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Message from the patron

Message from the MUMSA President Its more than a pleasure and yet humbling to welcome you to the international students scientific conference this year. Its a pleasure. Every year the Makerere University Medical Students Association through ISSCOCH organizes the 7th MUMSA conference, the international students scientific conference, however this year its more than a conference; as students we are giving back to the community. (Proceeds from this conference will be donated to the pediatric department of Mulago hospital, and yet we are going to come up with fundamentally improving strategies towards health of the sub-Saharan Africa child About 29000 children die every day (21 each minute), sadly from preventable causes. Well as South- central Asia has the highest number of neonatal deaths, sub-Saharan Africa has the highest rates where 1 child in 8 dies before age5 (more than 20 times in developed countries). Under-five deaths are increasingly concentrated in sub-Saharan Africa and south Asia, while the share of the rest of the world dropped from 33 percent in 1990 to 20percent in 2010. Seventy percent of the 11 million deaths in the world annually are attributable to six causes i.e. diarrhoea, malaria, neonatal infection, pneumonia, preterm delivery, or lack of oxygen at birth. To this UNICEF has responded by 1) providing high impact health and nutritional interventions, 2) improving family care practices 3) responding to rapid emergencies. Looking closely at the tracks of this conference, clearly in black and white its visible that we are on track as far as child health improvement is concerned I am therefore more than proud to be part of the team welcoming you to this conference bearing in mind that your participation for the next two days shall bring about vital and necessary promotion of child health in the sub-Saharan Africa. Special gratitude to our dear patron Prof. Tumwine, Dr. Kitaka Sabrina and ISSCOCH (organizing committee) for your tireless effort that has seen this day come, not only to pass but with meaningful life changing results. I wish you all a fruitful participation; children are not only todays angels but tomorrows health providers.

Ndawula Andrew MUMSA President

Message from the chairperson, organizing committee

Chairmans remarks Dear colleagues, as the chairman I would like to welcome you to this years international students scientific conference of child health. Let me start by quoting a great man Charles H tweed whose philosophy states, the search for truth and the quest of excellence in diagnosis and treatment is characterized by honesty with ourselves, with our patients. It is sincerity of purpose and action, with the belief that the service rendered is infinitely more important than the reward received This years conference has been aimed on child health and my hope is that this conference will not only become your primarily source of knowledge and cutting edge technology in the field of medicine but will also serve as a platform to showcase our practice and research skills thus becoming the indispensable conduit for those that seek knowledge from those that have it. I wish you all the best and enjoy the conference. May God bless you.

Jjuuko Edrin Chairman Organizing committee

Message from the chairperson, scientific committee Its with great pleasure that I welcome you to the international students scientific conference on child health, the 7th Makerere University Medical Students Association (MUMSA) conference. MUMSA has a tradition of championing better health in Sub Saharan Africa amongst Medical students in a number of ways but most evident through an annual international students scientific conference. This years conference which directly tackles the clearly defined MDG 4 follows last years conference which sought to address health issues about mdgs 5 in sub Saharan Africa as the 2 goals are so deeply interwoven that to address one requires the other. We have received a number of greatly written abstracts and I am particularly grateful to our those who forwarded their abstracts for presentation for they have wonderful information which I believe shall be the corner stone of our practice, policy and pray they shall influence the much sought change to better health in order to reduce child mortality in greater numbers than what is evidenced currently. I would also like to thank our sponsors; partners who have made this conference possible and such a success and pray they shall continue in the same spirit continue to be Makerere University Medical Students Association (MUMSA) partners for its marvelous programs.


Ismael Kawooya Chair, scientific committee

Organizing committee

Executive committee MUMSA President :- Ndawula Andrew Chairperson Organising committee: Jjuuko Edrin General Secretary: Asiimwe Martha Chairperson scientific committee: Kawooya Ismael Finance committee chairperson: Nsamba Ronald Chairperson Medical camp: Nakanjako Lydia Chairperson Logisitic committee: Kakaire Daniel Conference Manager: Mukisa John Exhibition committee chairperson: Nalwanga Damalie Internal coordination committee Chairperson: Lusobya Rebecca External coordination committee chairperson: Das Gaurav Mentors Conference Patron: Prof. James K. Tumwine Mentor: Dr. Sabrina Kitaka- Bakeera Sub committees Scientific committee Kawooya Ismael Semusu Moses International coordination committee Das Gaurav Iraguha Daniel Kizito Umar Nassimbwa Patience Medical camp committee

Nakanjako Lydia Kisuule Ivan Ntegeka Sylvia Asiimwe Fiona Internal coordination committee Lusobya Rebecca Cornellius Masambu Mukeere John Logistics committee Kakaire Daniel Ainembabazi Rozen Tusiime Emmanuel Patricia Turimumahora Conference Managing committee Mukisa John Finance committee Nsamba Ronald Matovu Paul Ssenjokyo Wilson Kyomuhangi Agnes

Sponsors and partners

UNICEF: Main Sponsor Gold sponsors Baylor College of Medicine Aquva Silver sponsors Bank of Baroda Gittoes Pharmacy Ministry of Health Abacus pharmaceuticals Makerere University College of Health Sciences

Medical Camp sponsors Rwenzori beverage Company limited UHMG Abacus Pharmaceuticals Baylor childrens foundation &BIPAI Ministry of Health



18TH NOVEMBER, 2011 Abstract No. ISSCOCH011/K1 TIME 08:00-08:30 08:30-8:40am 8:40- 9:10am ACTIVITY Arrival and Registration MC: Welcome Remarks Keynote: The current state of PMTCT, successes, challenges and an acceleration plan towards achieving MDG4.- Prof. Philippa Musoke Discussion Pediatric HIV: Chair; Mr. Ojur Marcellino. Co. chair; M/s Ngonzize Mary Magdalene A Capacity Building Model in Scaling up HIV care at primary healthcare level in Ethiopia.Dr. Solomie Jebessa Role of nutrition care and support in PMTCT: The Mild May Experience- Gloria Kirungi The Family centered approach in the provision of holistic HIV & AIDS treatment, care and support to children: A Case Study of Mildmay Uganda.- Harriet Othieno .M. Discussion Tea break Official opening ceremony; Chair: Tuguume Lillian, Co-chairKeynote: Promoting child health in sub Saharan Africa looking ahead of 2015 and making it right- Dr. Sabrina Bakeera- Kitaka. Welcome Remarks by Chair, organizing committee of ISSCOCH (7th MUMSA conference) Mr. Jjuuko Edrin Remarks by Baylor College of Medicine Remarks from Bank of Baroda; CSR Remarks from Aquva; CSR Remarks by Abacus Pharmaceuticals Remarks by MUMSA President; Together we can promote child health- need to involve students. Mr. Ndawula Andrew Remarks by Conference Patron- Prof. J. K. Tumwiine Remarks by Dean School of Health Sciences (Ag. Principal MakCHS) Remarks by the Vice Chancellor; Makerere University

9:10-9:30 Plenary Session; Pine Hall ISSCOCH011/A01 ISSCOCH011/A02 ISSCOCH011/A03 9:30-9:45am 9:45-10:00am 10:00-10:15am

10:15am- 10:40am 10:40am-11:00am Pine Hall ISSCOCH011/K3 11:00-11:20am 11:20am- 11:30am 1130-1140am 1140am- 1145pm 1145-1150am 1150pm-1155am 1155pm- 1205pm 1205pm- 1215pm 1215pm-1220pm 1220pm- 1230pm

1230pm- 1245pm 12:45pm-1:00pm 1:00pm -2:00pm PLENARY SESSION: PINE HALL ISSCOCH011/D01 2:00pm- 2-15pm ISSCOCH011/D02 ISSCOCH011/D05 2:15-2:30pm 2:30-2:45pm

2:45-3:30pm PLENARY SESSION: PINE HALL ISSCOCH011/D03 ISSCOCH011/D04 3:30pm- 3:45pm 3:45pm- 4:00pm

4:00pm-4:30pm 19th November, 2011 Abstract No. TIME 08:00-08:30

Remarks on promoting child health in sub Saharan Africa; UNICEF Country Director Official opening with exhibition LUNCH Child psychiatry. Chair; Co. Chair; Attention- deficit Hyperactive Disorder Among children in Uganda - Nambafu Jamila Can we do more to improve the psychosocial aspects of children living with HIV in Uganda Dave Dhara Ashok The impact of child domestic work on the health of child domestic workers in Togo: A cross sectional study.- Dr Komakech Patrick Discussion Role of health professionals: Chair Mr. Kaduyu Robert; Co- Chair; MUST IFHRRO Global Health Campaigns and the role of Health Workers.- Dr. Kalanzi Joseph Assessing the role of undergraduate medical students at Makerere University College of Health Science in promoting child healthIsmael Kawooya Discussion Evening Tea ACTIVITY Arrival and Registration
Child survival strategies and case reports of management of common childhood illnesses. Chair; Mr. Opwonya Julius; Co- Chair M/s Ntegeka Sylvia Sickle cell: A time bomb in public health Mrs. Ruth Mukiibi Discussion Prevalence and factors associated with malaria parasitaemia in severely malnourished children at Mulago Hospital- Dr. Asea Introducing Kangaroo Mother care For High Risk Babies In Rural Settings: A Case study of Iganga/ Mayuge districts, Uganda.- Dr Gertrude Namazzi Bushenyi and Rubirizi districts health facility assessment for newborn healthcare standards - Healthy Child Uganda Discussion Tea break Child survival strategies and case reports of management of common childhood illnesses. Chair; Gulu ; Co- Chair

Plenary session: Pine Hall ISSCOCH011/K2

8:30- 8:45am 8: 45- 8:55 8:55-9:15am 9:15- 9:30am 9:30- 9:45am 9:45-10:30am 10:30- 11:00am


Plenary session: Pine Hall

Victoria University



ISSCOCH011/C05 Plenary Session ISSCOCH011/B01


Plenary Session ISSCOCH011/B04 ISSCOCH011/B03

Plenary session Plenary session

Prevalence, presentation and immediate outcome of critically ill children with hypoglycemia presenting to the Acute care Unit of Mulago hospital Dr. Mbabazi Nester 11:15amReview of severe Malaria treatment guideline 11:30am change- Dr. Okui Peter; Clinton foundation 11:30am-1200pm Discussion Nutrition: Chair M/s Asiimwe Martha, Co Chair: MUST 12:00amAssociation between malnutrition and knowledge, 12:15am practices and perception of infant and young child feeding among HIV negative mothers at Mulago hospital - Euphrasia Katuutu 12:15- 12:30am Assessment of the consumption of Vitamin A rich foods and other Vitamin A deficiency associated factors amongst children (6-59 months) in selected households in Kiryandongo county- Masindi district.Katanku Dennis Musoga 1211pm-1:00pm Discussion 1:00pm 2:00pm Lunch Nutrition: Chair KIU , Co Chair: 2:00-2:15pm Child Nutrition In Uganda, where are we?- Dr. Mupere Ezekiel 2:15pm-2:30pm Prevalence and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago Hospital, Uganda.- Dr. Richard Kalisa 2:30-3:00pm Discussion Evaluation of the conference- Chair; Mbiine Ronald Co- Chair- Jamila Nambafu 3:00pm-3:05pm Group discussion- Conference manager Closing ceremony; Chair MC. Co chair; Co-MC 11:30am-11:35am Medical students can do more; case from the child health camp; by child Health camp chairperson; M/s Nakanjako Lydia. 3:05pm- 3:15pm Remarks by Chair, scientific committee-Kawooya Ismael 3:15-3:25pm Remarks by chairperson organizing committee; Jjuuko Edrin 3:25pm- 3:35pm Closing remarks by MUMSA president; Ndawula Andrew 3:35pm- 3:45pm Remarks by a conference mentor; 3:45pm-4:00pm Remarks from the Ass. comm. Child Health 4:00pm-4:20pm Remarks from the Director general of health services Photography session by participants






ISSCOCH011 A Capacity Building Solomie Jebessa /A01 Model in Scaling up HIV care at primary healthcare level in Ethiopia. ISSCOCH011 Role of nutrition care and Gloria Kirungi /A02 support in PMTCT: The Mild May Experience. ISSCOCH011 The Family centered Harriet Othieno .M. /A03 approach in the provision of holistic HIV & AIDS treatment, care and support to children: A Case Study of Mildmay Uganda. ISSCOCH011 Association between Euphrasia Katuutu /B01 malnutrition and knowledge, practices and perception of infant and young child feeding among HIV negative mothers at Mulago hospital ISSCOCH011 Assessment of the Katanku Dennis Musoga /B02 consumption of Vitamin A rich foods and other Vitamin A deficiency associated factors amongst children (6-59 months) in selected households in Kiryandongo countyMasindi district. ISSCOCH011 Prevalence and factors Dr. Richard Kalisa /B03 associated with delayed initiation of breastfeeding among mothers who deliver in Mulago Hospital, Uganda. ISSCOCH011 Child Nutrition In Uganda, Dr. Mupere Ezekiel /B04 where are we?

Department of Paediatrics & child health, MakCHS.

ISSCOCH011 Prevalence and factors Dr. Asea /C01 associated with malaria parasitaemia in severely malnourished children at


KEYNOTE ADDRESSES ISSCOCH011/K1:_ The current state of PMTCT, successes, challenges and an acceleration plan towards achieving MDG4 By: Prof. Philipa Musoke ISSCOCH011/K2:_ Sickle cell: A time bomb in public health By: Mrs. Ruth Mukiibi ISSCOCH011/K3:_ Promoting child health in sub Saharan Africa looking ahead of 2015 and making it right: By: Dr. Sabrina Bakeera- Kitaka.

ABSTRACTS ISSCOCH011/A01:_A Capacity Building model in Scaling up Pediatrics HIV care at Primary Health Care level in Ethiopia Author: Solomie Jebessa , ANECCA , Ethiopian country program team Introduction: ANECCA (African network for care of children affected by HIV/AIDS) is network of professionals involved, in promoting the pediatric HIV prevention, treatment, care and support in Africa, established in 2001. ANECCA Utilizes existing local human resources to build human resource capacity for paediatrics HIV through technical assistance to in-service training programs in Uganda, Kenya, Tanzania, Rwanda, Burundi, Zambia, Zimbabwe, Namibia, DRC & West African countries, and through clinical mentoring programs in Uganda, Kenya, Tanzania, Rwanda & Nigeria. Additionally ANECCA developed and disseminated key resource materials such as Handbook on Pediatric AIDS in Africa and Comprehensive Pediatric HIV Care Training Curriculum (in English and French) which were adapted into national curricula in Kenya, Tanzania, Rwanda, Zambia, Namibia, Uganda, and Ghana; and used by several West African countries as generic training materials. ANECCA has country chapters in many African countries and is registered in Ethiopia, and has been giving technical assistance to the Ministry of Health in collaboration with MSH, HCSP program, to scale up pediatrics HIV services at 350 health centers in : Oromia, Tigrai, Amhara, Addis Ababa and SNNPR since Feb 2009 to June 2011. Objective: To scale up Pediatrics HIV treatment, care and support program at health center level in Ethiopia. Setting: The scale up program was done in Oromia, Tigrai, Amhara , SNNPR and Addis Ababa . Methods: I -Provision of High Quality Trainings: on pediatric HIV treatment, care and support 2- Provision of direct and indirect clinical mentoring for health care providers 3- Development & promotion of utilization of relevant job aides 4- Active participation in the national technical working group for Revision of national training curricula.

5- Net working with Ethiopian Pediatric Society. Result: ANECCA trained 643 health care providers on Pediatrics HIV treatment, care and support from the 350 health centers and provided direct clinical mentor ship support for 174 health centers health care providers and indirectly through training of HCSP mentors for the rest 176 health centers from the five regions from Feb 2009 -June 2011 along with distribution of Relevant job aids. The impact was reflected in the increment in the enrollment of patients in Pediatric HIV care and treatment services. The number of Pediatrics HIV patients on chronic care in these 350 health centers were only 1447 in September 2008 and the number of children taking ART were only 48 and on the assessment done at the end of the program (June 2011) it was found that those on chronic care have been increased to 9869 and those taking ART increased to 3763. Conclusion: This model of technical assistance helped to rapidly scale up the pediatrics HIV services at the health centers in Ethiopia within the past two years to raise the number of Pediatrics HIV patients enrolled from mean percentage of 0.9 % to 4.8 % in 350 health centers, in Oromia , Tigrai , Amhra, SNNPR and Addis Ababa and we recommend for further use of this model to scale up the pediatrics HIV services in the other regions of Ethiopia .

ISSCOCH011/A02:_ Role of Nutrition care and support in the Prevention of Mother To Child Transmission of HIV-The Mildmay Experience Main Author: Gloria Kirungi, Other authors: Moses Kamba, Dr. Yvonne Karamagi, Dr. Ekiria Kikule, Dr. Emmanuel Luyirika and Esther Kawuma. Introduction: Forty % of children born to HIV positive mothers with no preventive measures get infected with HIV in Uganda. Fifteen % of children born to HIV positive mothers who are taking ARVs get infected with HIV through pregnancy, labour and breastfeeding resulting from the poor nutrition care and support provided before, during and after pregnancy, inaccessibility of appropriate infant and young child feeding (IYCF) support which has forced many acceptability, feasibility, affordability, sustainability and safety (AFASS) negative mothers to opted for alternative feeding options hence the high morbidity and mortality of these children due to diarrhea, pneumonia and other infections. Mildmay Uganda started providing comprehensive PMTCT nutrition care package to all PMTCT mothers to reduce MTCT through to zero. Implementation of the Practice: All HIV positive women aged 15-49 are routinely screened for pregnancy. Those confirmed pregnant are enrolled into the PMTCT program which in addition to providing ART care according to MOH 2010 guidelines, a comprehensive nutrition package is provided regularly; Nevirapine syrup to children born to HIV positive mothers for 6 weeks, routine nutritional screening and assessment, PMTCT nutrition education and counseling in maternal and IYCF nutrition, Drug and food interactions, dietary planning, medical nutritional therapy for HIVrelated illnesses, food security training-demonstration gardens, nutritional rehabilitation for the malnourished, home care and follow ups. All mothers are encouraged to exclusively breastfeed

their babies for the first 6 months then introduce complementary feeding while continuing to breastfeed up to 12 months & wean off gradually with in 1 month. Routine growth monitoring and promotion (GMP) & AFASS screening is done at every visit and when the mother would like to stop breastfeeding. All clinical staff have been trained to provide basic IYCF counseling at all points, however, 2 nutrition nurses and 1 dietitian/nutritionist provide further nutrition care and support to the mothers. All these activities are carried out using locally available materials thus minimal resource implication to the organization. Results of the Practice: For the past 12 months, 407 pregnant mothers have been confirmed and received nutritional care and support, 83.8% of these mothers opted for exclusive breastfeeding for the first 6 months of life while 16.2 % opted for replacement feeding particularly cows milk. 394 children (97%) had HIV negative DNA-PCR results at 6 weeks, thus 3% children got HIV through either EBF or mixed feeding for those who opted for replacement feeding when AFASS negative. 629 children have received nutrition care and support, which has enhanced their quality of life. ART treatment, continuous nutrition care and support, vigilant follow up, training of all clinical staff in provision of basic nutrition education, vigilance in screening of all PMTCT mothers facilitated our success although the influence of community, peers and adopting the new PMTCT guidelines that promote EBF have paused great challenges to behavioral change and decision making. Conclusion: This has restored confidence and hope to many positive mothers to have HIV negative babies- more HIV positive mothers are willingly opting for exclusively breastfeed for the first 6 months, introduction of complementary feeds while continuing to breastfeed up to 12 months of life as opposed to replacement feeding hence the low mortality and morbidity due to diarrhoeal, pneumonia and other infections Recommendations: Integration of nutrition services in the maternal and child health programs is key to reduction of transmission of HIV from mother to child by increasing access to quality nutrition care and support services.

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ISSCOCH011/A03:_The family centered approach in the Provision of holistic HIV and AIDS treatment, care and support to Children, A case study of Mildmay Uganda Authors: Harriet Othieno Massawi, Esther Kawuma, Moses Kamba, Margaret Awori, Yvonne Karamagi Address: Mildmay Uganda P.O.BOX24985 Kampala Uganda Email: Introduction: Mildmay Uganda (MUg) continues to provide comprehensive HIV prevention, care and treatment services to HIV-positive clients including children and their families. A one year old female baby with a birth weight of 4.8kg born to a 27 years old full time house wife and a business man was admitted at MUg 10/02/11 with Severe Acute Malnutrition(SAM),loss of appetite, diarrhea, cough, and a weight of 4kg. Other ailments included failure to thrive, delayed mile stones and a positive DNA PCR. While the mother tested HIV positive 2 years ago during PMTCT, she never revealed her sero status and other family members were not tested. Further assessment revealed WFH 60%, WFA 40% and severely wasted muscles. Intervention: Intensive nutrition rehabilitation, on therapeutic feeds, close supervision and documentation of feeds, daily weight monitoring increased weight from 4kg to 6.4kgs and resolved SAM. Nursing care like, oral hygiene, daily bed birth, daily changing of beddings, provision of warmth improved the health of the baby. Family social support and counseling by social workers & counselors, pastoral care, helped the wife to disclose to the husband and the whole family was brought into care at Mug. Nutrition education and counseling to the care taker empowered her with skills and knowledge on preparation of complementary feeds to prevent malnutrition to subsequent siblings. Play therapy helped the child start sitting up and playing. On11/03/11, baby had increased WFH from 60% to 87%, WFA from 40% to 60% and discharged on plumpynut to continue rehabilitation at home to follow up. Lessons Learnt: Nursing care like, oral hygiene, daily bed birth, daily changing of beddings, provision of warmth improved the health of the baby. Family social support and counseling by social workers & counselors, pastoral care, helped the wife to disclose to the husband and the whole family was brought into care at Mug. Nutrition education and counseling to the care taker empowered her with skills and knowledge on preparation of complementary feeds to prevent malnutrition to subsequent siblings. Play therapy helped the child start sitting up and playing. On11/03/11, baby had increased WFH from 60% to 87%, WFA from 40% to 60% and discharged on plumpynut to continue rehabilitation at home to follow up.

Conclusion: Using a family centered approach to provide holistic care is the best practice in prevention, treatment, care and support for HIV/AIDS programs. 0754412998 Mbabazi Nakato (mother)


Senior House Officer, Makerere University College of Health Sciences, Kampala, Uganda,

Associate Professor, Department of Paediatrics, Makerere University College of Health


Paediatrician, Department of Paediatrics-Makerere University college of Health

Sciences, Kampala,Uganda,

Paediatrician, Department of Paediatrics-Makerere University College of Health

Sciences, Kampala,Uganda. Introduction: To prevent malnutrition and its complications, appropriate maternal knowledge, proper feeding practices together with good perceptions on infant and young child feeding is fundamental. WHO recommends initiation of breastfeeding within the first hour of life, breastfeeding on demand, and exclusive breastfeeding for six months, with timely introduction of complementary feeds with continued breastfeeding up to two years and beyond. We set out to identify association between malnutrition and knowledge, practices and perceptions on infant and young child feeding among HIV negative mothers, attending Assessment Centre, Mulago hospital.

Methods: Un- matched case-control study using both quantitative and qualitative methods was carried out between January to March. Three hundred and two study participants were systematically recruited by taking every second mother-child pair. Of these half were malnourished (cases) and other half were well nourished children (controls) aged 1-24 months. Mothers were tested for HIV and only HIV negative mothers were included in the study. Mother-child pair demographics and social history were collected. Perceptions on feeding infants and young children in the context of HIV/AIDS were assessed using Focus group discussions. Quantitative data was entered into EPI-DATA (version 3.1) and analyzed using STATA (version 10). Data was summarized using tables and pie charts. Data from the focus group discussions was analysed in themes and sub-themes. Direct quotes from the respondents were used in the presentation of the study findings. RESULTS: This study showed inadequate maternal knowledge regarding the frequency of breastfeeding a baby and frequency of giving complementary foods were associated with malnutrition (p-value 0.001,CI:1.58-6.64,and (p-value 0.010,CI:1.20-4.22) respectively. The following incorrect maternal practices: stopping breastfeeding before 24 months of age (pvalue 0.005, CI: 1.28-4.69), lack of exclusive breastfeeding practice up to six months (p-value 0.000, CI: 1.51-4.04), lack of correct frequency of complementary feeding (p-value 0.042, CI: 0.31-1.00) and lack of nutrition education (p-value 0.039, CI: 0.33-1.00) were associated with malnutrition. Poor maternal perceptions regarding infant and young child feeding practices were prevalent and were associated with malnutrition as elaborated in FGDs. Conclusion: There is an association between malnutrition and knowledge, practices and perceptions on infant and young child feeding among HIV negative mothers, attending Assessment Centre at Mulago Hospital. Recommendations: 1. There is need to health educate the mothers about proper feeding of infants and young children at every contact with a health worker in order to reduce malnutrition among young children. Health education for mothers should target their perceptions of infant feeding practices. 2. There is need to identify malnourished children in Assessment Center for referral to Outpatient Therapeutic Clinic-Mwanamugimu Nutrition Unit before they slip into severe malnutrition.

ISSCOCH011/B02:_ Assessment of the consumption of vitamin A rich foods and other vitamin a deficiency associated factors amongst children (6-59 months) in selected households in kiryandongo County- masindi district By; Katanku Denis Musoga, 0783800551, Introduction/ background; Vitamin A deficiency still remains a significant public health problem at global level and estimated 33% of pre-school children and about 15% women do not have enough vitamin A in their daily diet and can be classified as vitamin A deficient t (WHO, 2009). In Western Uganda where masindi district is part, the problem of night blindness and other related Vitamin A diseases amongst children(6 -59 months) is rampant( UDHS, 2006), despite the fact that there are a number of foods of both plant and animal origin that are rich in Vitamin A. Various aspects that were looked. Methodology; the study was carried out in Kiryandongo sub- county, Masindi district in western Uganda, it boarders Apac in East, Gulu in North, Luwero and Hoima in South, and L. Albert in west. Its on the area 9442 sq. km with a population of 469,865 people. The study was descriptive and cross section in which quantitative and qualitative methods of data collection were used. The study included children below 5years in selected households. A total of 60 respondents were selected by random sampling. Data was analyzed by chi square and SPSS. Results; 80% of the respondents were females, and these were between the age of 23 and 30 (48.3). 50% were teenage mothers, only 10% had no formal education.31.7% were involved in business activities. 75% were economically stable. About 66.7% were Christians. 45% gave fried vegetables to children, 10% and 6.7% fed on fish and beef respectively. 65% feed on fried vegetables, 31.7 on fruits. 100% are not affected by cultural beliefs. 85% had knowledge of VAD and 66.7% know the foods rich in Vitamin A and their importance. 40% gave foods locally grown, 96.7 immunize their children, and 75% were consistent, only 70% received the Vitamin A capsule. Conclusion: with improvement of Agricultural sector and sensitization of the people about good nutritional practices. It was expected that it would improve the nutrition status but repeated episodes of Vitamin A deficiency have remained prevalent.

ISSCOCH011/B03:_ Prevalence and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital, Uganda.

Name of authors: Richard Kalisa, James Tumwine, Jolly Nankunda Makerere University College of Health Sciences; Department: Paediatrics and Child Health, Makerere University P.O.Box 7072, Kampala, Uganda. Authors contact: Richard KALISA E-mail: Phone: +256 774 965875 Background: Exclusive breastfeeding could prevent 15 million child death in 10 years. Early infant breastfeeding practices remain an important determinant of nutritional and health status of children. Objective: We set out to determine the prevalence and factors associated with delayed initiation of breastfeeding among mother-infant pairs who deliver in Mulago hospital. Methods: In a descriptive cross sectional study, a total of 665 mother-infant pairs were interviewed within 24 hours following birth delivery. The mothers demographic characteristics, pregnancy, history and well as the babies first sucking characteristics were elicited. Qualitative data were collected through five focus group discussions with mothers to discuss the questions regarding the reasons for delaying initiation of breastfeeding and promoters for early initiation of breastfeeding. Results: In this study, 31.4% had delayed initiation of breastfeeding. Delayed breastfeeding was associated with maternal HIV positive status (AOR 2.3; 95% CI 1.3-4.2), lack of prenatal guidance regarding the advantages of breastfeeding (AOR 3.6; 95% CI 1.9-6.8), mother who didnt receive professional assistance to initiate breastfeeding (AOR 1.8; 95% CI 1.2-2.8) and mothers who delivered by Caesarean section (AOR 8.6; 95% CI 4.7-16). The main reasons reported for delaying initiation of breast-feeding were the perception of a lack of breast milk, mothers medical condition like HIV, the belief that the mother and baby needed rest after birth and performing post birth activities such as bathing the baby. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding and the belief that putting the baby to the breast encourages the milk to come.

Conclusions: In Mulago hospital 1:3 mothers delayed initiation of breastfeeding. The reasons for delayed initiation of breastfeeding include; inadequate information to mothers during ANC, HIV positive serostatus, Caesarian section delivery and negative cultural ideas about colostrum. Key words: Breastfeeding, Initiation, Delayed

ISSCOCH011/B04:_ Childhood Nutrition in Uganda, Where are We? By: Ezekiel Mupere Department of Paediatrics & Child Health, School of Medicine MakCHS Background Although Uganda has made tremendous progress in economic growth and poverty reduction over the past 20 years, her progress in reducing malnutrition remains very slow. Yet adequate nutrition is an essential prerequisite in attaining the MDGs; and attaining and sustaining human, social, and economic development. Objective Explore an overview of childhood nutrition situation in Uganda. Methods Review of published literature in Uganda, aggregate data for national and regional nutritional units in Uganda, and Namutumba district experience. Results and Conclusions Uganda is experiencing a double burden of malnutrition, increasing trends of severe acute malnutrition with associated high mortality, and high prevalence of malnutrition in epidemic proportions in several communities. Over 1200 children were screened for severe and moderate acute malnutrition following social mobilization in a period of three of weeks during the Namutumba malnutrition outbreak. Of these, 60% were found to have acute malnutrition. Recommendations Multi-sectoral systematic approaches to improve the design and delivery of nutrition services in order to prevent, reduce, and control malnutrition are urgently needed at policy, leadership and programmatic levels.

ISSCOCH011/C01:_Prevalence and factors associated with malaria parasitaemia in severely malnourished children at Mulago Hospital By: Dr. Benjamin Asea, Makerere University College of Health Sciences

Abstract Introduction: Malnutrition remains one of the most common causes of morbidity and mortality among children worldwide, and is a global challenge facing the worlds poor. In Uganda, severe malnutrition is among the leading causes of childhood morbidity and mortality. Children under five years are most vulnerable to morbidity and mortality from malaria. In sub-Saharan Africa at least 20% of childhood deaths are attributed to malaria. About 90% of all malaria deaths in the world today occur in Africa south of the Sahara. The relationship between malaria and malnutrition is controversial. Malnutrition and malaria are common in sub-Saharan Africa, and understanding the relationship between malnutrition and malaria is of great importance. Few studies have examined the association of malaria with malnutrition in areas with intense perennial malaria infection. Objective: To determine the prevalence and factors associated with malaria parasitaemia in severely malnourished children admitted to Mulago Hospital. Design: Descriptive cross sectional study. Methods: One hundred and fifty severely malnourished children aged 6-60 months and whose caretakers consented was consecutively enrolled into the study. Sociodemographic characteristics, clinical history, examination and laboratory findings were recorded. Malaria parasites were detected by microscopy. Results: The prevalence of malaria parasitaemia among the severely malnourished children was 16%. Factors found to be independently associated with malaria parasitaemia in the severely malnourished children included: the number of people living in a household and presence of stagnant water bodies around the homestead. The birth order, level of education of the caretaker, presence of thickets around the homestead, use of iron sheet roofs, ITN use, use of mosquito coils, and HIV status were not independently associated with malaria parasitaemia. Conclusion and recommendations: The prevalence of malaria parasitaemia is 16%. Malaria testing and treatment should be included in the protocol guidelines of management of severe malnutrition.

Malaria must be suspected in those with low haemoglobin levels and living in households with close proximity of stagnant water. Reducing breeding grounds of mosquitoes or aquatic habitats of larvae is one of the ways malaria can be tackled.

ISSCOCH011/C02:_ Introducing Kangaroo Mother Care for High Risk Babies in Rural Settings: A Case Study of Iganga/Mayuge Districts, Uganda G. Namazzi, P. Waiswa, S. Peterson, K. Kallander, S.Namusoko, S.Namutamba, J. Kalungi, , R.Byaruhanga, M.Nakakeeto, H. Sengendo, G.Pariyo BACKGROUND In Uganda, 45,000 newborn deaths occur annually with an equal number of still births. Preventable causes dominate with: infections accounting for an estimated 31% of neonatal deaths, followed by birth asphyxia (27%), and complications of preterm delivery (25%). Formative research conducted as part of an integrated community based maternal-neonatal health intervention linked to health facilities showed gross deficiencies in newborn care. None of the health units promoted Kangaroo Mother Care (KMC) practice. To keep warm, preterm babies were being wrapped in many clothes. Feeding practices promoted in the hospital and the lower health units were poor, it was common to start feeding babies on sugar water. As part of the integrated maternal/newborn care package, KMC practice was introduced in Iganga/Mayuge districts in order to improve the survival of preterm and low birth weight babies. Methods The interventions included a six day skills based training of frontline health workers in maternal and newborn care, including KMC; a one-off provision of health facilities with basic equipment, drugs and medical supplies; and support supervision through the district health system. Preliminary Results: Since January 2010 to March 2011, 253 preterm and LBW babies were admitted in the KMC unit in Iganga hospital, and 207 babies (81.8%) were discharged alive. Follow up of babies through a postnatal clinic has shown that KMC is continued at home and babies rapidly gain weight. CHWs and lower level facilities support KMC by identifying low birth weight babies, providing advice on care, and/or refer to the hospital. Conclusion: High risk (preterm and low birth weight) babies can survive in poor resource settings using low cost interventions. ISSCOCH011/C03:_ BUSHENYI AND RUBIRIZI DISTRICTS HEALTH FACILITY ASSESSMENT FOR NEWBORN HEALTH CARE SERVICES STANDARDS Introduction

National success in reducing newborn deaths will go a long way towards attaining Millennium Development Goal 4 since more than 40% of under-five mortality occurs in the first month of life. This survey compared the state of newborn health care services in Bushenyi and Rubirizi districts against the Uganda Standards for newborn health care services as a baseline for future newborn health programming. Methodology Twenty one (21) Health facilities (HFs) conducting most deliveries or located within Healthy Child Uganda areas of operation were purposefully selected for the Survey. A standard Ministry of Health assessment tool for newborn health service standards was used to assess the state of newborn care in the districts. Recommended infrastructure and equipment, management systems, infection prevention measures, clinical services and village health team linkage to health facilities were assessed among others. The proportion of health facilities with or without a recommended newborn health care service standard was determined. Results Three (14.6%) out of 21 HFs had a poster listing offered services, 52.4% (11/21) had postnatal registers but 4 HFs had no antenatal and birth registers. Sick newborn treatment and monitoring charts were found in only 3 HFs out of the 14 mandated to treat sick babies. Gentamycin was available in 95.2%, ampicillin in 42% and Vitamin K in 23.4%. Partographs were present in 5 HFs only. All units dont conduct maternal and peri-natal death audits. 9 HFs had bag and masks for resuscitation but only 5 had neonatal resuscitation space. 7 HFs had trained VHTs in their catchment areas but all inactive. Conclusions Health facilities still score low against the national standards for newborn health care services. This is across all the areas of: Infrastructure and equipment, Management systems, Infection prevention; Information, Education and Communication; Clinical services; Client Services; and linkage with the Village Health Teams.

ISSCOCH011/C04:_ Prevalence, presentation and immediate outcome of critically ill children with hypoglycemia presenting to the Acute Care Unit of Mulago hospital Authors: Mbabazi Nestor, Achan Jane , Mupere Ezekiel and Mworozi A Edison

Background: Hypoglycemia has been described as a common complication among critically ill children presenting to emergency paediatric units, associated with prolonged hospital stay and increased risk of mortality. Objective: To determine the prevalence, describe the clinical presentation and immediate outcome of critically ill children with hypoglycemia presenting to the acute care unit (ACU) of Mulago hospital. Methods: Cross sectional descriptive and longitudinal observational designs. Four hundred and fifty seven critically ill children aged 2 months -12 years presenting to the ACU were enrolled into the study. A random blood sugar, history and physical examination, blood slide for malaria parasites and a complete blood count were done. All participants were followed up for seven days to observe immediate outcomes that included death, discharge or still on ward by the last day of follow up. Results: In March and April 2011, four hundred and fifty seven critically ill children were studied, the median age was 15 months (Range 2-144) and the male to female ratio was 1.2:1. Hypoglycemia was present in 27 out the 457 participants 5.9% (95% CI 3.7-8.1). The clinical features which were associated with hypoglycemia were inability to breastfeed or drink, difficulty in breathing, last meal 12 hours, prostration, prolonged capillary refill > 3 seconds and leucocytosis 11000 cells /l. Among 27 hypoglycemic participants 9 (33.3%) died while only 16 out of the 423 participants with out hypoglycemia died (3.8%). Both hypoglycemic and none hypoglycemic participants who survived had comparable duration of hospital stay with in seven days of follow up. Recommendations: Hypoglycaemia should be suspected among critically ill children with inability to breastfeed or drink, difficulty in breathing, last meal 12 hours, prostration and prolonged capillary refill > 3 seconds. Glucose testing facilities and 10% dextrose should be availed in paediatric emergency units so that hypoglycemic critically ill children who need therapeutic intervention can be identified and treated.

ISSCOCH011/C05:_ Review of the treatment of severe malaria By. Dr. Okui Peter, Clinton foundation

Malaria is still a major cause of sickness and death in Uganda. Malaria also affects all levels of society but in particular has serious effects on children less than five years of age and pregnant women. The wide ranging impact of the disease, from health to social and economic issues, means it presents a considerable barrier to the work to improve the lives of all Ugandans and to achieving the Millennium Development Goals (MDGs). There are over 15M cases of malaria in Uganda every year leading to roughly 100,000 deaths. If someone gets malaria, the first stage is known as uncomplicated malaria. The most effective medicine to treat malaria is an artemisinin-combination therapy, otherwise known as an ACT. In addition to increased efficacy, lower side effects and a shorter duration of treatment, ACTs protect against resistance by combining two different malaria treatments into one. The Ministry of Health is currently piloting the Affordable Medicines Facility for malaria (AMFm). AMFm is an initiative under the Global Fund to Fight AIDS, Tuberculosis and Malaria that allows Uganda to access ACTs at heavily subsidized prices. If malaria goes untreated or treatment fails, then malaria progresses to the severe stage. Once at this life-threatening stage, a patient requires parenteral treatment immediately. Currently, Severe Malaria is treated with IV or IM Quinine. However, based on data from two significant studies [1] that demonstrated the clinical superiority of injectable artesunate over its alternative quinine, the WHO recently[2] revised its treatment guidelines to recommend injectable artesunate for both adults and children with severe malaria. The Ugandan Ministry of Health is also currently revising their treatment guidelines for Severe Malaria to include Parenteral Artesunate as the new preferred treatment for severe malaria.

Parenteral Artesunate has a number of benefits over the current treatment of IV Quinine: Increased efficacy - A study of over 5,000 African children showed a 22.5% relative mortality reduction for artesunate vs. quinine Easier administration - Compared to quinine, artesunate requires fewer doses and fewer consumables, and can be administered in four minutes vs four hours for quinine. Fewer side effects - Compared to quinine, artesunate reduces risk of convulsions, coma, and hypoglycemia.

ISSCOCH011/D01:_Attention-Deficit Hyperactivity Disorder among Children in Uganda By: Nambafu Jamila, Katsigazi Ronald
[1] [2]

AQUAMAT (Nov 2010), SEQUAMAT (Aug 2005) Revision severe malaria treatment guidelines for children issued April 2011

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. The child has a characteristic pattern of diminished sustained attention and/or higher levels of impulsivity and hyperactivity than expected at that age. It is diagnosed after a child has shown six or more specific symptoms of inattention and/or hyperactivity on a regular basis occurring before age seven for more than six months in more than two settings. Like most childhood psychiatric disorders in Uganda ADD/ADHD is rarely diagnosed and therefore untreated, which can profoundly affect their academic achievement, well-being and social interactions as illustrated by JN case seen at Mulago CAMHS. The focus of this paper is to provide a review of ADD/ADHD and bridge the awareness gap amongst the health professionals.

ISSCOCH011/D02:_ CAN WE DO MORE TO IMPROVE THE PSYCHOSOCIAL WELLBEING OF CHILDREN LIVING WITH HIV IN UGANDA? By . Dave Dhara Ashok, MBChB III, 2. Kabugo Deus, MBChB III, 3. Katsigazi Ronald, MBChB III, Introduction A strong association has been found between HIV and psychosocial dysfunction in children; it can either directly affect cognition or indirectly cause the harm due to the stigma and discrimination in society or through a combination of both. By 2009, 150,000 children were infected with HIV in Uganda as reported by United Nations General Assembly Special Session (UNGASS) Country Progress Report for Uganda. It causes an array of syndromes from anxiety to behavioral disturbances and mental retardation. This article explores the psychosocial problems of children infected with / affected by HIV; the associated factors; the possible interventions in Uganda as well as giving an insight into what more can be done to improve the quality of life of these children. Methods The information was got from literature review of articles obtained from a pubmed search using the words psychosocial support + children + HIV and through an interview of a staff member at Mwana Mujimu Nutritional Unit- Mulago Hospital. Results Although Uganda has various Nongovernmental organizations supporting HIV/AIDs care, only less than a fifth of the children with HIV were actually receiving anti retroviral treatment, as reported by the UNGASS Country Progress Report Uganda, January 2008-December 2009. Other services provided include HIV testing and counseling, nutritional education, financial support and sponsorship to children for formal education. Despite all this, many children and adolescents still experience psychosocial problems including stigma, discrimination, depression and anxiety, hyperactivity, learning disorders, hyperkinetic disorders, temporary tic disorders and mental

retardation, emotional and behavior problems. These problems result from neurological and environmental stressors or some combination of both. Unfortunately most of the psychosocial problems are not identified and therefore go untreated due to lack of awareness amongst the families as well most health professionals. Left untreated such psychosocial problems affect the social wellbeing as well as academic functioning of these children. A lot more needs to be done in order to improve the quality of life of such children. Such measures would include implementation of peer mentors and support groups, enhancement of the Straight Talk Foundation (STF) and Presidents Initiative on AIDS Strategy for Communication to Youth (PIASCY) initiatives, training health professionals on the psychosocial aspects of HIV/AIDs care. Psychosocial aspects of HIV/AIDs care should be included in National Guidelines for care and treatment of HIV, in addition to the clinical aspects of management. Conclusion The psychosocial dimension of HIV infected children is one of those aspects that should not be ignored in the provision of holistic care and management; hence it needs special attention in the national care guidelines in order to improve the future of these children.

ISSCOCH011/D03:_ IFHHRO GLOBAL HEALTH CAMPAIGNS AND THE ROLE OF HEALTH WORKERS Dr.Kalanzi Joseph, IFHHRO Regional Focal Point Office-Africa IFHHRO, established in 2003 , is a Federation of Members, observer organizations and individuals currently consisting of 31 organizations, including 8 from Africa and 2 from Uganda. It focuses on the vital role of health professionals and how their medical expertise could be mobilized to promote and protect health rights as well as stimulating international cooperation between health and human rights organizations. The IFHHRO mission is to mobilize health workers for the worldwide progressive realization of health-related human rights. It accomplishes its work through the Rights-based approach to health as well as building networks. Work in Uganda includes training on shadow reporting for CSOs, training on HR for SEHC members as well as advocacy for inclusion of HR in medical curricula. Global campaigns include the Stop Cruel, Inhumane & Degrading Treatment in the Health Care Setting. IFHHRO is looking ahead to increased involvement and training of health professionals and medical students at the CHS on the rights based approach to health. ISSCOCH011/D04:_ Assessing the role of undergraduate medical students, at Makerere University College of Health Sciences in promoting child health.

By: Ismael Kawooya, Achakolong Mary, Amanda Akatukunda, Semusu Moses, Dr. Dan Kaye, Dr. Ian Munabi Introduction: The education system is responsible for producing health professionals who are mindful of the needs of the community. At Makerere University College of Health Sciences students are expected to complete their community service during the community based education service (cobes) in the first four academic years and also go through their clinical rotations in their final 2 years. In this study we aimed at assessing the role of the undergraduate medical students in promoting child health in the community and health facilities. Methods: Review of 40 cobes reports and interviews of 20 representative students were done. 10 representative reports from each year of study for the previous cobes of the students still present at the college of health sciences and a checklist based on 12 WHO/ UNICEF child survival strategies expanded into different activities showing knowledge of it and practicing it. The interviews were to assess attitude and practice of the students. Results: A report of select activities from the checklist showing the frequency of the students who performed the activities i. recognizing malnutrition children (32.5%) ii. Measurement of weight and height (37.5%) iii. Mentioning of immunization activities at the health facility, (35%) iv. Identification of immunized children (30%) v. identification of children in need of vit A supplements (0%); vi. Identification of families using ITNs, (32.5%); participation in the distribution of ITNs, (22.5%). Of the activities recorder performance decreased over the years of study. Interview results showed that students had good attitude and practice towards promoting child health. Conclusions and recommendations Students though had good attitude and practice to promote child health didnt adequately show this in their cobes reports probably due to oversight or under sight to child health and the decrease in the performance of activities could probably due to the different projects that students dont consider child health as key. It is important to introduce the Integrated Management Childhood illness earlier during the course to provide more sight into how students can promote child health before their clinical rotations.

ISSCOCH011/D05:_ Title: The impact of child domestic work on the health of child domestic workers in Togo: A cross sectional study.

Author: Dr Komakech Patrick Makerere University School of Public Health-CDC fellowship program. Email: Introduction: The practice of child labour especially in the developing world continues to happen despite the conventions that have been put in place to protect children. Unlike other forms of child labour, the challenge with child domestic workers is that they are often hidden behind closed doors and the practice is considered normal by many communities. Objective: The objective of the study was to determine the impact of child domestic work on the health of Togolese Child domestic workers and factors associated with poor health among the child domestic workers. Methods: Primary data analysis of quantitative data retrieved from a 2009 cross sectional study on the psychosocial effects of domestic work on children was done. A sample of 200 child domestic workers matched with 200 non-domestic workers all aged between 12-17 years were selected for the study using snowball sampling technique. The study was carried out in Togo by Anti-Slavery International and Wao Afrique. Self rated health status alongside the prevalence of chronic back pain, chronic musculoskeletal pain, chronic fatigue and feeling sad most of the time as reported by the respondents were the main health outcomes analysed. Data was analysed using Stata 10. Both descriptive statistics and logistic regressions were carried out to establish patterns and associations. Results: 360 (90%) respondents were female and 40 (10%) were male. The main activities carried out by the child domestic workers were house cleaning, dishwashing and laundry. Child domestic workers were more likely to report a self rated health status as bad (OR=2.16; p<0.05). Live in child domestic workers and those with friends that had faced physical abuse were also more likely to have a self rated health status reported as bad (OR=2.97; p=0.003, OR=4.32; p=0.009). Child domestic workers were more likely than the non-CDWs to have all the four illness or symptoms analysed i.e. chronic back pain, chronic musculoskeletal pain, chronic fatigue and feeling sad most of the time (OR=9.80; p<0.05, OR=1.95; p=0.029, OR=6.33; p<0.05 and OR=43.68; p<0.05 respectively). Conclusion: Child domestic work negatively impacts on the health of child domestic workers. Therefore child protection laws need to be enforced and communities need to be sensitised about negative health repercussions of child domestic work.

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