To Love & Serve As One
By: Nicole Otey
Country Visited:
Uganda
City Visited: Gulu
(located in Northern
Uganda)
•
http://wftwuganda2012.blogspot.com
Objectives
1. To research the epidemiological significance of diarrhea,
specifically regarding the Rotavirus
2. To study individual strategies of care in order to
prevent and treat diarrhea in Ugandan children.
3. To identity how community and governmental
strategies are reducing the occurrence of rotavirus
diarrhea in the pediatric population.
4. To recognize and provide ways to overcome barriers
associated with vaccines for children in Uganda.
5. To evaluate the importance of fluid replacement with
severe rotavirus diarrhea.
Background Information
 Population of Uganda: ~36 million
 Population of Uganda >5 years old: ~7 million
 Population of Gulu, Uganda: ~366,000
 Rotavirus Significance:
• 43.5% of the Ugandan population were treated with ORS (oral
rehydration solution) because of diarrhea
• Diarrhea is the fourth leading disease treated at St. Mary Lacor
Hospital
• The most common infection leading to diarrhea is the rotavirus, with
approximately 400,000 deaths occurring in children under 5 years
• The occurrence of infections have not decreased in the last 20 years
•
•
http://www.unicef.org/infobycountry/uganda_statistics.html
http://www.lacorhospital.org
St. Mary’s Hospital
• 482 bed hospital with 3
health centers around
community that serve
• Treats over 300,000 people
annually, half of which are
under the age of six
• Treats ~600 outpatients
everyday
• Multiple Units including:
•
Casualty
•
Maternity
•
Pediatrics
•
Burn Unit
•
ICU
•
Antenatal
•
Medicine
•
•
http://www.lacorhospital.org
Personal Photo from trip
Specific Learning Objective
 The main issue investigated is how the rotavirus can
lead to diarrhea, which in turn can cause
dehydration, specifically in children.
Epidemiology
• Children 5 years old and
younger most commonly
die from diarrhea in
Uganda
• The rotavirus causes
diarrhea, leading to
excessive fluid loss
resulting in dehydration
• Dehydration in turn leads
to longer hospitalizations
stays and can cause death
if severe enough
• Risk factors: Poor nutrition
status, low birth weight,
occurrence during dry
season, etc.
•
•
•
Nakawesi, Wobudeya, Ndeezi, Mworozi, &Tumwine, 2010
http://www.infectionlandscapes.org/2011/11/rotavirus.html
http://www.theguardian.com/katine/2010/mar/25/newspoliticsandhistory
Individual Strategies
Causation
 Transmission is spread
through contaminated
hands, objects, and
occasionally food and
water
 Effects the villi in
intestines, decreasing
absorption of fluids
 Illness peaks between ages
4-23 months
•
Parashar, Nelson, & Kang, 2013
Treatment
 Acute fever and vomiting
accompanied by watery
stool
 Stool sample collected for
verification
 Patient treated for
dehydration mainly: IV
fluids and/or ORS
Governmental Strategies
Currently the vaccination to protect individuals from the virus has not been
approved in Uganda
Anticipated date of vaccine adoption is sometime in 2014
•
•
http://www.r-wow.com/work/print/others/others.html
Tate, Kisakye, Mugyenyi, Kizza, Odiit, & Braka, 2011
Barriers to Vaccinations
 As previously discussed the vaccine is not approved
yet but when/if it becomes available there are some
common concerns guardians feel about vaccinating:
1.
Lack of information about immunizations
 How many shots are required?
 When should I come for other doses?
2.
Perceived benefits of immunizations
 Thought to have HIV in vaccine to kill off Africans
3.
Concerns about immunizations
 Level of training of those giving vaccinations
4.
•
Misconceptions
Braka, Asiimwe, Soud, Lewis, Makumbi, & Gust, 2012
Fluid Replacement
 ORS decreases diarrheal
mortality by up to 93%
 Home fluids are not
intended to reduce
mortality but instead they
prevent dehydrations from
taking place to begin with
 Treatment: Discussed with
nurses in health centers
and doctors on pediatric
unit that zinc is given for 10
days, along with ORS
•
•
Munos, Walker, & Black, 2010
http://www.unicefinnovation.org/case-studies/battlingdiarrhoea-repackaging-ors-and-zinc-worldwide
Summary
 Rotavirus is prevalent in Uganda, killing an
immense amount of children
 Loss of fluids is the #1 reason for hospitalization
and death
 The vaccine needs to be approved immediately to
combat this issue
Clinical
Experience
•
http://www.healthynewbornnetwork.org/blog/how-globaltwitter-relay-chat-can-spur-action-newborns-lessonsworldprematurityday
1st day of going to wards:
within 2 hours of getting
accustomed to maternity
ward I see my first baby being
born!!! Does not go as
smoothly as I expected…baby
has complications with not
breathing and it takes over 2
minutes for the newborn to
receive ventilation by ambu
bag. However, the baby
recovers and the mother is
reunited with her 1st child.
One of scariest and happiest
moments while there.
Cultural
Experience
I do not think there is a more
giving, joyous, self-less group
of people on this planet. The
experiences I had while in
Uganda were made even
more special by the people
who I got to spend time with.
It is the people I encountered
everyday who made me
realize what the true meaning
of being blessed and
happiness is. Happiness is not
defined by the dollar signs
you have to your name,
instead it is defined by who
you surround yourself with
and learning to accept all of
life’s curveballs
References
1.
Braka, F., Asiimwe, D., Soud, F., Lewis, R. F., Makumbi, I., & Gust, D. (2012). A
qualitative analysis of vaccine safety perceptions and concerns among caretakers
in Uganda. Maternal and Child Health Journal, 16(5), 1045-1052.
2.
Munos, M. K., Walker, C. L., & Black, R. E. (2010). The effect of oral rehydration
solution and recommended home fluids on diarrhoea mortality. International
Journal of Epidemiology, 39(Supplement 1), 75-87.
3.
Nakawesi, J. S., Wobudeya, E., Ndeezi, G., Mworozi, E. A., &Tumwine, J. K.
(2010). Prevalence and factors associated with rotavirus infection among children
admitted with acute diarrhea in Uganda. BMC Pediatrics, 10(1), 1-5.
4.
Parashar, U. D., Nelson, E. A., & Kang, G. (2013). Diagnosis, management, and
prevention of rotavirus gastroenteritis in children. BMJ, 347(dec30 1), 1-10.
5.
Tate, J. E., Kisakye, A., Mugyenyi, P., Kizza, D., Odiit, A., &Braka, F. (2011).
Projected health benefits and costs of pneumococcal and rotavirus vaccination in
Uganda. Vaccine, 29(17), 3329-3334.