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Edison Mworozi

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Iam a Professor and senior consultant pediatrician. Iam an experienced researcher and have published numerous articles in pear reviewed jounals. I have alotof experience intraining health professionals especially docors at both undergarduate and graduate levels.

less

Northern Arizona University

Heather Wyatt-Nichol

University of Baltimore

Aristotle University of Thessaloniki

Bradley Carpenter

University of Louisville

Indera Syahrul Mat Radzuan

Universiti Tun Hussein Onn Malaysia

Landmark University

Vrije Universiteit Amsterdam

AYODOTUN IBIDUNNI

Lau/Cu

Amom Albernaz Pires

Universidade de Brasília - UnB

Subburaj Alagarsamy

Villa College

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Papers by Edison Mworozi

Molecular detection and characterization of emerging pathogens of Rickettsia- felis and felis-like organisms from peri-domestic fleas in Uganda

Background: Flea-borne spotted fever is an emerging zoonosis caused by Rikecttsia felis, a Gram-n... more Background: Flea-borne spotted fever is an emerging zoonosis caused by Rikecttsia felis, a Gram-negative obligate intracellular bacterium. The agent is believed to be cosmopolitan, following the distribution pattern of its host and reservoir, Ctenocephalides felis. However, the epidemiology and public health risk it poses remains poorly understood in sub-Saharan Africa, including Uganda. Yersinia pestis, is primarily transmitted by rodent fleas, Xenopsylla cheopis, but other fleas, particularly C. felis, have vectoral capacity. They are neglected in Ugandan entomological surveillance and public health practices, particularly outside endemic foci of bubonic plague. Methods: We collected 14,641 fleas from domestic animals, rodents and homestead environment; compared their diversity and abundance. Pooled into 714 flea pools by species, collection time, host, and host species, 172 pools were selected based on seasons and analyzed for Yersinia pestis Pla genes, while 62 pools were tested...

Whole Genome Sequencing Reveals High Genetic Diversity, Diverse Repertoire of Virulence-Associated Genes and Limited Antibiotic Resistance Genes among Commensal Escherichia coli from Food Animals in Uganda

Microorganisms

Commensal Escherichia coli with broad repertoire of virulence and antimicrobial resistance (AMR) ... more Commensal Escherichia coli with broad repertoire of virulence and antimicrobial resistance (AMR) genes pose serious public health risks as reservoirs of AMR and virulence. This study undertook whole genome characterization of commensal E. coli from food-producing animals in Uganda to investigate their genome variability (resistome and virulome). We established that the E. coli had high genomic diversity with 38 sequence types, 24 FimH types, and 33 O-antigen serotypes randomly distributed within three phylogroups (A, B1, and E). A greater proportion (≥93.65%) of the E. coli were resistant to amoxicillin/clavulanate and ampicillin antibiotics. The isolates were AmpC beta-lactamase producers dominated by blaEC-15 (71.88%) and tet(A) (20.31%) antimicrobial resistant genes besides a diverse armory of virulence-associated genes in the class of exotoxin, adhesins, iron uptake, and serine protease autotransporters which varied by host species. Cattle were found to be the major source of E....

Molecular characterisation of human adenoviruses associated with respiratory infections in Uganda

BMC Infectious Diseases

Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of t... more Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of the respiratory, urogenital and gastrointestinal tracts and keratoconjunctivitis. There are seven species of human adenoviruses with 113 genotypes which may contain multiple genetic variants. This study characterised respiratory human adenoviruses and associated factors in samples collected from selected hospitals in Uganda. A total of 2,298 nasopharyngeal samples were collected between the period of 2008 to 2016 from patients seeking health care at tertiary hospitals for influenza-like illness. They were screened by polymerase chain reaction (PCR) to determine the prevalence of HAdV. HAdV was cultured in A549 cell lines and the hexon gene was sequenced for genotyping. Of the 2,298 samples tested, 225 (9.8%) were adenovirus-positive by PCR. Age was found to be significantly associated with HAdV infections (p = 0.028) with 98% (220/225) of the positives in children aged 5 years and below a...

Wide distribution of Mediterranean and African Spotted fever agents and the first identification of Israeli Spotted Fever agent in ticks in Uganda

Rickettsia microorganisms are causative agents of several neglected emerging infectious diseases ... more Rickettsia microorganisms are causative agents of several neglected emerging infectious diseases transmitted to humans by ticks among other arthropod vectors. In this study, ticks were collected from four geographical regions of Uganda, pooled in sizes of 1-179 ticks based on location, tick species, life stage, host, and time of collection, and were tested by real time PCR for Rickettsia species harboured. The tick pools were tested with primers targeting gltA, 17kDa and ompA genes, followed by Sanger sequencing of 17kDa and ompA genes. Of the 471 tick pools tested, 116 (24.6%) were positive for Rickettsia spp. by the gltA primers. The prevalence of Rickettsia varied by district with Gulu recording the highest (30.1%) followed by Luwero (28.1%) and Kasese had the lowest (14%). Tick pools with highest positivity rates were from livestock (cattle, goats, sheep, and pigs), 26.9%, followed by vegetation 23.1% and pets (dogs and cats) 19.7%. Of 116 gltA-positive tick pools, 86 pools were...

Molecular Characterisation of Human Respiratory Adeno Viruses in Uganda

Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of t... more Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of the respiratory, urogenital and gastrointestinal tracts, and keratoconjunctivitis. There are seven species of human adenoviruses with over 51 serotypes and 69 genotypes which may contain multiple genetic variants. This study characterised the genotypes of human respiratory adenoviruses and associated factors in samples collected from selected hospitals in Uganda. A total of 2,298 nasopharyngeal samples were collected from patients seeking health care at tertiary hospitals for influenza-like illness. They were screened by Polymerase Chain Reaction (PCR) to determine the prevalence of HAdV. HAdV was isolated in A549 cell lines and the Hexon gene from the HAdV isolates was sequenced by sanger sequencing method using the BigDye Terminator v3.1. Of the 2,298 samples tested, 225 (9.8%) were adenovirus positive by PCR. Age and HAdV infection were found to be significantly associated (p = 0.028) ...

Genetic Evolution of Avian Influenza A (H9N2) Viruses Isolated from Domestic Poultry in Uganda Reveals Evidence of Mammalian Host Adaptation, Increased Virulence and Reduced Sensitivity to Baloxavir

Viruses

A (H9N2) avian influenza A viruses were first detected in Uganda in 2017 and have since establish... more A (H9N2) avian influenza A viruses were first detected in Uganda in 2017 and have since established themselves in live bird markets. The aim of this study was to establish the subsequent genetic evolution of H9N2 viruses in Uganda. Cloacal samples collected from live bird market stalls in Kampala from 2017 to 2019 were screened by RT-PCR for influenza A virus and H9N2 viruses were isolated in embryonated eggs. One hundred and fifty H9N2 isolates were subjected to whole genome sequencing on the Illumina MiSeq platform. The sequence data analysis and comparison with contemporary isolates revealed that the virus was first introduced into Uganda in 2014 from ancestors in the Middle East. There has since been an increase in nucleotide substitutions and reassortments among the viruses within and between live bird markets, leading to variations in phylogeny of the different segments, although overall diversity remained low. The isolates had several mutations such as HA-Q226L and NS-I106M t...

Seroprevalence of human coronaviruses among patients visiting hospital-based sentinel sites in Uganda

BMC Infectious Diseases, 2021

BackgroundHuman coronaviruses are causative agents of respiratory infections with severalsubtypes... more BackgroundHuman coronaviruses are causative agents of respiratory infections with severalsubtypes being prevalent worldwide. They cause respiratory illnesses of varying severity and have been described to be continuously emerging but their prevalence is not well documented in Uganda. This study assessed the seroprevalence of antibodies against the previously known human coronaviruses prior 2019 in Uganda.MethodsA total 377 serum samples collected from volunteers that showed influenza like illness in five hospital-based sentinel sites and archived were analyzed using a commercial Qualitative Human Coronavirus Antibody IgG ELISA kit. Although there is no single kit available that can detect the presence of all the circulating coronaviruses, this kit uses a nucleoprotein, aa 340–390 to coat the wells and since there is significant homology among the various human coronavirus strains with regards to the coded for proteins, there is significant cross reactivity beyond HCoV HKU-39849 2003...

Viral causes of Influenza Like Illness in Uganda, 2008 to 2017

Online Journal of Public Health Informatics, 2018

Introduction: Respiratory pathogens continue to present an ever increasing threat to public healt... more Introduction: Respiratory pathogens continue to present an ever increasing threat to public health (1,2). Influenza, Respiratory syncytial virus, human metapneumovirus and other respiratory viruses are major etiological agents for influenza like illnesses (ILI) (3-5). Establishment of viral causes of ILI is critical for prevention and mitigation strategies to disease threats. Makerere University Walter Reed Project (MUWRP) together with the Ugandan Ministry of Health and partners undertook surveillance to determine viral causes of influenza-like illness in Uganda.Methods: From 2008, MUWRP established hospital-based sentinel sites for surveillance activities. A total of five hospital-based sites were established, where patients aged 6 months or older presenting with ILI were enrolled. Consents were obtained as required, and a throat and/ or nasopharyngeal swab collected. Samples were screened by PCR for viral causes.Results: From October 2008 to March 2017 a total of 9,472 participan...

Sudden onset methaemoglobinaemia in a previously well Ugandan child: a case report and literature review

The Pan African medical journal, 2012

Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limit... more Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limited settings are very rare but clinical signs can be a good guide. We set out to describe a case of Methaemoglobinaemia, raise awareness among practitioners in resource limited settings and to share experiences in its diagnosis and management. A previously well three and a half year old girl was admitted with central cyanosis of sudden onset. She underwent clinical, laboratory and radiological evaluation. Having been in a resource limited setting, the process of making a diagnosis was slow and difficult. After the diagnosis, the treatment was not available in the country but we managed to get it all the way from Nairobi, Kenya. A diagnosis of Methaemoglobinaemia was made using Spectrophotometry and she was successfully treated using 2 doses of intravenous Methylene blue. The cause of Methaemoglobinaemia was established to have been nitrites from food preservatives.

Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010

International Journal for Quality in Health Care, 2017

Objective: To assess the factors associated with malnutrition among children <5 years in Burkina ... more Objective: To assess the factors associated with malnutrition among children <5 years in Burkina Faso. Design: This study was based on secondary analysis of cross-sectional population-based data from Burkina-Faso Demographic Health Surveys 2010. Setting: This study was carried out in Burkina Faso, West Africa. Participants: The participants were 6337 children <5 years and their mothers. Main outcome measures: Demographic characteristics, child nutrition and health status, and maternal and household information were collected. Survey-specific SAS procedures for weighting, clustering and stratification in the survey design were used. The distribution of different nutritional status, such as underweight, stunting and wasting and the effects of risk factors on malnutrition was analyzed. Results: Out of 6337 children <5 years, 51.0% of children were male and 57.8% of children had an average size at birth. There were 15.6, 21.5 and 10.6% of children who recently suffered from diarrhea, fever and acute respiratory infection, respectively. Child sex, age, size at birth, child morbidity, mother's education and body mass index and household wealth index were significantly associated with undernutrition among children <5 years in Burkina Faso. Conclusions: In addition to the improvement of household wealth index, more health and nutritional education for mothers should be implemented by the government to improve health and nutritional status of children <5 years in Burkina Faso.

High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study

Upsala journal of medical sciences, Jan 25, 2015

In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-of... more In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics. In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test. Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates...

Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda

BMC Pediatrics, 2010

Background: Rotavirus remains the commonest cause of severe dehydrating diarrhea among children w... more Background: Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, Uganda Methods: Three hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit. Results: The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary) level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school. Conclusions: Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.

Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda

BMC Pediatrics, 2010

Background: Lactose intolerance is a common complication of diarrhoea in infants with malnutritio... more Background: Lactose intolerance is a common complication of diarrhoea in infants with malnutrition and a cause of treatment failure. A combination of nutritional injury and infectious insults in severe protein energy malnutrition reduces the capacity of the intestinal mucosa to produce lactase enzyme necessary for the digestion of lactose. The standard management of severe malnutrition involves nutritional rehabilitation with lactose-based high energy formula milk. However, some of these children may be lactose intolerant, possibly contributing to the high rate of unfavorable treatment outcomes. This study was therefore designed to establish the prevalence of lactose intolerance and associated factors in this population. Methods: A descriptive cross sectional study involving 196 severely malnourished children with diarrhoea aged 3-60 months was done in Mwanamugimu Nutrition Unit (MNU), Mulago hospital between October 2006 and February 2007. Results: During the study period, 196 severely malnourished children with diarrhoea were recruited, 50 (25.5%) of whom had evidence of lactose intolerance (stool reducing substance ≥ 1 + [0.5%] and stool pH < 5.5) and it occurred more commonly in children with kwashiorkor 27/75 (36.0%) than marasmic-kwashiorkor 6/25 (24.0%) and marasmus 17/96 (17.7%). Oedematous malnutrition (p = 0.032), perianal skin erosion (p = 0.044), high mean stool frequency (p = < 0.001) and having ≥2 diarrhoea episodes in the previous 3 months (p = 0.007) were the independent predictors of lactose intolerance. Other factors that were significantly associated with lactose intolerance on bi-variate analysis included: young age of 3-12 months; lack of up to-date immunization; persistent diarrhoea; vomiting; dehydration, and abdominal distension. Exclusive breastfeeding for less than 4 months and worsening of diarrhoea on initiation of therapeutic milk were the other factors. Conclusions: The prevalence of lactose intolerance in this study setting of 25.5% is relatively high. Routine screening by stool pH and reducing substances should be performed especially in the severely malnourished children with diarrhoea presenting with oedematous malnutrition, perianal skin erosion, higher mean stool frequency and having had ≥2 diarrhoea episodes in the previous 3 months. Use of lactose-free diets such as yoghurt should be considered for children found to have evidence of lactose intolerance and whose response on standard therapeutic milk formula is poor.

Bacteraemia in homozygous sickle cell disease in Africa: is pneumococcal prophylaxis justified?

Archives of Disease in Childhood, 2007

Background: The high frequency of Streptococcus pneumoniae as a cause of bacteraemia in homozygou... more Background: The high frequency of Streptococcus pneumoniae as a cause of bacteraemia in homozygous sickle cell (SS) disease and its effective prevention has led to the routine use of pneumococcal prophylaxis in developed countries. The reported infrequency of this organism as a cause of bacteraemia in SS disease in Africa raises questions on the epidemiology of bacterial infection and on the need for pneumococcal prophylaxis in that continent. Methods: A study of blood cultures in 155 Ugandan children (165 episodes) with SS disease and axillary temperatures of >38˚C, attending the University Teaching Hospital in Kampala (Uganda, East Africa). Results: Positive blood cultures, obtained in 47/165 episodes, showed Staphylococcus aureus in 28 (60%) samples, Haemophilus influenzae in 9 (19%), Staphylococcus epidermidis in 4 (9%), and single cases of Streptococcus viridans, Escherichia coli and an unidentified Gram negative rod. Streptococcus pneumoniae was identified in only 3 (6%) episode. Conclusion: The infrequent isolation of Streptococcus pneumoniae from febrile children with SS disease in this study and in four other studies from Nigeria raises questions on a different spectrum of bacterial causes for bacteraemia in malarial areas. There are several possible explanations for this finding, but the data cast sufficient doubt on the case for pneumococcal prophylaxis for a controlled trial on its effectiveness in that environment to seem justified. These data are necessary to determine its role in African children and to provide the evidence base for healthcare authorities in equatorial Africa.

The clinical pattern, prevalence, and factors associated with immune reconstitution inflammatory syndrome in Ugandan children

AIDS, 2010

With antiretroviral therapy (ART), there has been a significant decline in AIDS-associated morbid... more With antiretroviral therapy (ART), there has been a significant decline in AIDS-associated morbidity and mortality [1-3]. However, between 5-45% of adults who start ART experience clinical deterioration as the immune system recovers [1,2,4]. This paradox is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS). Two distinct clinical scenarios of IRIS occur. 'Paradoxical IRIS' is the clinical recrudescence of a previous successfully treated opportunistic infection (OI). The symptoms of paradoxical IRIS can be quite similar to the initial infection potentially leading to clinical misclassification as an OI relapse and immunologic ART failure. The second scenario, 'unmasking IRIS,' is the immunologic unmasking of subclinical infections after ART initiation and is characterized by the rapid development of new OI's with accelerated,

Humidity and monthly number of flu cases

<p>Humidity and monthly number of flu cases.</p

Rainfall and monthly number of flu cases

<p>Rainfall and monthly number of flu cases.</p

MUWRP Influenza Surveillance Work Flow

<p>MUWRP Influenza Surveillance Work Flow.</p

Temporal distribution of influenza type and subtype by month

<p>Temporal distribution of influenza type and subtype by month.</p

Average temperatures and monthly number of flu cases

<p>Average temperatures and monthly number of flu cases.</p

Molecular detection and characterization of emerging pathogens of Rickettsia- felis and felis-like organisms from peri-domestic fleas in Uganda

Background: Flea-borne spotted fever is an emerging zoonosis caused by Rikecttsia felis, a Gram-n... more Background: Flea-borne spotted fever is an emerging zoonosis caused by Rikecttsia felis, a Gram-negative obligate intracellular bacterium. The agent is believed to be cosmopolitan, following the distribution pattern of its host and reservoir, Ctenocephalides felis. However, the epidemiology and public health risk it poses remains poorly understood in sub-Saharan Africa, including Uganda. Yersinia pestis, is primarily transmitted by rodent fleas, Xenopsylla cheopis, but other fleas, particularly C. felis, have vectoral capacity. They are neglected in Ugandan entomological surveillance and public health practices, particularly outside endemic foci of bubonic plague. Methods: We collected 14,641 fleas from domestic animals, rodents and homestead environment; compared their diversity and abundance. Pooled into 714 flea pools by species, collection time, host, and host species, 172 pools were selected based on seasons and analyzed for Yersinia pestis Pla genes, while 62 pools were tested...

Whole Genome Sequencing Reveals High Genetic Diversity, Diverse Repertoire of Virulence-Associated Genes and Limited Antibiotic Resistance Genes among Commensal Escherichia coli from Food Animals in Uganda

Microorganisms

Commensal Escherichia coli with broad repertoire of virulence and antimicrobial resistance (AMR) ... more Commensal Escherichia coli with broad repertoire of virulence and antimicrobial resistance (AMR) genes pose serious public health risks as reservoirs of AMR and virulence. This study undertook whole genome characterization of commensal E. coli from food-producing animals in Uganda to investigate their genome variability (resistome and virulome). We established that the E. coli had high genomic diversity with 38 sequence types, 24 FimH types, and 33 O-antigen serotypes randomly distributed within three phylogroups (A, B1, and E). A greater proportion (≥93.65%) of the E. coli were resistant to amoxicillin/clavulanate and ampicillin antibiotics. The isolates were AmpC beta-lactamase producers dominated by blaEC-15 (71.88%) and tet(A) (20.31%) antimicrobial resistant genes besides a diverse armory of virulence-associated genes in the class of exotoxin, adhesins, iron uptake, and serine protease autotransporters which varied by host species. Cattle were found to be the major source of E....

Molecular characterisation of human adenoviruses associated with respiratory infections in Uganda

BMC Infectious Diseases

Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of t... more Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of the respiratory, urogenital and gastrointestinal tracts and keratoconjunctivitis. There are seven species of human adenoviruses with 113 genotypes which may contain multiple genetic variants. This study characterised respiratory human adenoviruses and associated factors in samples collected from selected hospitals in Uganda. A total of 2,298 nasopharyngeal samples were collected between the period of 2008 to 2016 from patients seeking health care at tertiary hospitals for influenza-like illness. They were screened by polymerase chain reaction (PCR) to determine the prevalence of HAdV. HAdV was cultured in A549 cell lines and the hexon gene was sequenced for genotyping. Of the 2,298 samples tested, 225 (9.8%) were adenovirus-positive by PCR. Age was found to be significantly associated with HAdV infections (p = 0.028) with 98% (220/225) of the positives in children aged 5 years and below a...

Wide distribution of Mediterranean and African Spotted fever agents and the first identification of Israeli Spotted Fever agent in ticks in Uganda

Rickettsia microorganisms are causative agents of several neglected emerging infectious diseases ... more Rickettsia microorganisms are causative agents of several neglected emerging infectious diseases transmitted to humans by ticks among other arthropod vectors. In this study, ticks were collected from four geographical regions of Uganda, pooled in sizes of 1-179 ticks based on location, tick species, life stage, host, and time of collection, and were tested by real time PCR for Rickettsia species harboured. The tick pools were tested with primers targeting gltA, 17kDa and ompA genes, followed by Sanger sequencing of 17kDa and ompA genes. Of the 471 tick pools tested, 116 (24.6%) were positive for Rickettsia spp. by the gltA primers. The prevalence of Rickettsia varied by district with Gulu recording the highest (30.1%) followed by Luwero (28.1%) and Kasese had the lowest (14%). Tick pools with highest positivity rates were from livestock (cattle, goats, sheep, and pigs), 26.9%, followed by vegetation 23.1% and pets (dogs and cats) 19.7%. Of 116 gltA-positive tick pools, 86 pools were...

Molecular Characterisation of Human Respiratory Adeno Viruses in Uganda

Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of t... more Human adenoviruses (HAdV) are a diverse group of viruses causing a broad range of infections of the respiratory, urogenital and gastrointestinal tracts, and keratoconjunctivitis. There are seven species of human adenoviruses with over 51 serotypes and 69 genotypes which may contain multiple genetic variants. This study characterised the genotypes of human respiratory adenoviruses and associated factors in samples collected from selected hospitals in Uganda. A total of 2,298 nasopharyngeal samples were collected from patients seeking health care at tertiary hospitals for influenza-like illness. They were screened by Polymerase Chain Reaction (PCR) to determine the prevalence of HAdV. HAdV was isolated in A549 cell lines and the Hexon gene from the HAdV isolates was sequenced by sanger sequencing method using the BigDye Terminator v3.1. Of the 2,298 samples tested, 225 (9.8%) were adenovirus positive by PCR. Age and HAdV infection were found to be significantly associated (p = 0.028) ...

Genetic Evolution of Avian Influenza A (H9N2) Viruses Isolated from Domestic Poultry in Uganda Reveals Evidence of Mammalian Host Adaptation, Increased Virulence and Reduced Sensitivity to Baloxavir

Viruses

A (H9N2) avian influenza A viruses were first detected in Uganda in 2017 and have since establish... more A (H9N2) avian influenza A viruses were first detected in Uganda in 2017 and have since established themselves in live bird markets. The aim of this study was to establish the subsequent genetic evolution of H9N2 viruses in Uganda. Cloacal samples collected from live bird market stalls in Kampala from 2017 to 2019 were screened by RT-PCR for influenza A virus and H9N2 viruses were isolated in embryonated eggs. One hundred and fifty H9N2 isolates were subjected to whole genome sequencing on the Illumina MiSeq platform. The sequence data analysis and comparison with contemporary isolates revealed that the virus was first introduced into Uganda in 2014 from ancestors in the Middle East. There has since been an increase in nucleotide substitutions and reassortments among the viruses within and between live bird markets, leading to variations in phylogeny of the different segments, although overall diversity remained low. The isolates had several mutations such as HA-Q226L and NS-I106M t...

Seroprevalence of human coronaviruses among patients visiting hospital-based sentinel sites in Uganda

BMC Infectious Diseases, 2021

BackgroundHuman coronaviruses are causative agents of respiratory infections with severalsubtypes... more BackgroundHuman coronaviruses are causative agents of respiratory infections with severalsubtypes being prevalent worldwide. They cause respiratory illnesses of varying severity and have been described to be continuously emerging but their prevalence is not well documented in Uganda. This study assessed the seroprevalence of antibodies against the previously known human coronaviruses prior 2019 in Uganda.MethodsA total 377 serum samples collected from volunteers that showed influenza like illness in five hospital-based sentinel sites and archived were analyzed using a commercial Qualitative Human Coronavirus Antibody IgG ELISA kit. Although there is no single kit available that can detect the presence of all the circulating coronaviruses, this kit uses a nucleoprotein, aa 340–390 to coat the wells and since there is significant homology among the various human coronavirus strains with regards to the coded for proteins, there is significant cross reactivity beyond HCoV HKU-39849 2003...

Viral causes of Influenza Like Illness in Uganda, 2008 to 2017

Online Journal of Public Health Informatics, 2018

Introduction: Respiratory pathogens continue to present an ever increasing threat to public healt... more Introduction: Respiratory pathogens continue to present an ever increasing threat to public health (1,2). Influenza, Respiratory syncytial virus, human metapneumovirus and other respiratory viruses are major etiological agents for influenza like illnesses (ILI) (3-5). Establishment of viral causes of ILI is critical for prevention and mitigation strategies to disease threats. Makerere University Walter Reed Project (MUWRP) together with the Ugandan Ministry of Health and partners undertook surveillance to determine viral causes of influenza-like illness in Uganda.Methods: From 2008, MUWRP established hospital-based sentinel sites for surveillance activities. A total of five hospital-based sites were established, where patients aged 6 months or older presenting with ILI were enrolled. Consents were obtained as required, and a throat and/ or nasopharyngeal swab collected. Samples were screened by PCR for viral causes.Results: From October 2008 to March 2017 a total of 9,472 participan...

Sudden onset methaemoglobinaemia in a previously well Ugandan child: a case report and literature review

The Pan African medical journal, 2012

Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limit... more Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limited settings are very rare but clinical signs can be a good guide. We set out to describe a case of Methaemoglobinaemia, raise awareness among practitioners in resource limited settings and to share experiences in its diagnosis and management. A previously well three and a half year old girl was admitted with central cyanosis of sudden onset. She underwent clinical, laboratory and radiological evaluation. Having been in a resource limited setting, the process of making a diagnosis was slow and difficult. After the diagnosis, the treatment was not available in the country but we managed to get it all the way from Nairobi, Kenya. A diagnosis of Methaemoglobinaemia was made using Spectrophotometry and she was successfully treated using 2 doses of intravenous Methylene blue. The cause of Methaemoglobinaemia was established to have been nitrites from food preservatives.

Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010

International Journal for Quality in Health Care, 2017

Objective: To assess the factors associated with malnutrition among children <5 years in Burkina ... more Objective: To assess the factors associated with malnutrition among children <5 years in Burkina Faso. Design: This study was based on secondary analysis of cross-sectional population-based data from Burkina-Faso Demographic Health Surveys 2010. Setting: This study was carried out in Burkina Faso, West Africa. Participants: The participants were 6337 children <5 years and their mothers. Main outcome measures: Demographic characteristics, child nutrition and health status, and maternal and household information were collected. Survey-specific SAS procedures for weighting, clustering and stratification in the survey design were used. The distribution of different nutritional status, such as underweight, stunting and wasting and the effects of risk factors on malnutrition was analyzed. Results: Out of 6337 children <5 years, 51.0% of children were male and 57.8% of children had an average size at birth. There were 15.6, 21.5 and 10.6% of children who recently suffered from diarrhea, fever and acute respiratory infection, respectively. Child sex, age, size at birth, child morbidity, mother's education and body mass index and household wealth index were significantly associated with undernutrition among children <5 years in Burkina Faso. Conclusions: In addition to the improvement of household wealth index, more health and nutritional education for mothers should be implemented by the government to improve health and nutritional status of children <5 years in Burkina Faso.

High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study

Upsala journal of medical sciences, Jan 25, 2015

In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-of... more In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia-often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics. In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test. Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates...

Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda

BMC Pediatrics, 2010

Background: Rotavirus remains the commonest cause of severe dehydrating diarrhea among children w... more Background: Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, Uganda Methods: Three hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit. Results: The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary) level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school. Conclusions: Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.

Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda

BMC Pediatrics, 2010

Background: Lactose intolerance is a common complication of diarrhoea in infants with malnutritio... more Background: Lactose intolerance is a common complication of diarrhoea in infants with malnutrition and a cause of treatment failure. A combination of nutritional injury and infectious insults in severe protein energy malnutrition reduces the capacity of the intestinal mucosa to produce lactase enzyme necessary for the digestion of lactose. The standard management of severe malnutrition involves nutritional rehabilitation with lactose-based high energy formula milk. However, some of these children may be lactose intolerant, possibly contributing to the high rate of unfavorable treatment outcomes. This study was therefore designed to establish the prevalence of lactose intolerance and associated factors in this population. Methods: A descriptive cross sectional study involving 196 severely malnourished children with diarrhoea aged 3-60 months was done in Mwanamugimu Nutrition Unit (MNU), Mulago hospital between October 2006 and February 2007. Results: During the study period, 196 severely malnourished children with diarrhoea were recruited, 50 (25.5%) of whom had evidence of lactose intolerance (stool reducing substance ≥ 1 + [0.5%] and stool pH < 5.5) and it occurred more commonly in children with kwashiorkor 27/75 (36.0%) than marasmic-kwashiorkor 6/25 (24.0%) and marasmus 17/96 (17.7%). Oedematous malnutrition (p = 0.032), perianal skin erosion (p = 0.044), high mean stool frequency (p = < 0.001) and having ≥2 diarrhoea episodes in the previous 3 months (p = 0.007) were the independent predictors of lactose intolerance. Other factors that were significantly associated with lactose intolerance on bi-variate analysis included: young age of 3-12 months; lack of up to-date immunization; persistent diarrhoea; vomiting; dehydration, and abdominal distension. Exclusive breastfeeding for less than 4 months and worsening of diarrhoea on initiation of therapeutic milk were the other factors. Conclusions: The prevalence of lactose intolerance in this study setting of 25.5% is relatively high. Routine screening by stool pH and reducing substances should be performed especially in the severely malnourished children with diarrhoea presenting with oedematous malnutrition, perianal skin erosion, higher mean stool frequency and having had ≥2 diarrhoea episodes in the previous 3 months. Use of lactose-free diets such as yoghurt should be considered for children found to have evidence of lactose intolerance and whose response on standard therapeutic milk formula is poor.

Bacteraemia in homozygous sickle cell disease in Africa: is pneumococcal prophylaxis justified?

Archives of Disease in Childhood, 2007

Background: The high frequency of Streptococcus pneumoniae as a cause of bacteraemia in homozygou... more Background: The high frequency of Streptococcus pneumoniae as a cause of bacteraemia in homozygous sickle cell (SS) disease and its effective prevention has led to the routine use of pneumococcal prophylaxis in developed countries. The reported infrequency of this organism as a cause of bacteraemia in SS disease in Africa raises questions on the epidemiology of bacterial infection and on the need for pneumococcal prophylaxis in that continent. Methods: A study of blood cultures in 155 Ugandan children (165 episodes) with SS disease and axillary temperatures of >38˚C, attending the University Teaching Hospital in Kampala (Uganda, East Africa). Results: Positive blood cultures, obtained in 47/165 episodes, showed Staphylococcus aureus in 28 (60%) samples, Haemophilus influenzae in 9 (19%), Staphylococcus epidermidis in 4 (9%), and single cases of Streptococcus viridans, Escherichia coli and an unidentified Gram negative rod. Streptococcus pneumoniae was identified in only 3 (6%) episode. Conclusion: The infrequent isolation of Streptococcus pneumoniae from febrile children with SS disease in this study and in four other studies from Nigeria raises questions on a different spectrum of bacterial causes for bacteraemia in malarial areas. There are several possible explanations for this finding, but the data cast sufficient doubt on the case for pneumococcal prophylaxis for a controlled trial on its effectiveness in that environment to seem justified. These data are necessary to determine its role in African children and to provide the evidence base for healthcare authorities in equatorial Africa.

The clinical pattern, prevalence, and factors associated with immune reconstitution inflammatory syndrome in Ugandan children

AIDS, 2010

With antiretroviral therapy (ART), there has been a significant decline in AIDS-associated morbid... more With antiretroviral therapy (ART), there has been a significant decline in AIDS-associated morbidity and mortality [1-3]. However, between 5-45% of adults who start ART experience clinical deterioration as the immune system recovers [1,2,4]. This paradox is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS). Two distinct clinical scenarios of IRIS occur. 'Paradoxical IRIS' is the clinical recrudescence of a previous successfully treated opportunistic infection (OI). The symptoms of paradoxical IRIS can be quite similar to the initial infection potentially leading to clinical misclassification as an OI relapse and immunologic ART failure. The second scenario, 'unmasking IRIS,' is the immunologic unmasking of subclinical infections after ART initiation and is characterized by the rapid development of new OI's with accelerated,

Humidity and monthly number of flu cases

<p>Humidity and monthly number of flu cases.</p

Rainfall and monthly number of flu cases

<p>Rainfall and monthly number of flu cases.</p

MUWRP Influenza Surveillance Work Flow

<p>MUWRP Influenza Surveillance Work Flow.</p

Temporal distribution of influenza type and subtype by month

<p>Temporal distribution of influenza type and subtype by month.</p

Average temperatures and monthly number of flu cases

<p>Average temperatures and monthly number of flu cases.</p