okot
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Nelson Onira Alema
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Anatomy, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Paska Apiyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Paska Layet
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Medicine, St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Denis Acullu
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Aga Kan Hospital, Mombasa, Kenya
| | | | - Denis Ochula
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Lamwo District Local Government, District Health Office, Padibe, Uganda
| | - Pamela Atim
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- St. Joseph's Hospital, Kitgum, Uganda
| | - Patrick Odong Olwedo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Amuru District Local Government, District Health Office, Amuru, Uganda
| | - Smart Godfrey Okot
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Ambrosoli Hospital, Kalongo, Uganda
| | | | - Janet Oola
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Nwoya District Local Government, District Health Office, Anaka, Uganda
| | | | - Judith Aloyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Rhites-N, Acholi, Gulu, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Surgery, Faculty of Medicine, Gulu University, Gulu, Uganda
- *Correspondence: David Lagoro Kitara ; orcid.org/0000-0001-7282-5026
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Mboussou F, Ndumbi P, Ngom R, Kamassali Z, Ogundiran O, Van Beek J, Williams G, Okot C, Hamblion EL, Impouma B. Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018. Epidemiol Infect 2019; 147:e299. [PMID: 31709961 PMCID: PMC6873157 DOI: 10.1017/s0950268819001912] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/03/2022] Open
Abstract
The WHO African region is characterised by the largest infectious disease burden in the world. We conducted a retrospective descriptive analysis using records of all infectious disease outbreaks formally reported to the WHO in 2018 by Member States of the African region. We analysed the spatio-temporal distribution, the notification delay as well as the morbidity and mortality associated with these outbreaks. In 2018, 96 new disease outbreaks were reported across 36 of the 47 Member States. The most commonly reported disease outbreak was cholera which accounted for 20.8% (n = 20) of all events, followed by measles (n = 11, 11.5%) and Yellow fever (n = 7, 7.3%). About a quarter of the outbreaks (n = 23) were reported following signals detected through media monitoring conducted at the WHO regional office for Africa. The median delay between the disease onset and WHO notification was 16 days (range: 0-184). A total of 107 167 people were directly affected including 1221 deaths (mean case fatality ratio (CFR): 1.14% (95% confidence interval (CI) 1.07%-1.20%)). The highest CFR was observed for diseases targeted for eradication or elimination: 3.45% (95% CI 0.89%-10.45%). The African region remains prone to outbreaks of infectious diseases. It is therefore critical that Member States improve their capacities to rapidly detect, report and respond to public health events.
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Affiliation(s)
- F. Mboussou
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - P. Ndumbi
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - R. Ngom
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Z. Kamassali
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - O. Ogundiran
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - J. Van Beek
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - G. Williams
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - C. Okot
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - E. L. Hamblion
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - B. Impouma
- Health Emergencies programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Amone D, Okot C, Mugabi P, Okello TR, Ogwang DM. Case Report: Swallowed toothbrush in the stomach of a 56 year female at St Mary’s Hospital Lacor, Uganda. AAS Open Res 2018. [DOI: 10.12688/aasopenres.12842.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Toothbrush swallowing is a rare occurrence. Toothbrush swallowing presents a risk of impaction and perforation along the gastrointestinal tract. This case report describes a 56 year old female that presented to the emergency unit of St Mary’s Hospital Lacor with a 1 day history of chest pain after a toothbrush was pushed down her throat by a traditional healer who was managing her for pharyngitis. The chest pain was associated with difficulty in breathing. She also reported dull abdominal pain. There was no history of vomiting or drooling of saliva. On examination, we found that she was in pain and had respiratory distress with a respiratory rate of 32 breath/ min and was using accessory muscles. There was no oedema, aneamia or jaundice. Blood pressure of 120/80 mmHg and pulse rate of 87 beats/ min. The abdominal findings were normal, but ultrasound scan suggested that the toothbrush was in the stomach. The plain erect abdominal x-ray was inconclusive. She was admitted to the ward for conservative management. After 2 weeks we decided to do exploratory laparotomy and we found the toothbrush in the stomach, that we removed and closed the abdomen in layers. Post-operatively the patient recovered uneventfully on the ward. Toothbrush swallowing is a rare occurrence. The commonest foreign bodies ingested by adults are bones, spoons and dentures. Toothbrush ingestion occurs commonly among patients with psychiatric conditions like bulimia or anorexia nervosa, schizophrenia and bezoar. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients. Most people who swallowed their toothbrushes did so entirely without erotic intent, as with this case where the patient had the brush pushed down her throat by a traditional healer. This is the first case of toothbrush swallowing in this hospital.
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Nabukenya I, Lukwago L, Okot C, Wamala J, Malimbo M, Namukose E, Musoke R, Nanyunja M, Makumbi I. Is Uganda a hub for zoonotic disease outbreaks? Lessons and challenges from ebola, marburg, yellow fever and anthrax outbreaks. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Idro R, Musubire KA, Byamah Mutamba B, Namusoke H, Muron J, Abbo C, Oriyabuzu R, Ssekyewa J, Okot C, Mwaka D, Ssebadduka P, Makumbi I, Opar B, Aceng JR, Mbonye AK. Proposed guidelines for the management of nodding syndrome. Afr Health Sci 2013; 13:219-32. [PMID: 24235917 DOI: 10.4314/ahs.v13i2.4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nodding Syndrome is a poorly understood neurologic disorder of unknown aetiology that affects children and adolescents in Africa. Recent studies have suggested that the head nods are due to atonic seizures and Nodding Syndrome may be classified as probably symptomatic generalised epilepsy. As part of the Ugandan Ministry of Health clinical management response, a multidisciplinary team developed a manual to guide the training of health workers with knowledge and skills to manage the patients. In the absence of a known cause, it was decided to offer symptomatic care. The objective is to relieve symptoms, offer primary and secondary prevention for disability and rehabilitation to improve function. Initial management focuses on the most urgent needs of the patient and the immediate family until 'stability' is achieved. The most important needs were considered as seizure control, management of behavioural and psychiatric difficulties, nursing care, nutritional and subsequently, physical and cognitive rehabilitation. This paper summarises the processes by which the proposed guidelines were developed and provides an outline of the specific treatments currently being provided for the patients.
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Affiliation(s)
- R Idro
- Department of Paediatrics and Child Health, Mulago hospital/Makerere University College of Health Sciences, Kampala, Uganda ; Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, UK
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Lukwago L, Wamala J, Erima B, Okot C, Bakamutumaho B, Nabukenya I, Lutwama J. H1N1 Pandemic: From imported cases in July 2009 to sustained transmission in school clusters in September, Uganda, 2009. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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