1. To Love & Serve As One By: Nicole Otey Country Visited: Uganda City Visited: Gulu (located in Northern Uganda) http://wftwuganda2012.blogspot.com

2. 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.

3. Background Information Population of Uganda: ~36 million Population of Uganda: ~36 million Population of Uganda >5 years old: ~7 million Population of Uganda >5 years old: ~7 million Population of Gulu, Uganda: ~366,000 Population of Gulu, Uganda: ~366,000 Rotavirus Significance: Rotavirus Significance: 43.5% of the Ugandan population were treated with ORS (oral rehydration solution) because of diarrhea 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 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 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 The occurrence of infections have not decreased in the last 20 years http://www.unicef.org/infobycountry/uganda_statistics.html http://www.lacorhospital.org

4. St. Mary’s Hospital 482 bed hospital with 3 health centers around community that serve 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 over 300,000 people annually, half of which are under the age of six Treats ~600 outpatients everyday Treats ~600 outpatients everyday Multiple Units including: Multiple Units including: Casualty Maternity Pediatrics Burn Unit ICU Antenatal Medicine http://www.lacorhospital.org Personal Photo from trip

5. Specific Learning Objective The main issue investigated is how the rotavirus can lead to diarrhea, which in turn can cause dehydration, specifically in children. The main issue investigated is how the rotavirus can lead to diarrhea, which in turn can cause dehydration, specifically in children.

6. Epidemiology Children 5 years old and younger most commonly die from diarrhea in Uganda 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 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 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. 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/news- politicsandhistory

7. 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 Treatment Acute fever and vomiting accompanied by watery stool Stool sample collected for verification Patient treated for dehydration mainly: IV fluids and/or ORS Parashar, Nelson, & Kang, 2013

8. 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

9. 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: 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? How many shots are required? When should I come for other doses? When should I come for other doses? 2. Perceived benefits of immunizations Thought to have HIV in vaccine to kill off Africans Thought to have HIV in vaccine to kill off Africans 3. Concerns about immunizations Level of training of those giving vaccinations Level of training of those giving vaccinations 4. Misconceptions Braka, Asiimwe, Soud, Lewis, Makumbi, & Gust, 2012

10. Fluid Replacement ORS decreases diarrheal mortality by up to 93% 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 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 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/battling- diarrhoea-repackaging-ors-and-zinc-worldwide

11. Summary Rotavirus is prevalent in Uganda, killing an immense amount of children Rotavirus is prevalent in Uganda, killing an immense amount of children Loss of fluids is the #1 reason for hospitalization and death Loss of fluids is the #1 reason for hospitalization and death The vaccine needs to be approved immediately to combat this issue The vaccine needs to be approved immediately to combat this issue

12. Clinical Experience 1 st 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 1 st child. One of scariest and happiest moments while there. http://www.healthynewbornnetwork.org/blog/how-global- twitter-relay-chat-can-spur-action-newborns-lessons- worldprematurityday

13. 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

14. 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.