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A New Study Reveals that Children with Cerebral Palsy have 25 Times Higher Risk Of Premature Death

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The largest study on Cerebral palsy in Africa to date reveals that interventions to prevent malaria infections such as the use of insecticide-treated mosquito nets, coupled with caregiver training and support, including best feeding practices and simple measures to prevent other infections, could potentially reduce mortality in children with Cerebral palsy in this region. The study found out that the main causes of death were malaria and aneamia. The children with severe malnutrition and severe motor impairments were the most likely to die.

Cerebral palsy (CP) is a developmental disorder and the most common cause of childhood physical disability globally. CP is significantly more prevalent in low-income and middle-income countries like Uganda where the researchers noted a lower prevalence in the older (8-17 years) than younger (2-7 years) age groups as demonstrated in the findings of an earlier study conducted in 2015. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30374-1/fulltext

The decline in prevalence of children with CP with increasing age in the 2015 study, led the researchers to hypothesize about the risk of premature death in these children.

In order to get a better understanding of the situation, a follow-up study was carried out at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in eastern Uganda. Earlier in 2015, the researchers had screened 31,756 children and identified 97 (aged 2–17 years) who were diagnosed as having CP. The children with CP were followed up to 2019 and compared with an age-matched sample of the IM-HDSS general non-CP population (n=41, 319). The rates and causes of deaths in these groups were determined.

The research team found that the rate of death was 25 times higher in the CP group than the general non-CP population sample. The mean age at death among the CP group was 10•2±5•9 years and 7•2±4•8 years among the general non-CP population sample. In the CP group, females and older children (10-18 years) had higher relative risks of death in relation to the non-CP general population. Significantly, in children with CP, there was an almost 7 times risk of death in those with severe motor impairments compared to those with milder ones. In addition, those with severe malnutrition had a more than 3 times higher risk of death than children without severe malnutrition. The causes of death were from common conditions like anemia, malaria and common infections.

The results of this study, are the first of its kind to reveal the true extent of the hidden humanitarian crisis of excessive mortality in the CP child population. Severe malnutrition as one of the risk factors of excessive mortality plays a dynamic multifaceted role, partly aggravated by severe oral motor impairments which lead to chewing and swallowing problems, and the need for special foods and prolonged feeding times. Furthermore, the age pattern for mortality in children with CP confirms this study’s hypothesis with many dying when approaching school age, compared to the non-CP general population. The probable reasons for this may be attributed to caregivers eventually losing hope as these children grow older when they realize that their child will not be cured, or alternatively as a result of the minimal time provided to the child with increasing age (including during supervised feedings), which increases their vulnerability.

The higher mortality among the females may suggest a preferential treatment of boys with CP in Uganda which needs further study. Finally, regarding the causes of death, the frequent occurrence of anemia as a cause of death may signify the interplay of the conditions of underlying malaria infections and severe malnutrition in severely impaired children with feeding problems.

A multipronged approach including raising awareness about this challenge should be emphasized locally and internationally to promote the development of appropriate health and advocacy policies. Although efforts to reduce child mortality are quite evident in the recent decades, targeted interventions to reduce mortality in the CP child population, such as the use of insecticide-treated mosquito nets to prevent malaria infections, provision of easy to use, locally available nutritious foods coupled with caregiver information and support should be encouraged. Reinforcement and regular review of the existing laws and policies related to their specific requirements should be enacted. In general, further research to identify long-term risk factors and immediate causes of death in children with developmental disabilities in the region is also urgently required

These findings are to be formally published in the journal ‘PLOS ONE’ and entitled: “Excessive premature mortality among children with cerebral palsy in rural Uganda: a longitudinal, population-based study”.

Publication

Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based study.

Namaganda LH, Almeida R, Kajungu D, Wabwire-Mangen F, Peterson S, Andrews C, et al
PLoS One 2020 ;15(12):e0243948

Related story by collaborators at Karolinska institute here:

https://news.ki.se/children-with-cerebral-palsy-in-rural-uganda-have-25-times-higher-risk-of-premature-death

This study was funded by the Swedish Research Council, and Promobilia.

Dr. Angelina Kakooza – Mwesige
Makerere University, College of Health Sciences
Kampala, UGANDA.
On behalf of the Researchers

Health

MU-JHU Positions: Locum Midwives/Nurses – WOMANPOWER Study June 2021

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Female staff at the Makerere University –Johns Hopkins University (MU-JHU) Research Collaboration Family Care Centre. Photo credit: MU-JHU

The Makerere University-Johns Hopkins (MU-JHU) Research Collaboration – MU-JHU CARE LTD, a Kampala – based equal opportunities Clinical Research and Service Delivery Organisation with more than 350 employees is seeking interested, committed and reliable professionals with the described qualifications to apply for the Locum positions listed below in support of the EDCTP funded studies. The positions are Locum positions on short term contract for 6 months.

1. Locum Midwife/Nurse: multiple positions
    Reports To: Nurse Coordinator
    Duty station: MUJHU, Kisenyi HCIV and Kawempe National Referral Hospital

Required qualifications and profile:

A Diploma in Midwifery/Nursing, with current registration for practice from the Uganda Nurses and Midwives councils (UNMC) with interest in working in a busy labour ward with minimum supervision. The candidates are required to have worked for at least three (3) years in a busy health centre/institution. Previous work experience in a clinical research environment and/or with HIV, TB and/or MCH clinical care would be a strong advantage. Computer literacy is required. The successful candidates should be willing and able to work extended duty shifts i.e. 12 hour day, and 12 hour night shifts, including public holidays and weekends.

The holder of this position will work under the direct supervision of the Nurse Coordinator with guidance from the Head of Nursing Section, and will be responsible for the following duties:

  • Working closely with other health professionals/research staff to obtain consents.
  • Provide midwifery/nursing care to study participants as well as do phlebotomy, cord blood sampling and other sample collection as required.
  • Collect data using tablets and laptops.
  • Participate in study data quality assurance and control.
  • Any other duties reasonably assigned by the relevant authorities.
  • Maintain professional GCP/HSP accreditation and complete study specific training as required.

Applications with complete C.Vs, including 3 referees and their full addresses or contact Telephone numbers, copies of academic certificates and testimonials, should be hand delivered to: MU-JHU Human Resource Manager, through the reception on first floor, MUJHU 1 Building – not later than 25th June, 2021 by 5.30pm.

Only short-listed applicants will be contacted. Successful candidates will be expected to start work immediately.

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Psychological Services for Community Members While Home

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Female Students hold a group discussion at the Main Campus, Makerere University.

COVID-19 is a terrible disease that has brought about so many psychological challenges within the population but with many more effects to the students and the entire community. Already as students were departing yesterday they made remarks like “shall we ever finish?” “Let us go and get married” etc. They put on faces of sadness, anxiety, and many other forms of negative emotions. At their homes parents too some are having other challenges and anxieties that we need to help them deal with.

The Counselling and Guidance Centre is going to intensify its online presence as an avenue to reach out to the community. We shall do the following:

  1. With support from the College of Computing and Information Sciences (CoCIS) staff we developed an App UniCare which people can download and reach a counsellor of their choice via e-mail, telephone, chat etc at any time at their convenience.
  2. We intend to have a zoom session every fortnight addressing a topic of interest basing on the prevailing need.
  3. Yesterday we held a meeting with student leaders who promised to work with us to deliver any content we develop to students via students’ WhatsApp groups.
  4. We are going to have continuous engagements with students via the Counselling and Guidance Centre Twitter and Facebook accounts.

We lost a student (Byengyera Natasha) from the School of Law to suicide on Sunday and she will be buried tomorrow.

We want to do our best to provide all support possible using the avenues above to support members of the community and we call upon you to reach out to as many students as possible with this information. Thank you very much.

We build for the future.

Henry Nsubuga
Manager, Counselling and Guidance Centre,
Plot 106, Mary Stuart Road (Opposite Mary Stuart Hall),
Makerere University
Email: hnsubuga[at]cgc.mak.ac.ug
Tel: +256-772-558022

Click here for more information about the Counselling and Guidance Centre

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MakSPH Annual Report 2020

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Dr. Rhoda Wanyenze, Professor & Dean, School of Public Health, Makerere University.

Dear Reader,

I am pleased to introduce our 2020 Annual Report, which illustrates the Makerere University School of Public Health, (MakSPH)’s shared commitment to advancing excellence in public health education, research, and innovation in Uganda and beyond.

In the face of the COVID-19 pandemic, the School of Public Health teams working together with the Ministry of Health and other partners moved fast towards enhancing the knowledge and awareness of our communities and other public health interventions to combat the spread of COVID-19 and mitigate a public health crisis that has thrown the world into disarray. We quickly adapted to the new normal, moving to working in a virtual environment and using blended approaches, to deliver our teaching, learning and research activities.

The pandemic has been a great challenge and slowed down several activities. However, this challenge has also propelled us towards fast-tracking some of our planned advancements including virtual
learning and partnerships, and has accelerated our public health innovations in a bid to contribute solutions to the current and future public health challenges.

Research

Our research has focused on current issues to support evidence-based decision making, and mitigate the impact of the pandemic on essential health and other services, especially in vulnerable groups such as adolescents and children, refugees, among others.

Construction

In 2020, we embarked on construction of our new home that we hope will reduce the space constraints for our staff and students. I am happy to report that the construction is now under way at Makerere University Main Campus. We are sincerely grateful to our partners, sponsors and staff for the efforts towards this great move.

Community Engagement

Our teams have maintained a very active community engagement focus and working with various stakeholders to share research findings and support processes for knowledge translation. We have also maintained a high level of scientific research outputs including over 250 peer reviewed publications in 2020. I cannot thank our researchers enough for this great effort.

Grants

The number of partnerships, grants and volume of work at the School has grown within Uganda and the African region. We are very grateful to our funders; partners and stakeholders for this continued growth.

I acknowledge the extraordinary efforts made by all our staff, students and alumni. We look forward to another productive year and decade of better service to our communities.

Have a nice read.

Dr. Rhoda Wanyenze,
Professor & Dean, School of Public Health, Makerere University

Please Downloads for the full report.

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