Makerere University College of Health Sciences (MakCHS) is a constituent college of Makerere University, Uganda's oldest university. The schools of the college offer undergraduate and postgraduate courses in the biomedical sciences, health sciences, human medicine and public health, covering a broad range of disciplines and specialties.
BACKGROUND:Paediatric acute kidney injury (AKI) is a complication of severe malaria, but its long-term outcomes remain poorly defined in low-income and middle-income countries. We aimed to evaluate the long-term association between paediatric AKI and kidney outcomes and mortality following severe malaria. METHODS:We pooled data from two prospective cohorts of Ugandan children (ie, those aged 6 months-12 years) admitted to hospital with severe malaria between 2008 and 2017. Children with stored admission blood samples available for creatinine measurement were included in the analysis. Surviving participants were enrolled in a follow-up study conducted from 2020 to 2023, when kidney function and survival were assessed, using Cox regression with age as the timescale to model mortality risk. Logistic regression was used to estimate the odds of chronic kidney disease (CKD), defined as two or more consecutive low estimated glomerular filtration rates 90 days or more apart, and long-term major adverse kidney events, defined as CKD or death. Adjusted analyses included the following enrolment characteristics: age, sex, height-for-age Z score, study site, study cohort, severe malaria group (ie, cerebral malaria, severe malarial anaemia, respiratory distress, complicated seizures, or prostration), and HIV status. FINDINGS:At enrolment, the median age was 2·5 years (IQR 1·8-3·5), 622 (57·8%) of 1077 were male and 455 (42·2%) were female, with Kidney Disease: Improving Global Outcomes-defined AKI occurring in 431 (40·0%) children. Over a median of 6·5 years (3·7-8·8), 147 (13·6%) of children died, with nearly half of deaths (71 of 147) occurring after hospital discharge. Adjusted odds of long-term major adverse kidney events were higher among children with AKI (adjusted odds ratio [aOR] 3·14, 95% CI 2·23-4·43), driven by a higher mortality risk (adjusted hazard ratio [aHR] 3·36, 95% CI 2·22-5·10) that remained elevated beyond 2 years after the acute episode (aHR 4·53, 1·80-11·37). AKI survivors had higher odds of chronic kidney disease over follow-up (odds ratio 1·77, 1·07-2·93), although not significant after adjustment (aOR 1·47, 95% CI 0·84-2·56; p=0·18). INTERPRETATION:In this paediatric population, AKI was associated with excess long-term mortality, suggesting AKI is a sentinel event that marks sustained vulnerability to death and highlights limitations of acute-care models in malaria-endemic settings. FUNDING:The US National Institute of Neurological Disorders and Stroke, the Fogarty International Center, the US National Institutes of Allergy and Infectious Diseases, and a Ralph W and Grace M Showalter Young Investigator Award.
Importance:Cerebral malaria and severe malarial anemia are associated with cognitive impairment and decreased academic achievement 1 to 2 years after the initial episode. The extent to which impairment persists into later childhood and adolescence is unknown. Objective:To determine whether severe malaria in children is associated with long-term cognitive impairment or decreased academic achievement. Design, Setting, and Participants:Assessment of Ugandan children enrolled in 2 prior cohort studies of severe malaria; 1247 children completed the prior studies (2008-2018), of whom 958 were traceable (77%), and 939 (75%) enrolled in the present study (2020-2023). Data from 889 individuals younger than 18 years were analyzed. Exposures:Cerebral malaria (n = 184), severe malarial anemia (n = 249), other forms of severe malaria (respiratory distress, complicated seizures, or prostration, n = 239), and unaffected community children (n = 217). Main Outcomes and Measures:Descriptive analysis including age-adjusted z scores of overall cognitive ability, attention, and academic achievement (math, reading). Results:Participants (mean age, 11.1 [SD, 3.4] years; 44.2% female) were tested 4 to 15 years (mean, 8.4 [SD, 2.7] years) after their severe malaria episode. Compared with community children, children with a history of cerebral malaria or severe malarial anemia had lower scores in overall cognition (adjusted mean difference, -0.41 [Bonferroni-corrected 95% CI, -0.74 to -0.09] and -0.31 [95% CI, -0.61 to -0.01], respectively) and math (-0.46 [95% CI, -0.78 to -0.14] and -0.32 [95% CI, -0.61 to -0.03], respectively), while attention and reading scores did not differ significantly. Cognitive and academic scores were not significantly different between children with other forms of severe malaria and community children. In children with cerebral malaria or severe malarial anemia, acute kidney injury, hyperuricemia, and elevated plasma angiopoietin-2 levels at the time of the severe malaria episode were associated with worse z scores in overall cognitive ability (-0.44 [95% CI, -0.80 to -0.08], -0.45 [95% CI, -0.88 to -0.02], and -0.33 [95% CI, -0.63 to -0.03], respectively). In children with cerebral malaria or severe malarial anemia, acute kidney injury was additionally associated with lower z scores in reading (95% CI, -0.42 [95% CI, -0.79 to -0.05]) and math (95% CI, -0.39 [-0.74 to -0.04]). Conclusions and Relevance:Among survivors of a severe childhood malaria episode, cerebral malaria and severe malarial anemia in childhood are associated with cognitive impairment and decreased academic achievement in some metrics 4 to 15 years after the index episode.
Over the last decade it has become clear that obesity and type 2 diabetes are key to the aetiology, pathogenesis and outcomes of metabolic dysfunction-associated steatotic liver disease (MASLD). The considerable current and potential burden of MASLD on patients and healthcare systems is therefore inextricably linked with today's global epidemics of obesity and type 2 diabetes. In this review, we discuss estimates of the global MASLD burden in terms of prevalence, incidence, disability from complications and reduced life expectancy associated with the condition. We also highlight the variability in MASLD prevalence estimates among different populations, with a particular focus on the sub-Saharan Africa and Asia Pacific regions, where population increases and the epidemiological transition (a sustained shift in population mortality and disease patterns from infectious diseases towards non-communicable diseases) are occurring most rapidly. Additionally, we consider the impact of social determinants of health, including socioeconomic conditions, structural inequities, care access, food environments and systemic discrimination. We also identify opportunities to advance equity in MASLD prevention, diagnosis and treatment worldwide.
BackgroundPre-eclampsia and other hypertensive disorders of pregnancy are the second leading cause of maternal mortality globally, with 95% of deaths occurring in low- and middle-income countries. In Uganda, these conditions account for approximately 16% of maternal deaths. Despite their burden, little is known about women's knowledge, perceptions, and management practices regarding pre-eclampsia in such settings, yet early recognition and care-seeking are critical to improving outcomes.ObjectiveTo explore community awareness, perceptions, and management practices related to pre-eclampsia in Mbale City, Eastern Uganda.MethodsAn exploratory qualitative study was conducted through face-to-face interviews with 81 women aged 18-49 years during a community outreach event on pre-eclampsia. Data was collected over six days (21st-26th May 2024) by 28 trained research midwives stationed at various community sites. Interviews were audio-recorded, transcribed, and thematically analyzed using ATLAS.ti software.ResultsParticipants exhibited limited and mixed understanding of pre-eclampsia, often associating it with symptoms such as swollen feet, headaches, body weakness, and high blood pressure, but also with misconceptions such as witchcraft, marital stress, and multiple pregnancies. Many lacked a local term for the condition. Women reported varied care-seeking responses, with some turning to traditional birth attendants and herbal remedies, while others sought biomedical care. Fear of death was a motivator for some to seek timely medical attention.ConclusionThere was a critical gap in accurate knowledge and awareness of pre-eclampsia among women in Mbale City. Misconceptions and reliance on traditional remedies contribute to delayed care-seeking. Targeted, culturally appropriate educational interventions are urgently needed to improve early recognition, promote biomedical care, and enhance maternal and newborn outcomes.
