Background Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda in order to identify appropriate targets for intervention. Methods and Results Using data from the Uganda RHD Registry (n=1,504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016, (2) retained in care, (3) appropriately prescribed BPG, and (4) optimally adherent to BPG (>80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (IQR) age was 23 (15–38) years; 69% were female; and 82% had clinical RHD. Median follow-up time was 2.4 (0.9–4.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% CI 54.1–59.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription [91.6% (95% CI 89.1–93.5%)] and optimal adherence (91.4% [95% CI 88.7–93.5]). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence. Conclusions Our study suggests that improving retention in care—possibly by decentralizing RHD services—would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.

Treatment with inhaled nitric oxide as an adjuvant therapy for pediatric patients with cerebral malaria for 48 hours did not result in a significant difference in plasma Angiopoietin-1 levels when compared with placebo in a phase II open-label clinical trial.

Background HAART and chronic HIV associated inflammation has been attributed to abnormal lipids in HIV infected people. Little is known about dyslipidemia among children in Uganda in the era of increasing Highly Active Anti Retroviral Therapy (HAART) use. We determined the prevalence of lipid abnormalities, the correlation of the lipid abnormalities to CD4 count, HIV clinical stage and duration on HAART among HIV infected children. Methods This was a cross-sectional, descriptive and analytical study of HIV infected children age 1–17 years receiving HAART for more than 6 months in Mbarara Regional Referral Hospital. Consent and assent were obtained as appropriate. Sociodemographic, clinical and immunological data were collected and recorded in a questionnaire. A blood sample was taken for lipid profiling. Dyslipidemia was defined as any low HDL (<=40mg/dl), high LDL (>130mg/dl), high TG (>130mg/dl) and a high total cholesterol (>200mg/dl) or a combination of these in the study population. The proportion of children with dyslipidemia was calculated and logistic regression analysis for associated factors. Results The mean age was 118 months (SD 49 months) with 49.5% of the children male and 62.1% had severe HIV disease at initiation of HAART. Mean duration of HAART was 55.6 months (SD 31.2 months). The prevalence of dyslipidemia was 74%. Among the children with dyslipidemia, 56.6% exhibited low HDL, 22% had hypertriglyceridemia, 15.6% had high LDL and 11% had hypercholesterolemia. We found significant association between dyslipidemia and WHO clinical stage at initiation of HAART (AOR 2.9 1.05 – 8.45 p=0.040). Conclusion There was a high prevalence of dyslipidemia associated with severe HIV disease at initiation of HAART among HIV-infected children on HAART.

Introduction: Patterns and prevalence of heart diseases are different between the high income countries and low income countries. Acquired heart diseases like RHD, cardiomyopathies, pericarditis are still a public health burden while congenital heart diseases still carry a poor outcome among children. The aim of this study was to report the burden and pattern of heart diseases in a semi urban referral hospital in Uganda. Methods:This was a prospective study in the paediatrics department at a regional referral hospital in south western Uganda over a period of 20 months. All children from birth up to 12 years who were referred or presented at the paediatrics department from different areas in the region for an index cardiac evaluation and had their transthoraxic echo done were included in the study. These children were enrolled and followed up in the cardiology clinic for chronic care. Those who did not turn up for their expected reviews were followed up with phone calls to find out their outcome.Results: Two hundred and forty children were screened during this period and 158 (65.8%) had abnormal echocardiological findings. More females than males were had abnormal Echos at 51.9%. VSD were the commonest acyanotic heart disease followed by PDA at 37% and 17% respectively. TOF has the highest prevalence at 8.23% followed by Truncus arteriosus at 5.9% amongst the cyanotic heart diseases. Mean age at diagnosis of congenital heart disease was 28 months (SD 33). RHD was the commonest acquired heart diseases (72.5%.) Sixty three percent of children needed and were referred to the national cardiac centre. Only 52% of referred children managed to go to the national referral cardiac centre. Of all the children who needed surgical intervention, 4.4% got the intervention. 25% of the children died while 12.7% were lost to follow up. Conclusion;There is a high burden of heart diseases in south western Uganda with limited access to interventional services.