Factors Associated with Malnutrition among Children in Internally Displaced Person's Camps; Northern Uganda

Introduction Since mid 1990s; Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in displaced settings is protein energy malnutrition. Objective To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district. Methods This was a cross sectional study undertaken among internally displaced people's in Omoro county; Gulu district during 13 - 23rd September 2006. Anthropometric measurements of 672 children aged 3 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z- scores of height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative data were collected through 6 focus group discussions; key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. Results The prevalence of global stunting was found to be 52.4and of global acute malnutrition 6.0. Male children are at risk of being stunted Adjusted OR 1.57 95CI 1.15-2.13; p value=0.004. Children in the age group 3 24 months were at risk of acute malnutrition Adjusted OR 2.78 95CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP; cultivation and purchase. Conclusion and Recommendations There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people's camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the nutritional status of IDPs especially children in the camp settings. The quantity of and access to household food supplies; health education on infant and child feeding and integrated management of childhood illnesses (IMCI) activities in the camps should be strengthened

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

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 > or =38 degrees 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.

Missed opportunities and caretaker constraints to childhood vaccination in a rural area in Uganda.

BACKGROUND: Despite concerted support to vaccination programmes, coverage remains low. While health service reasons for this are known, there is little information on caretaker constraints to vaccination in Africa. OBJECTIVE: To establish the prevalence of missed vaccination opportunities and caretaker constraints to childhood vaccinations. DESIGN: Cross-sectional descriptive study. SUBJECTS: Caretakers of 408 children aged 12-23 months were interviewed. SETTING: Kiyeyi, a rural area in Eastern Uganda. RESULTS: Complete vaccination coverage by card was 26.7% while by history and card it was 44.6%. Of the 215 eligible children who sought treatment in a health facility where vaccination could be offered, 59.6% missed an opportunity to be vaccinated while 24.4% of the children missed an opportunity during routine vaccination sessions. Reasons for non-completion of vaccination included caretaker 'not bothered', being busy, or ill and fear of rude health workers. While most caretakers were aware of vaccination and its benefits, none knew the immunisation schedule. The major caretaker constraints were low level of formal education, fear of vaccine side effects, and perceived contraindications to vaccinations. CONCLUSION: Promotion of formal education for girls and educating mothers and health workers on the timing of vaccinations, their side effects and management might contribute to higher vaccination coverage.

AIDS and civil war: a devil's alliance. Dislocation caused by civil strife in Africa provides fertile ground for the spread of HIV.

PIP: The factors that play a role in the spread of HIV in Africa are: Disruption/destruction of the African social structure by civil wars which tended to discouraged immorality. Civil wars have led to families being separated and displaced. children especially girls will be forced to engage in early sex. During civil wars most men are engaged in the war. Those men who remain behind end up with many women as their sex partners leading to the spread of sexually transmitted diseases (STDs)/AIDS. Young boys who are displaced by the war or whose parents die join the army, as happened in Uganda during the 1981-1986 civil war and recently during 1987-1991. Many of these young soldiers got infected with STDs/HIV. Restriction on mobility, curfews, and road blocks also encourage promiscuity with the resultant acquisition of STDs. In East, Central and Southern Africa HIV prevalence is higher in urban (up to 30%) than in rural areas. During civil wars through increased mobility the AIDS epidemic, which was initially confined to urban areas, is spread to the rural areas as well. Somalia, Sudan, Ethiopia, and Mozambique are examples of refugees as a result of civil wars who are easy targets for promiscuous sexual activities for survival. Human rights abuses include rape and torture by soldiers. The destruction of economy and infrastructure also hampers control efforts. In Uganda it took from 1981 to 1984 to introduce an AIDS Control program because the country was busy with the civil war (1981-1985). The result was the unchecked spread of HIV infection throughout the country with the result of highly trained people leaving. During civil wars, African Governments do not allow access to information including the dissemination of information about AIDS in some countries. Loss of international confidence also occurs as a result of the persistent civil wars in Africa.^ieng

Natural History of Perinatally Acquired HIV-1 Infection in Children followed from 0-7 years

Objectives: To study the natural history of perinatally acquired HIV-1 infection in children. Methods: This study started in 1986. This paper covers August 1989 - Feb. 1993. Children born to HIV+mothers (study) and HIV - mothers (controls) were followed up clinically and serologically at regular intervals. All the children were breastfed and immunised. Results: A total of 159 children (72 study and 87 controls) were studied; 99 were over 24 months old. Almost all the children 68/72 study and 81/87 controls breastfed. over all mortality (study group) was 14/72 (19) versus 5/87 (6) (controls) (p

HIV-1 Infection in Women and Children : The Future of AFrican Children

Objectives: To highlight the future crisis of African children due to HIV/AIDS in women and children. Methods: A review of available data and projections of HIV/AIDS in women and children in Africa. Results and Discussion: It is estimated that 3 out of 10 million infected people worldwide are women of children bearing age; 50of them in Africa. East and Central Africa ; 10-36of prenatal women in some urban areas are HIV positive. HIV positive women have 25-40chnaces of infecting their new borns vertically. Such infected children have a 25chance of dying before age one; and 80by age 5. Thus maternal and paediatric HIV/AIDS poses a socio-economic crisis for Africa. In East and Central Africa; 1:10 AIDS cases are children and estimated that during the 1990s; 2.9 million women and 2.7 million chidlren will die of AIDS. The children of HIV+ mothers who survive may have no-one to care for them. hence there is emerging an orphan crisis in this region. The traditional African extended family can no longer cope. There is also a rise in street children with attendant dangers of juvenile deliquency; drug and sex abuse; STDs including HIV and crime. Conclusions and Recommendations: African children face major crises requiring urgent attention:- 1. Increased morbidity/mortality rates. 2. Increasing numbers of orphans and street children