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Researchers Recommend Drug to Win the Malaria War in Children

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Malaria is a terrible disease. It affects you beyond discharge. Once treated for malaria, you are susceptible to more infections, and the chances for re-admission are very high.”

Uganda’s fight against malaria has received a boost after medical researchers recommended that a wonder drug that has produced positive results in Uganda, Kenya and Malawi be embraced globally.

Results of the study showed that treatment with Dihydroartemisinin–Piperaquine (DP) should now be the preferred treatment for malaria in both children and adults after discharge. The trials in children indicated reduced number of deaths from severe malaria by 80 per cent. 

The study-the Malaria Chemoprevention in the Postdischarge management of severe Anemia was carried out over a two-year period at Jinja, Kamuli, Hoima, Masaka and Mubende Regional Referral hospitals and studied 1,049 children with severe malaria, which kills nearly a million people each year, mainly young children and pregnant women.

Dr. Robert Opoka, a Senior Lecturer at the Department of Paediatrics and Children Health, College of Health Sciences, Makerere University

“We focused on those hospitals because those are the areas that are most hit with Malaria.We found out that Children who have been hospitalized with severe anemia in areas of Africa in which Malaria is endemic have a high risk of readmission and death within 6 months after discharge,” said Dr. Robert Opoka, a Senior Lecturer at the Department of Paediatrics and Children Health, Makerere University College of Health Science.

Dr. Opoka noted that they allocated children with severe malaria with antimalarial during the first 3months post-discharge at 2,6 and 10 weeks and they were followed for three months and found out that 80 percent of the children on the antimalarial survived.

“It was observed that there was 70% significant reduction in either deaths or re-admissions among the children receiving the antimalarials compared to the group of children who were not on admission,” Dr. Opoka noted.

Dr. Richard Idro, Senior Lecturer, College of Health Sciences, Makerere University
Dr. Richard Idro, Senior Lecturer, College of Health Sciences, Makerere University

The study, whose findings have been published in the latest edition of the New England Journal of Medicine (NEJM), was funded by the Norwegian Research Council. It involved an international consortium of researchers. Some of the members of the research team from Makerere University College of Health Sciences included: Dr. Richard Idro, Dr. Aggrey Dhabangi and Dr. Robert Opoka

Malaria is caused by parasites that are injected into the bloodstream by infected mosquitoes. Severe malaria is often the main reason why children are admitted to hospital in sub-Saharan Africa, and one in 10 of these children die.

The Ministry of Health 25th Health Sector Joint Review report 2018/2019 showed that malaria was still the leading cause of admissions for all ages accounting for 32.9 per cent of all admissions.

Dr. Aggrey Dhabangi, Lecturer, College of Health Sciences, Makerere University

“The drug has a huge impact on reducing mortality and morbidity in children under five-years recovering from severe malaria. The children who were not on antimalarials developed respiratory distress, complicated seizures, movement disorders, vision impairment, speech and language impairments, cognitive deficits, epilepsy and destructive behavior,” said Dr. Aggrey Dhabangi, a Lecturer at the Makerere University College of Health Sciences.

Dr. Dhabangi noted that DP is available in both private and public pharmacies. And a dose goes for UGX 3,000 for children and UGX 3,500 for adults and it is supposed to be taken for 3days in a month. “(DP) is a reliably oral effective drug, and it is given to children according to weight and it should be given 14days after discharge and later after a month,” Dhabangi noted.

During the meeting held on 3rd December 2020, Dr. Richard Idro, a Senior Lecturer at the Makerere University College of Health Sciences, revealed that further studies in Malawi have demonstrated that delivery of the drugs using community-based approaches is associated with much higher adherence 24% than hospital-based approaches.

Dr. Charles Olaro, Director of Curative Services, Ministry of Health

“These children are readmitted or die because by the time they are discharged from the hospital they have not fully recovered so when they go back home especially to places with high infections, they get attacked again, but with the antimalarial they get protected until they recover and gain their immunity,” Dr. Idro noted. The researchers recommended that after discharge, the children should be given Multi-Vitamin supplementation and use mosquito nets. 

Responding to the findings, Dr. Charles Olaro, the Director of Curative Services at the Ministry of Health, said that he was happy with the research findings and promised to translate the research findings into policy so that Children in Uganda are saved.

Dr. Sabrina Kitaka, College of Health Sciences, Makerere University

“Malaria is still one of the diseases burdening clinical services, so we still need more research and innovations in that area. We need to start up a package where health workers do not only stop at discharging patients but also educate them about the post discharge,” Dr. Olaro, noted. He assured the public that the Ministry of Health had stocked enough Dihydroartemisinin-Piperaquine (DP) for public hospitals.

The Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe who was represented by Dr. Sabrina Kitaka from the College of Health Sciences commended the research team comprising Makerere University researchers for creating a paradigm shift that focuses on only treatment of malaria to a preventive approach that will save lives.  The Vice Chancellor expressed Makerere University’s readiness to review the curricula to include prevention of malaria and chemo prevention in the management of malaria. Noting that the researchers focused on three (3) months after discharge, he appealed to research team to consider an option of extending the period of follow up to six (6) months so that more lives are saved.

Dr. Jimmy Opigo, Assistant Commissioner-Health Services, National Malaria Control Division (NMCD), Ministry of Health

Dr. Jimmy Opigo, the Assistant Commissioner-Health Services at the National Malaria Control Division said: “We are happy that this PMC study has enabled people to realise that treatment of malaria and discharge is not enough. There is need for longitudinal management of those discharged. The medical team and health care workers should add patient education and improve health care practices in the management of malaria.”

Article by Mak Public Relations Office

Health

Boy Children Report More Physical & Emotional Abuse

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Men in the intervention group during the Parenting for Responsibility (PfR) project training session.

By George Kisetedde

On 3rd August, 2022, the CHDC (Child Health and Development Centre) disseminated study findings from one of the research studies carried out at the centre. These findings were presented under the title,“The Prevention of Violence against Children and Women: Baseline and Implementation Science Results from Parenting Cluster Randomised Trial.” Moderated by Dr. Anthony Batte, a lecturer at CHDC. Study findings were presented by Joseph Kahwa, the trial manager of the Parenting for Responsibility (PfR) project, under which this study falls.

Kahwa described PfR as a community based parenting programme delivered to both male and female parents. This programme aims to improve parenting skills, prevent violence against children, and to improve spousal relationships.

Findings from the study

Findings from this study showed that parents maltreat boy children more than girl children. The boys reported more emotional and physical violence than girls. Furthermore, the boy children reported that male caregivers specifically, maltreat them more. On the other hand, the girl children reported more sexual violence from caregivers than boys. On the whole, the children reported that female caregivers emotionally and physically abused them more compared to male caregivers.

More findings, according to Kahwa, showed that 46.5% of parents in Amuru can provide their children with soap to wash, 44.5% can provide school fees, 44.4% can provide school materials, 44.2% can provide new clothes, 43.3% can buy school uniform, and 35.9% can provide a pair of shoes.

How the research is conducted

The study is divided into 16 group sessions. The first 9 sessions are single sex, that is, male caregivers and female caregivers train separately. The next 7 sessions are mixed with male and female participants combined during training.

A mixed group parenting session for both men and women.
A mixed group parenting session for both men and women.

Kahwa explained that this programme was initiated to deal with VAC (violence against children) and IPV (intimate partner violence). These two vices are closely linked and have a significant impact on how children turn out.

Kahwa added that the PfR research programme aims at addressing the four major factors that may lead to VAC/IPV. These include; poor parental bonding, harsh parenting, unequal gender socialisation and spousal relationships.Poor parental bonding refers to the absence of a healthy close connection between a parent and their child. When a parent and child are not close, the parent may lack empathy for the child and the ability to perceive and respond to their child’s needs. When this bond is weak, a parent is unable to appreciate a child’s needs and can end up being unrealistically tough, which results in harsh parenting. Unequal gender socialisation generally refers to the different expectations that parents have of their children depending on their gender-male or female. The quality of the spousal relationship between parents also affects a child’s life. These four areas are what the parenting sessions concentrate on during the training.

The PfR study employed a cluster randomised controlled trial (RCT) design. Male and female caregivers were recruited from cluster villages in the Wakiso and Amuru districts in Uganda. One child aged 10 to 14 per household was randomly selected and assessed.

The caregivers were divided into two groups; the intervention group and the control group. The intervention group underwent all the 16 sessions of the training while the control group underwent a 2 session lecture on parenting. The impact of the PfR intervention was then ascertained by comparing baseline and endline results (or the before-and-after experiences of parents). The study participants were from 54 Villages selected in both Amuru and Wakiso districts. 108 caregiver groups (54 groups per intervention)were selected. This resulted in 2328 parents recruited and 886 children.

In conclusion, Mr. Kahwa said that maltreatment is still prevalent in the population. Generally, the PfR programme was well-received by parents and it had ad good attendance from parents. The programme also registered good male engagement. The peer facilitators who were recruited also had great potential in expanding the PfR programme at community level.

This study was conducted by Dr Siu Godfrey as the Principal Investigator. Other members of the team included Carolyn Namutebi, Richard Sekiwunga, Joseph Kahwa, Dr Betty Okot, and Martha Atuhaire. They were supported by the Director from CHDC, Dr. Herbert Muyinda and the CHDC Finance & Administration team. The team from Glasgow & Oxford Universities in the UK included, Prof Daniel Wight, Dr Jamie Lachman , Francisco Calderon and Dr Qing Han. On the other side, the team from the SOS Children’s Village from Gulu and Wakiso included, Rachel Kayaga, Sindy Auma Florence and Godfrey Otto.

Contact: George Kisetedde – kisetedde@gmail.com | Edited by Agnes Namaganda – agnesvioletnamaganda@gmail.com

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Makerere Medical Journal: Golden Jubilee Edition 2022

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Cover Page of the Makerere Medical Journal Golden Jubilee Edition 2022.

It’s with great pleasure that I welcome you to the Golden Jubilee edition of this phenomenal journal. Yes, The Makerere Medical Journal marks 50 years of publication with this year’s edition and all this has been made possible by the endless efforts and contributions of the Makerere University College of Health Sciences Staff and students because without your research submissions and financial support, the journal wouldn’t have made it this far. To you reading this, thank you for contributing to the sustainability of this great project, year in year out.

Here’s a quote to ponder on as you delve into this year’s well-crafted articles and it’s by Zora Hurston (1891-1960), “Research is formalized curiosity. It is poking and prying with a purpose.” And doesn’t that just define our purpose as researchers?!

This edition’s articles cover pertinent topics ranging from Antimicrobial Stewardship, COVID-19 interventions, Oral Health amongst others. It also features student projects, write-ups on student-led organizations and societies that are making a difference in the life of a health sciences’ student and many more interesting writings. Featured in this issue are international manuscripts from countries like Nigeria and we were also honored to work with other universities within the country and feature some of their students’ articles.

I would like to extend my most sincere gratitude to my team of editors that engaged in a rigorous peer review process to ensure that the articles published are up to standard. As the editorial team, we are quite pleased to see the number of undergraduates involved in research steadily increasing and all the efforts that have been put in by the different stakeholders to see this happen are commendable.

With that said, I hope you enjoy every second of your read!!!

LINDA ATULINDA,
MBChB IV

EDITOR-IN-CHIEF,
Research and Writers’ Club 2021-2022

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Health

Call for Applications: HEPI Masters Support Fellowship

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Panelists L-R: Professor Elsie Kiguli-Malwadde, Professor Francis Omaswa, Professor Jehu Iputo and Professor Joel Okullo at the HEPI-ACHEST Health Professions Education Symposium, 17th June 2022, Makerere University.

Applications are invited for the Health Professional Education Partnership Initiative (HEPI-SHSSU) Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences (MakCHS)
  • Kabale University School of Medicine
  • Clarke International University
  • Faculty of Health Sciences, Busitema University

The programme will support graduates in their final year of training leading to the award of a Masters degree on any of the Master’s graduate training programs at the stated University for a maximum of 19 successful candidates.

The closing date for the receipt of applications is 30th September 2022.

Inquiries and Applications must be submitted to hepishssu@gmail.com

See attachment for more details 

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