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Nutritional rickets among children admitted with severe pneumonia at Mulago hospital, Uganda: a cross-sectional study
(Springer Nature, 2019-10-29) Piloya, Thereza; Odongkara, Beatrice; Were, Edward Maloba; Ameda, Faith; Mworozi, Edison; Laigong, Paul
Background: There’s abundant sunshine in the tropics but severe rickets is still observed. Nutritional rickets is
associated with an increased risk of acute lower respiratory infections. Pneumonia is the leading cause of death in
the under 5-year old children with the highest burden in developing countries. Both Pneumonia and rickets are
common in the developing countries and may affect clinical presentation and outcome. This study aimed to
determine the prevalence and associated factors of nutritional rickets in children admitted with severe pneumonia.
Methods: This was a cross-sectional study of children aged 2–59 months presenting with severe pneumonia at an
emergency unit. We enrolled 221 children between February and June 2012 after consent. A pre-coded questionnaire
was used to collect data on socio-demographic, nutritional and past medical history. Physical exam was done for signs
of rickets and anthropometric measurements. Serum calcium, phosphorus, and alkaline phosphatase (ALP) were
assessed. Children with any physical signs of rickets or biochemical rickets (ALP > 400 IU); had a wrist x-ray done.
Nutritional rickets was defined as the presence of radiological changes of cupping or fraying and/ or metaphyseal
thickening. Severe pneumonia was defined using the WHO criteria.
Statistical analysis was performed using the Stata 10 statistical package. P- value < 0.05 was significant.
Results: The prevalence of nutritional rickets among children with severe pneumonia is 9.5%. However, 14.5%
had raised ALP (biochemical rickets). The factors independently associated with rickets was an elevated alkaline
phosphatase; p-value < 0.001, or 32.95 95% CI (10.54–102.93). Other factors like breastfeeding, big family size,
birth order were not significantly associated with rickets. Low serum calcium was detected in 22 (9.9%) of the
221 participants. Overall few children with rickets had typical clinical features of rickets on physical examination.
Conclusion: Rickets is a common problem in our setting despite ample sunshine.
Clinicians should actively assess children for rickets in this setting and screen for rickets in those children at high
risk even without clinical features.
Keywords: Rickets, Pneumonia, Children, Uganda
New Biologically Active Compounds from 1, 3-Diketones
(Research Journal of Chemical Sciences, 2011-06-07) George, Mulongo; Jolocam, Mbabazi; Odongkara, B.; Twinomuhwezi, H; Mpango, G.B.
The ready availability of cyclohexanones and the enhanced reactivity at their α-positions render them
starting materials of choice in the present study. The synthesis of new compounds of antimicrobial
activity was undertaken by the coupling of aromatic amines with 5,5-dimethyl cyclohexan-1,3-dione
(dimedone). The products were refluxed with N–benzyl-N-phenylhydrazine in acetic acid. The structures
of the products were elucidated using micro- and IR-spectral analyses. They were confirmed using 1H
NMR at 60MHz and TMS as internal standard. The diketone derivatives were tested for their biological
activity against gram-positive Cocci and Bacilli, and gram-negative Bacilli. The study showed that the
derivatives gave a wide range of activity from inactive to highly active, which proves it to be of fresh
pharmaceutical interest.
Key words: Dimedone, Antimicrobial activity, Gram-positive Cocci and Bacilli, Gram-negative Bacilli
Neonatal hypothermia in Northern Uganda: a community- based cross- sectional study
(BMJ OPEN, 2021-01-25) Mukunya , A David; Tumwine, James K.; Nankabirwa, Victoria; Odongkara, Beatrice; Tongun, Justin B.; Arach, Agnes A; Tumuhamye, Josephine; Napyo, Agnes; Zalwango, Vivian; Vicentina Achora,; Musaba , Milton W; Ndeezi, Grace; Tylleskär, Thorkild
Objective To determine the prevalence, predictors and
case fatality risk of hypothermia among neonates in Lira
district, Northern Uganda.
Setting Three subcounties of Lira district in Northern
Uganda.
Design This was a community- based cross- sectional
study nested in a cluster randomised controlled trial.
Participants Mother–baby pairs enrolled in a cluster
randomised controlled trial. An axillary temperature was
taken during a home visit using a lithium battery- operated
digital thermometer.
Primary and secondary outcomes The primary outcome
measure was the prevalence of hypothermia. Hypothermia
was defined as mild if the axillary temperature was 36.0°C
to <36.5°C, moderate if the temperature was 32.0°C
to <36.0°C and severe hypothermia if the temperature
was <32.0°C. The secondary outcome measure was the
case fatality risk of neonatal hypothermia. Predictors of
moderate to severe hypothermia were determined using
a generalised estimating equation model for the Poisson
family.
Results We recruited 1330 neonates. The prevalence of
hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI
46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to
35.2 had mild hypothermia, whereas 18.7% (249/1330),
95% CI 15.8 to 22.0 had moderate hypothermia. None
had severe hypothermia. At multivariable analysis,
predictors of neonatal hypothermia included: home
birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4
to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3)
and delayed breastfeeding initiation (aPR 1.2, 95% CI
1.0 to 1.5). The case fatality risk ratio of hypothermic
compared with normothermic neonates was 2.0 (95% CI
0.60 to 6.9).
Conclusion The prevalence of neonatal hypothermia
was very high, demonstrating that communities in
tropical climates should not ignore neonatal hypothermia.
Interventions designed to address neonatal hypothermia
should consider ways of reaching neonates born at home
and those with low birth weight. The promotion of early
breastfeeding initiation and skin- to- skin care could reduce
the risk of neonatal hypothermia.
Management of Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar States
(Journal Gurus, 2024) Mungai, L N Wainaina; Abdalla, Asmahan T Msuya, levina J.; Odongkara, Beatrice; Iroro, Yarhere; Ameyaw, Emmanuel; Bodieu, Adele Chetcha; Majaliwa, Edna Siima; Mandilou, Steve Vassili Missambou; Omondi, Vincent O.; Hanas, Ragnar; Abdullah, Mohamed
The global rise in diabetes mellitus prevalence has implications for Africa, with diabetic ketoacidosis
(DKA) being its most severe acute complication. In Sub-Saharan Africa, DKA rates at first diagnosis among children
and adolescents range from 24%-82% constituting 76% of paediatric endocrine admissions. DKA and hyperglycaemic
hyperosmolar state (HHS) result in significant morbidity and mortality. Yet, healthcare disparities and unique issues
such as severe malnutrition challenge African Management in Africa. Methodology: Diagnosis criteria for DKA
include symptoms like polyuria, polydipsia, and weight loss combined with hyperglycaemia (>11 mmol/L), venous
pH <7.3, and ketonemia (blood ß-hydroxybutyrate ≥3 mmol/L) or significant Ketonuria. Emergency management
prioritizes restoring circulation, obtaining relevant laboratory samples, and initiating fluid and insulin therapy. Special
attention is given to unique considerations, like administering oral rehydration solution (ORS) without IV fluids or
handling severe malnutrition with RESOMAL. Treatment: Fluid therapy involves administering deficit replacement
plus maintainance. Based on clinical conditions, potassium is added, and bicarbonate is reserved for severe cases.
Insulin, vital for treatment, is introduced an hour after fluid therapy. Monitoring for cerebral oedema, especially in
high-risk groups, is critical. Following the acute treatment phase, preventative measures are underscored to mitigate
recurrence. For HHS, a subset of patients with particular diagnostic criteria, including elevated plasma glucose (>33.3
mmol/L) and higher pH levels, management focuses on restoring volume, renal perfusion, and a steady decline in
serum sodium concentration and osmolality. The approach diverges from DKA regarding fluid volume, insulin timing,
and monitoring specifics. Conclusion: Effective diagnosis and Management of DKA and HHS are pivotal in the
African context, considering healthcare limitations and unique challenges. Guidelines that consider these intricacies
ensure comprehensive care for affected individuals.
Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda
(Springer Nature, 2019-08) Mukunya, David; Tumwine, James K.; Ndeezi, Grace; Tongun, Tumuhamye, Josephine; Vincentina; Kizito, Samuel; Napyo, Agnes; Achora. Vincentina; Odongkara, Beatrice; Arach, Agnes Anna; Arach, Agnes Anna
Aim To assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira
district, Northern Uganda.
Subjects and methods In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern
Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The
concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP
package. We also conducted multivariable logistic regression to assess factors associated with home births.
Results A third of mothers (n=308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a
health facility was pro-rich with a concentration index of 0.10 [95% CI(0.05–0.14)]. Upondecomposing the concentration index,
the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable
logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95% CI (1.8–5.3)], precipitate labor [AOR 4.18, 95%
CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more
likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication
during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)].
Conclusion There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births
should prioritize poorer mothers and those in rural areas.
Keywords Inequity .Homebirths .Uganda .Post-conflict .Healthfacilitybirth . Hospitaldelivery