Browsing by Author "Francis, Kazibwe et.al"

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The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic
(African Health Sciences, 2019) Francis, Kazibwe et.al
Background: Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices. Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among pa tients with UGIB in rural SSA where schistosomiasis is endemic. Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accu racy. Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood trans fusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test). Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa.
Epidemiology and control of intestinal schistosomiasis on the Sesse Islands, Uganda
(BioMed Central Ltd, 2010) Francis, Kazibwe et.al
Background: Intestinal schistosomiasis is often widespread among the populations living around Lake Victoria and on its islands. The Sesse Island group (containing some 84 islands), however, is typically assumed to be a low prevalence zone, with limited transmission, but has never been surveyed in detail. Here, we present a rapid mapping assessment, bringing together snail and parasite information, at 23 sites for the presence of intermediate host snails and at 61 sites for the prevalence of intestinal schistosomiasis in school-aged children (N = 905). Two different diagnostic tools were used and compared at 45 of these sites: Kato-Katz thick faecal smears and circulating cathodic antigen (CCA) urine dipsticks. Results: Biomphalaria snails were found at 11 sites but in low numbers; none was found shedding schistosome cercariae. At 22 out of the 45 sites, local prevalence by urine and/or stool diagnostics was in excess of 50%, although mean prevalence of intestinal schistosomiasis overall was 34.6% (95% confidence intervals (CI) = 31.0- 38.3%) by Kato-Katz and 46.5% (95% CI = 42.7-50.4%) by CCA if ‘trace’ reactions were considered infection-positive (if considered infection-negative, mean prevalence was 28.1% (95% CI = 24.7-31.7%)). Diagnostic congruence between CCA and Kato-Katz was poor and significant discordance in estimated prevalence by location was found, with each often inferring different mass drug administration regimes. Conclusions: Accurate estimation of schistosome prevalence is important for determining present and future treatment needs with praziquantel; the wide range of schistosome prevalence across the Sesse Island group requires a treatment regime largely tailored to each island. In high prevalence locations, further malacological sampling is required to confirm the extent of local transmission, especially on the northern islands within the group. The observation that different diagnostic tests can provide varying results in terms of estimating prevalence by location, and hence change treatment recommendations, suggests that care must be taken in interpreting raw prevalence data. In particular, further research into the reasons for the differences in the poorer performance of the CCA test should be pursued
Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin
(Springer Open, 2021) Francis, Kazibwe et.al
Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.
Microgeographical and tribal variations in water contact and Schistosoma mansoni exposure within a Ugandan fishing community
(Blackwell Publishing Ltd, 2007) Francis, Kazibwe et.al
objective To explore patterns of water contact and Schistosoma mansoni exposure by age, sex, tribe and space within a single village. methods For 10 months, we systematically observed water contacts made by the 800 inhabitants of a small Ugandan fishing village. In order to estimate cercarial exposure, times spent in water were weighted by snail infection levels, time of day and degree of immersion. results There were marked differences in water contact patterns between the two main tribes, which inhabited geographically distinct ends of the village resulting in geographically distinct spatial patterns of water contact. The distributions of the intermediate hosts, Biomphalaria sudanica and Biomphalaria stanleyi, also appeared to differ over small distances. This led to quite different exposure patterns between the two tribes, particularly amongst females. conclusions Schistosoma mansoni exposure can vary markedly within a single village. Such non homogenous patterns of exposure are likely to have wider implications for schistosomiasis control programmes and research studies.