Risk Factors for Measles among HIV-infected Children in Uganda

Risk Factors for Measles among HIV-infected Children in Uganda by Miriam Nanyunja MPH, University of South Florida, 1998 MB CHB, Makerere University, 1992 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University August 2016 Abstract Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have aMeasles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age group with the highest measles susceptibility in the exposed children, which could inform timing for revaccination, was investigated. The role of age at initiation of HAART, low CD4+ count, and undernutrition as predictors of the risk of measles in the exposed children was examined. Univariate, bivariate, and binomial logistic regression analytical procedures were used in data analysis. Results showed no significant difference in the risk of measles between exposed and unexposed children. The age groups 5 to 9 years and 2 to 4 years were the first and second most affected by measles among the exposed children. Undernutrition (stunting) was a significant predictor of measles in exposed children (odds ratio of 4.14, p = 0.02), while age at initiation of HAART and CD4+ count prior to measles exposure were not. The study findings provide evidence to inform vaccination policy and nutrition care for HIVinfected children on HAART in Uganda, so as to reduce their risk of measles illness and mortality, thus contributing to positive social change for the children and the country. Risk Factors for Measles among HIV-infected Children in Uganda by Miriam Nanyunja MPH, University of South Florida, 1998 MB CHB, Makerere University, 1992 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Epidemiology Walden University August 2016 Dedication This dissertation is dedicated to my late parents, Mr. Frederick Kalibwani Kaggwa and Mrs. Gertrude Kaggwa, who inspired me to pursue excellence in all that I do and to never give up on my goals even when faced with challenges; and to my daughters Rebecca, Noella, and Angel to inspire them to pursue their dreams with excellence. Acknowledgments First of all, I would like to thank my husband, Mr. Barnabas Tumusingize, and my daughters Rebecca Zeta Kirabo, Noella Tamar Mwebaza, and Angel Siima Tusiime who have supported me throughout my PhD journey and allowed me to share some time I would be spending with them for my school work. You have been there for me and have been very understanding. Your support has not been in vain. Further acknowledgements go to my Committee Chair, Dr. Maria Rangel, for the guidance she offered me throughout the dissertation process; and to Dr. Aimee Ferraro, my second committee member for the encouragement, advice, and support during the dissertation journey. I also extend my gratitude to Dr. Susan Nyanzi, the University Research Reviewer that reviewed my proposal and dissertation report. I extend my sincere gratitude to Walden University for the Commitment to Social Change scholarship awarded to me that enabled me to pay part of my tuition, especially for the course work. Special thanks also go to all the faculty that facilitated the different courses and residencies I undertook in the program. I learned a lot from you and from the courses and residencies that has enabled me to contribute to positive social change in my work as a public health practitioner and epidemiologist. In a special way I would like to thank my friends including Dr. Juliet NabyongaOrem who encouraged me to embark on the PhD in Public Health –Epidemiology, supported and prayed for me throughout the PhD journey; and Mrs. Pamela Tumwebaze that prayed with me, followed the progress I was making step by step, and encouraged me not to give up when the going was tough. To my brothers and sisters, your continuous invaluable advice and support is greatly appreciated. Thank you all for being there for me. Above all, I would like to thank the Almighty God for His guidance and favor throughout my life and during the course of the PhD journey. Without His guidance, daily presence, encouragement, and provisions, I would never have made it. I will forever be grateful for His love and mercy.