Browsing by Author "Sajatovic, Martha"

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Community Knowledge of and Attitudes Toward Epilepsy in Rural and Urban Mukono District, Uganda: A Cross-Sectional Study
(Elsevier, 2016-01) Kaddumukasa, Mark; Kakooza, Angelina; Kayima, James; Kaddumukasa, N. Martin; Ddumba, Edward; Mugenyi, Levi; Furlan, Anthony; Lhatoo, Samden; Sajatovic, Martha; Katabira, Elly
Introduction: The lack of adequate knowledge poses a barrier in the provision of appropriate treatment and care of patients with epilepsy within the community. The purpose of this study was to determine the knowledge of and attitude towards epilepsy and its treatment by community dwellers in Uganda. Methods: A cross sectional population survey was conducted in urban and rural Mukono district, central Uganda. Adult respondents through multistage stratified sampling were interviewed about selected aspects of epilepsy knowledge, attitudes, and perception using a pretested structured questionnaire. Results: Ninety-one percent of the study respondents had heard or read about epilepsy or knew someone who had epilepsy and had seen someone having a seizure. Thirty-seven percent of the respondents did not know the cause of epilepsy, while 29% cited genetic causes. About seventeen percent of the subjects believed that epilepsy is contagious. Only 5.6% (21/377) of the respondents would take a patient with epilepsy to hospital for treatment. Conclusion: Adults in Mukono are very acquainted with epilepsy but have many erroneous beliefs about the condition. Negative attitudes are pervasive within communities in Uganda. The national epilepsy awareness programs need to clarify the purported modes of transmission of epilepsy, available treatment options, and care offered during epileptic seizures during community sensitizations in our settings.
A Cross-Sectional Population Survey on Stroke Knowledge and Attitudes in Greater Kampala, Uganda
(Informa UK Limited, 2017-05-19) Kaddumukasa, Mark; Kayima, James; Nakibuuka, Jane; Mugenyi, Levi; Ddumba, Edward; Blixen, Carol; Welter, Elisabeth; Katabira, Elly; Sajatovic, Martha
Background: Stroke is a neurological condition with rapidly increasing burden in many low- and middle income countries. Africa is particularly hard-hit due to rapid population growth, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. Reducing stroke risk factors and teaching people to respond to stroke warning signs can prevent stroke and reduce burden. However, being able to address gaps in knowledge and improving both preventative and early-response care requires a clear understanding of practical and potentially modifiable topics. In this cross sectional study, we assessed the knowledge and attitudes among an urban population residing within the greater Kampala, Uganda. Methods: A population cross sectional survey was conducted in urban Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 440 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire. Results: A total of 440 study participants were enrolled. The leading risk factors for stroke identified by the participants were stress (75.7%) and hypertension (45.2%) respectively. Only two (0.5%) of the study participants identified cigarette smoking as a stroke risk factor. Individuals with hypertension have poor knowledge regarding stroke in spite their high risk for stroke. Conclusion: Stroke knowledge is poor while, stress and hypertension are the leading perceived risk factors in our settings. While stress is contributing factor, hypertension is likely a more amenable and practical intervention target. Targeting individuals with stroke risk factors to increase stroke knowledge and education is crucial for engagement in healthcare. Implementing a self-management program to support and motivate this high-risk group as well as adopting healthy life-styles may be a way to reduce stroke burden in Uganda.
Early Mortality and Functional Outcome After Acute Stroke in Uganda: Prospective Study With 30 day Follow-up
(BioMed Central Ltd, 2015-08-25) Nakibuuka, Jane; Sajatovic, Martha; Nankabirwa, Joaniter; Ssendikadiwa, Charles; Furlan, J. Anthony; Katabira, Elly; Kayima, James; Kalema, Nelson; Byakika‑Tusiime, Jayne; Ddumba, Edward
Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index ≥60) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension
Effect of a 72 Hour Stroke Care Bundle on Early Outcomes After Acute Stroke: A Non Randomised Controlled Study
(PUBLIC LIBRARY SCIENCE , 1160 BATTERY STREET, STE 100, SAN FRANCISCO, USA, CA, 94111, 2016-05-04) Nakibuuka, Jane; Sajatovic, Martha; Nankabirwa, Joaniter; Ssendikadiwa, Charles; Kalema, Nelson; Kwizera, Arthur; Byakika-Tusiime, Jayne; Furlan, J. Anthony; Kayima, James; Ddumba, Edward; Katabira, Elly
Background Integrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda. Methods In a one year non-randomised controlled study, 127 stroke patients who had ‘usual care’ (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group). Patients were consecutively enrolled (controls first, intervention group second) into each group over 5 month periods and followed to 30-days post stroke. Incidence outcomes (mortality and functional ability) were compared using chi square test and adjusted for potential confounders. Kaplan Meier survival estimates and log rank test for comparison were used for time to death analysis for all strokes and by stroke severity categories. Secondary outcomes were in-hospital mortality, median survival time and median length of hospital stay. Results Mortality within 7 days was higher in the intervention group compared to controls (RR 13.1, 95% CI 3.3–52.9). There was no difference in 30-day mortality between the two groups (RR 1.2, 95% CI 0.5–2.6). There was better 30-day survival in patients with severe stroke in the intervention group compared to controls (P = 0.018). The median survival time was 30 days (IQR 29–30 days) in the control group and 30 days (IQR 7–30 days) in the intervention group. In the intervention group, 41patients (32.3%) died in hospital compared to 23 (18.1%) in controls (P < 0.001). The median length of hospital stay was 8 days (IQR 5–12 days) in the controls and 4 days (IQR 2–7 days) in the intervention group. There was no difference in functional outcomes between the groups (RR 0.9, 95% CI 0.4–2.2). Conclusions While implementing elements of a stroke-focused ICP in a Ugandan national referral hospital appeared to have little overall benefit in mortality and functioning, patients with severe stroke may benefit on selected outcomes. More research is needed to better understand how and when stroke protocols should be implemented in sub-Saharan African settings.
Global Medical Education Partnerships to Expand Specialty Expertise: A Case Report on Building Neurology Clinical and Research Capacity
(BMC , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2014-12-30) Kaddumukasa, Mark; Katabira, Elly; Salata, A. Robert; Costa, A Marco; Ddumba, Edward; Furlan, Anthony; Kakooza-Mwesige, Angelina; Kamya, R Moses; Kayima, James; Longenecker, T Chris; Mayanja-Kizza, Harriet; Mondo, Charles; Moore, Shirley; Pundik, Svetlana; Sewankambo, Nelson; Simon, I Daniel; Smyth, A Kathleen; Sajatovic, Martha
Background: Neurological disorders are a common cause of morbidity and mortality in sub-Saharan African, but resources for their management are scarce. Collaborations between training institutions in developed and resource-limited countries can be a successful model for supporting specialty medical education and increasing clinical and research capacity. Case report: This report describes a US National Institutes of Health (NIH) funded Medical Education Partnership Initiative (MEPI) to enhance expertise in neurology, developed between Makerere University College of Health Sciences in Kampala, Uganda, and Case Western Reserve University School of Medicine in Cleveland, OH, USA. This collaborative model is based on a successful medical education and research model that has been developed over the past two decades. The Ugandan and US teams have accumulated knowledge and 'lessons learned' that facilitate specialty expertise in neurological conditions, which are widespread and associated with substantial disability in resource-limited countries. Strengths of the model include a focus on community health care settings and a strong research component. Key elements include strong local leadership; use of remote technology, templates to standardize performance; shared exchanges; mechanisms to optimize sustainability and of dissemination activities that expand impact of the original initiative. Efficient collaborations are further enhanced by external and institutional support, and can be sequentially refined. Conclusion: Models such as the Makerere University College of Health Sciences - Case Western Reserve University partnership may help other groups initiate collaborative education programmes and establish successful partnerships that may provide the opportunity to expand to other chronic diseases. A benefit of collaboration is that learning is two-directional, and interaction with other international medical education collaborators is likely to be of benefit to thelarger global health community.
Knowledge and Attitudes of Parkinson’s Disease in Rural and Urban Mukono District, Uganda: A Cross-Sectional, Community-Based Study
(Hindawi, 2015-11-25) Kaddumukasa, Mark; Kakooza, Angelina; Kaddumukasa, N. Martin; Ddumba, Edward; Mugenyi, Levi; Sajatovic, Martha
Background. Parkinson’s disease (PD) negatively affects the quality of life. There is limited information on PD published from Africa. Lack of adequate knowledge poses a barrier in the provision of appropriate treatment and care for individuals with PD. Methods. A cross-sectional survey was conducted in urban and rural Mukono district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants, interviewed on selected aspects of PD knowledge and attitudes. Results. Of the 377 participants, 47% were from urban settings and 68% (260/377) were women with a median age (IQR) of 34 (26–48) years. Half of the study respondents did not know the body part involved in or apparent cause of PD. Nearly 1/3 of individuals believed that PD is a form of insanity and 17% believed that PD is contagious. Rural dwellers were more likely to have incorrect knowledge regarding selected aspects of PD. Conclusions. Understanding the cause of PD is very limited in our setting. Some beliefs about PD aetiology may potentially worsen stigma and social isolation. This study highlights the need for increasing PD awareness in our settings. Public health approaches that improve knowledge are urgently needed to promote care access and community response to Parkinson’s disease.
Knowledge and Perception of Stroke: A Population-Based Survey in Uganda
(Hindawi Publishing Corporation, 2014) Nakibuuka, Jane; Sajatovic, Martha; Katabira, Elly; Ddumba, Edward; Byakika-Tusiime, Jayne; Furlan, J. Anthony
Purpose. This study, designed to complement a large population survey on prevalence of stroke risk factors, assessed knowledge and perception of stroke and associated factors. Methods. A population survey was conducted in urban Nansana and rural Busukuma, Wakiso district, central Uganda. Adult participants selected by multistage stratified sampling were interviewed about selected aspects of stroke knowledge and perception in a pretested structured questionnaire. Results. There were 1616 participants (71.8% urban; 68.4% female; mean age: 39.6 years ± 15.3). Nearly 3/4 did not know any stroke risk factors and warning signs or recognize the brain as the organ affected. Going to hospital (85.2%) was their most preferred response to a stroke event. Visiting herbalists/traditional healers was preferred by less than 1%. At multivariable logistic regression, good knowledge of stroke warning signs and risk factors was associated with tertiary level of education (OR 4.29, 95% CI 2.13–8.62 and OR 5.96, 95% CI 2.94–12.06), resp.) and self-reported diabetes (OR 1.97, 95% CI 1.18–3.32 and OR 1.84, 95% CI 1.04–3.25), resp.). Conclusion. Knowledge about stroke in Uganda is poor although the planned response to a stroke event was adequate. Educational strategies to increase stroke knowledge are urgently needed as a prelude to developing preventive programmes.
Knowledge, Attitudes and Perceptions of Stroke: A Cross-Sectional Survey in Rural and Urban Uganda
(SPRINGERNATURE , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2015-12-26) Kaddumukasa, Mark; Kayima, James; Kaddumukasa, N. Martin; Ddumba, Edward; Mugenyi, Levi; Pundik, Svetlana; Furlan, J. Anthony; Sajatovic, Martha; Katabira, Elly
Background: Information regarding the increasing burden of non-communicable diseases such as stroke is largely unknown among the vulnerable communities. This analysis, which is part of a larger U.S. National Institute of Heath funded Medical Education Partnership Initiative neurological disorder survey, assessed community knowledge and attitudes on stroke and stroke risk factors. Methods: A population cross-sectional survey was conducted in urban and rural Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire. Results: A total of 377 participants were enrolled (47 % urban). The leading risk factors identified by the participants were stress (36.6 %) and hypertension (28.9 %) respectively. None of the study participants identified cigarette smoking as a stroke risk factor. Seventy six percent of the participants did not recognize stroke as a disease of the brain. Conclusion: Stroke knowledge is poor in both rural and urban Uganda. Tailored public health approaches that improve stroke awareness, knowledge and self management approaches are urgently needed to develop effective preventive measures and community response to stroke
Poor Drug Adherence and Lack of Awareness of Hypertension Among Hypertensive Stroke Patients in Kampala, Uganda: A Cross Sectional Study
(SPRINGERNATURE , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2016-01-02) Mugwano, Isaac; Kaddumukasa, Mark; Mugenyi, Levi; Kayima, James; Ddumba, Edward; Sajatovic, Martha; Sila, Cathy; DeGeorgia, Michael; Katabira, Elly
Background: Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda. Methods: In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data. Results: A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5–75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17 % were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge. Conclusions: Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.
Post-Stroke Depression Among Stroke Survivors Attending Two Hospitals in Kampala Uganda
(MAKERERE UNIV, FAC MED , PO BOX 7072, KAMPALA, UGANDA, 2015-12) Gyagenda, Ogavu Joseph; Ddumba, Edward; Odokonyero, Raymond; Kaddumukasa, Mark; Sajatovic, Martha; Smyth, Kathyleen; Katabira, Elly
Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD. Results: Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD. Conclusion: There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient’s inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.
Prevalence and Incidence of Neurological Disorders Among Adult Ugandans in Rural and Urban Mukono District; A Cross-Sectional Study
(BMC , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2016-11-17) Kaddumukasa, Mark; Mugenyi, Levi; Kaddumukasa, N. Martin; Ddumba, Edward; Devereaux, Michael; Furlan, Anthony; Sajatovic, Martha; Katabira, Elly
Background: The burden of neurological diseases is increasing in developing countries. However, there is a prominent scarcity of literature on the incidence of neurological diseases in sub-Saharan Africa. This study was therefore undertaken to determine the prevalence and incidence of neurological diseases in this setting to serve as a baseline for planning and care for neurological disorders in Uganda. Methods: The study was conducted within rural and urban Mukono district, east of Kampala city of Uganda, central region. Over a period of six months, a cross sectional survey was conducted and screening was performed using a standardized questionnaire. All subjects with neurological symptoms and signs were reviewed by a team of neurologists and neurological diagnoses made. Results: Of the 3000 study subjects, 50.3% (1510/3000) were from the rural setting. Out of the participants screened, 67.4% were female, with a median age of 33 years. Among the 98 subjects with confirmed neurological disorders, the frequency of diseases was as follows; peripheral neuropathy (46.2%), chronic headaches (26.4%), and epilepsy (8.5%), followed by pain syndromes (7.5%), stroke (6.6%) and tremors/Parkinson disease (3.8%). The crude prevalence rates of these disorders (95% CI) were 14.3% (8.5–24.1); 13.3% (7.7–22.8); 33.7% (23.9–47.4) for stroke, epilepsy and peripheral neuropathy respectively. Peripheral neuropathy followed by chronic headaches had the highest estimated incidence/1000 years. Stroke had an estimated incidence of 3.6 new cases with 95% CI of (2.1–6.1)/1000 years. Conclusion: Peripheral neuropathy, chronic headaches and epilepsy disorders are major causes of morbidity in Sub-Saharan settings. There is an urgent need of more robust and powered studies to determine the incidence of these diseases.
Stroke-Risk Factors Differ Between Rural and Urban Communities: Population Survey in Central Uganda
(KARGER , ALLSCHWILERSTRASSE 10, BASEL, SWITZERLAND, CH-4009, 2015-05-07) Nakibuuka, Jane; Sajatovic, Martha; Nankabirwa, Joaniter; Furlan, J. Anthony; Kayima, James; Ddumba, Edward; Katabira, Elly; Byakika-Tusiime, Jayne
Background: Socioeconomic transition is changing stroke risk factors in Sub-Saharan Africa. This study assessed stroke risk factors and their associated characteristics in urban and rural Uganda. Methods: We surveyed 5,420 urban and rural participants and assessed the stroke-risk factor prevalence and socio-behavioural characteristics associated with risk factors. Results: Rural participants were older with higher proportions of men and fewer poor compared to urban areas. The most prevalent modifiable stroke-risk factors in all areas were hypertension (27.1% rural and 22.4% urban, p = 0.004), overweight and obesity (22.0% rural and 42% urban, p < 0.0001), and elevated waist hip ratio (25.8% rural and 24.1% urban, p = 0.045). Diabetes, smoking, physical inactivity, harmful alcohol consumption were found in ≤ 5%. Age, family history of hypertension, and waist hip ratio were associated with hypertension in all, while BMI, HIV were associated with hypertension only in urban dwellers. Sex and family history of hypertension were associated with BMI in while age, socio-economic status and diabetes were associated with BMI only in urban dwellers. Conclusions: The prevalence of stroke-risk factors of diabetes, smoking, inactivity and harmful alcohol consumption was rare in Uganda. Rural dwellers belonging to a higher age group tended to be with hypertension and elevated waist hip ratio. Unlike high-income countries, higher socioeconomic status was associated with overweight and obesity