Browsing by Author "Mukose, Aggrey David"

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    Cost-effectiveness of GeneXpert Omni compared with GeneXpert MTB/Rif for point-of-care diagnosis of tuberculosis in a low-resource, high-burden setting in Eastern Uganda: a cost-effectiveness analysis based on decision analytical modelling
    (BMJ, 2022-08-08) Ejalu, David Livingstone; Irioko, Aaron; Kirabo, Rhoda; Mukose, Aggrey David; Ekirapa, Elizabeth; Kagaayi, Joseph
    To determine the cost-effectiveness of Xpert Omni compared with Xpert MTB/Rif for point-of-care diagnosis of tuberculosis among presumptive cases in a low-resource, high burden facility. Cost-effectiveness analysis from the provider’s perspective. Setting A low-resource, high tuberculosis burden district in Eastern Uganda. Participants A provider’s perspective was used, and thus, data were collected from experts in the field of tuberculosis diagnosis purposively selected at the local, subnational and national levels. A decision analysis model was contracted from TreeAge comparing Xpert MTB/Rif and Xpert Omni. Cost estimation was done using the ingredients’ approach. Oneway deterministic sensitivity analyses were performed to identify the most influential model parameters. Outcome measure The outcome measure was incremental cost per additional test diagnosed expressed as the incremental cost-effectiveness ratio. The total cost per test for Xpert MTB/Rif was US$14.933. Cartridge and reagent kits contributed to 67% of Xpert MTB/Rif costs. Sample transport costs increased the cost per test of Xpert MTB/Rif by $1.28. The total cost per test for Xpert Omni was $16.153. Cartridge and reagent kits contributed to over 71.2% of Xpert Omni’s cost per test. The incremental costeffectiveness ratio for using Xpert Omni as a replacement for Xpert MTB/Rif was US$30.73 per additional case detected. There was no dominance noted in the cost-effectiveness analysis, meaning no strategy was dominant over the other. The use of Xpert Omni at the point-of-care health facility was more effective but with an increased cost compared with Xpert MTB/Rif at the centralised referral testing facility.
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    Prevalence, Factors Associated and Treatment Outcome of Hyperbilirubinaemia in Neonates Admitted to St Francis Hospital, Nsambya, Uganda: A Descriptive Study
    (African Health Sciences Makerere University Medical School, 2020-04-20) Nyangabyaki-Twesigye, Catherine; Mworozi, Edison; Namisi, Charles; Nakibuuka, Victoria; Kayiwa, Joshua; Ssebunya, Robert; Mukose, Aggrey David
    Background: With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a drastic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbilirubinaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubinaremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. Methods: A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbilirubinaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. Results: The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies admitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with significant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Conclusion: Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is admin istered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region.