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Wiens MO, Nguyen V, Bone JN, Kumbakumba E, Businge S, Tagoola A, Sherine SO, Byaruhanga E, Ssemwanga E, Barigye C, Nsungwa J, Olaro C, Ansermino JM, Kissoon N, Singer J, Larson CP, Lavoie PM, Dunsmuir D, Moschovis PP, Novakowski S, Komugisha C, Tayebwa M, Mwesigwa D, Knappett M, West N, Mugisha NK, Kabakyenga J. Prediction models for post-discharge mortality among under-five children with suspected sepsis in Uganda: A multicohort analysis. PLOS Glob Public Health 2024; 4:e0003050. [PMID: 38683787 PMCID: PMC11057737 DOI: 10.1371/journal.pgph.0003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis. Four prospective cohort studies of children in two age groups (0-6 and 6-60 months) were conducted between 2012-2021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation. 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74-0.80) for 0-6-month-olds and 0.75 (95%CI 0.72-0.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds. Simple prediction models at admission with suspected sepsis can identify children at risk of post-discharge mortality. Further external validation is recommended for different contexts. Models can be digitally integrated into existing processes to improve peri-discharge care as children transition from the hospital to the community.
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Affiliation(s)
- Matthew O. Wiens
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
- Walimu, Kampala, Uganda
| | - Vuong Nguyen
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
| | - Jeffrey N. Bone
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Elias Kumbakumba
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Abner Tagoola
- Jinja Regional Referral Hospital, Jinja City, Uganda
| | | | | | | | | | - Jesca Nsungwa
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - Charles Olaro
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - J. Mark Ansermino
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Niranjan Kissoon
- BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Charles P. Larson
- School of Population and Global Health, McGill University, Montréal, Canada
| | - Pascal M. Lavoie
- BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Dustin Dunsmuir
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Peter P. Moschovis
- Division of Global Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Stefanie Novakowski
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | | | | | | | - Martina Knappett
- Institute for Global Health at BC Children’s and Women’s Hospital, Vancouver, Canada
| | - Nicholas West
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | | | - Jerome Kabakyenga
- Maternal Newborn & Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Wiens MO, Bone JN, Kumbakumba E, Businge S, Tagoola A, Sherine SO, Byaruhanga E, Ssemwanga E, Barigye C, Nsungwa J, Olaro C, Ansermino JM, Kissoon N, Singer J, Larson CP, Lavoie PM, Dunsmuir D, Moschovis PP, Novakowski S, Komugisha C, Tayebwa M, Mwesigwa D, Zhang C, Knappett M, West N, Nguyen V, Mugisha NK, Kabakyenga J. Mortality after hospital discharge among children younger than 5 years admitted with suspected sepsis in Uganda: a prospective, multisite, observational cohort study. Lancet Child Adolesc Health 2023; 7:555-566. [PMID: 37182535 PMCID: PMC10543357 DOI: 10.1016/s2352-4642(23)00052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Substantial mortality occurs after hospital discharge in children younger than 5 years with suspected sepsis, especially in low-income countries. A better understanding of its epidemiology is needed for effective interventions to reduce child mortality in these countries. We evaluated risk factors for death after discharge in children admitted to hospital for suspected sepsis in Uganda, and assessed how these differed by age, time of death, and location of death. METHODS In this prospective, multisite, observational cohort study, we recruited and consecutively enrolled children aged 0-60 months admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. Suspected sepsis was defined as the need for admission due to a suspected or proven infectious illness. At admission, trained study nurses systematically collected data on clinical variables, sociodemographic variables, and baseline characteristics with encrypted study tablets. Participants were followed up for 6 months after discharge by field officers who contacted caregivers at 2 months and 4 months after discharge by telephone and at 6 months after discharge in person to measure vital status, health-care seeking after discharge, and readmission details. We assessed 6-month mortality after hospital discharge among those discharged alive, with verbal autopsies conducted for children who had died after hospital discharge. FINDINGS Between July 13, 2017, and March 30, 2020, 16 991 children were screened for eligibility. 6545 children (2927 [44·72%] female children and 3618 [55·28%] male children) were enrolled and 6191 were discharged from hospital alive. 6073 children (2687 [44·2%] female children and 3386 [55·8%] male children) completed follow-up. 366 children died in the 6-month period after discharge (weighted mortality rate 5·5%). Median time from discharge to death was 28 days (IQR 9-74). For the 360 children for whom location of death was documented, deaths occurred at home (162 [45·0%]), in transit to care (66 [18·3%]), or in hospital (132 [36·7%]) during a subsequent readmission. Death after hospital discharge was strongly associated with weight-for-age Z scores less than -3 (adjusted risk ratio [aRR] 4·7, 95% CI 3·7-5·8 vs a Z score of >-2), discharge or referral to a higher level of care (7·3, 5·6-9·5), and unplanned discharge (3·2, 2·5-4·0). Hazard ratios (HRs) for severe anaemia (<7g/dL) increased with time since discharge, from 1·7 (95% CI 0·9-3·0) for death occurring in the first time tertile to 5·2 (3·1-8·5) in the third time tertile. HRs for some discharge vulnerabilities decreased significantly with increasing time since discharge, including unplanned discharge (from 4.5 [2·9-6·9] in the first tertile to 2·0 [1·3-3·2] in the third tertile) and poor feeding status (from 7·7 [5·4-11·0] to 1·84 [1·0-3·3]). Age interacted with several variables, including reduced weight-for-age Z score, severe anaemia, and reduced admission temperature. INTERPRETATION Paediatric mortality following hospital discharge after suspected sepsis is common, with diminishing, although persistent, risk during the first 6 months after discharge. Efforts to improve outcomes after hospital discharge are crucial to achieving Sustainable Development Goal 3.2 (ending preventable childhood deaths under age 5 years). FUNDING Grand Challenges Canada, Thrasher Research Fund, BC Children's Hospital Foundation, and Mining4Life.
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Affiliation(s)
- Matthew O Wiens
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Walimu, Kampala, Uganda.
| | - Jeffrey N Bone
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Elias Kumbakumba
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Abner Tagoola
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja City, Uganda
| | | | | | | | | | - Jesca Nsungwa
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - Charles Olaro
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - J Mark Ansermino
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Kissoon
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dustin Dunsmuir
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Peter P Moschovis
- Division of Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Stefanie Novakowski
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Cherri Zhang
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Martina Knappett
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas West
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Vuong Nguyen
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | | | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Kamacooko O, Kitonsa J, Bahemuka UM, Kibengo FM, Wajja A, Basajja V, Lumala A, Kakande A, Kafeero P, Ssemwanga E, Asaba R, Mugisha J, Pierce BF, Shattock RJ, Kaleebu P, Ruzagira E. Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey. Int J Environ Res Public Health 2021; 18:7004. [PMID: 34208959 PMCID: PMC8297128 DOI: 10.3390/ijerph18137004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/12/2023]
Abstract
Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs' knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom's cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02-1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04-1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79-0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41-2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.
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Affiliation(s)
- Onesmus Kamacooko
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Jonathan Kitonsa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Ubaldo M. Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Freddie M. Kibengo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Anne Wajja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Vincent Basajja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | | | - Ayoub Kakande
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Paddy Kafeero
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | | | - Robert Asaba
- Our Lady of Consolata Kisubi Hospital, Entebbe P.O. Box 40, Uganda;
| | - Joseph Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Benjamin F. Pierce
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; (B.F.P.); (R.J.S.)
| | - Robin J. Shattock
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; (B.F.P.); (R.J.S.)
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
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Kitonsa J, Kamacooko O, Bahemuka UM, Kibengo F, Kakande A, Wajja A, Basajja V, Lumala A, Ssemwanga E, Asaba R, Mugisha J, Pierce BF, Shattock R, Kaleebu P, Ruzagira E. Willingness to participate in COVID-19 vaccine trials; a survey among a population of healthcare workers in Uganda. PLoS One 2021; 16:e0251992. [PMID: 34043693 PMCID: PMC8158909 DOI: 10.1371/journal.pone.0251992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at high risk of acquiring SARS-CoV-2 and COVID-19 and may therefore be a suitable population for COVID-19 vaccine trials. We conducted a survey to evaluate willingness-to-participate in COVID-19 vaccine trials in a population of HCWs at three hospitals in Uganda. METHODS The survey was conducted between September and November 2020. Using a standardised questionnaire, data were collected on socio-demographics, previous participation in health research, COVID-19 information sources, underlying health conditions, and willingness-to-participate in COVID-19 vaccine trials. Data were analysed descriptively and a binomial generalised linear model with a log link function used to investigate factors associated with unwillingness to participate. RESULTS 657 HCWs (female, 63%) were enrolled with a mean age of 33 years (Standard Deviation, 10). Overall willingness-to-participate was 70.2%. Key motivating factors for participation were: hope of being protected against COVID-19 (81.1%), altruism (73.3%), and the opportunity to get health care (26.0%). Selected hypothetical trial attributes reduced willingness-to-participate as follows: weekly-quarterly study visits over a 12-month period (70.2%-63.2%, P = 0.026); provision of approximately 50ml of blood at each study visit (70.2%-63.2%, P = 0.026); risk of mild-moderate local adverse reactions (70.2%-60.3%, P<0.001); chance of receiving candidate vaccine or placebo (70.2%-56.9%, P<0.001); and delay of pregnancy [Overall, 70.2%-57.1% P<0.001); Female, 62.8%-48.4% (P = 0.002); Male, 82.5%-71.5% (P = 0.003)]. Collectively, these attributes reduced willingness-to-participate from [70.2%-42.2% (P<0.001) overall; 82.5%-58.1% (P<0.001) in men; 62.8%-32.6% (P<0.001) in women]. Among individuals that were unwilling to participate, the commonest barriers were concerns over vaccine safety (54.6%) and fear of catching SARS-CoV-2 (31.6%). Unwillingness to participate was associated with being female (aRR 1.97, CI 1.46-2.67, P<0.001) and having university or other higher-level education (aRR 1.52, CI 1.05-2.2, P = 0.026). CONCLUSIONS Willingness-to-participate in COVID-19 vaccine trials among HCWs in Uganda is high but may be affected by vaccine trial requirements and concerns about the safety of candidate vaccines.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ubaldo Mushabe Bahemuka
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Freddie Kibengo
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Anne Wajja
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Vincent Basajja
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | | | - Robert Asaba
- Our Lady of Consolata Kisubi Hospital, Wakiso District, Uganda
| | - Joseph Mugisha
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Benjamin F. Pierce
- Department of Infectious Disease, Imperial College London, Norfolk Place, London, United Kingdom
| | - Robin Shattock
- Department of Infectious Disease, Imperial College London, Norfolk Place, London, United Kingdom
| | - Pontiano Kaleebu
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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