Browsing by Author "Seeley, Janet"

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Caring for a Stroke Patient: The Burden and Experiences of Primary Caregivers in Uganda: A qualitative Study
(WILEY , 111 RIVER ST, HOBOKEN, USA, NJ, 07030, 2019-07-15) Namale, Gertrude; Kawuma, Rachel; Nalukenge, Winifred; Kamacooko, Onesmus; Yperzeele, Laetitia; Cras, Patrick; Ddumba, Edward; Newton, Robert; Seeley, Janet
Aim: We assessed the burden and experiences of caregivers looking after stroke patients in Kampala, Uganda. Design: We conducted a qualitative cross‐sectional study between May 2018–July 2018 among primary caregivers of stroke patients. Methods: The primary caregiver was defined as the person spending most of the time providing daily care for the stroke patient for at least four months. Purposive sampling was used to consecutively recruit the primary caregivers. In‐depth interviews were conducted, and audiotape recorded, and observations were also made. Data were managed using NVIVO 12.0 following thematic approach. Results: Twenty‐five caregivers were included in the analysis with a mean age of 39.3, SD 10.7. Four themes were identified from the qualitative analysis on caregivers’ experiences of looking after stroke patients: taking on new responsibilities, factors that protected caregivers from breaking down, limited resources and experiences with patient outcomes. Our findings highlight the need for interventions to support stroke patients and their caregivers
Nsambya Community Home-Based Care Complements National HIV and TB Management Efforts and Contributes to Health Systems Strengthening in Uganda: An Observational Study
(HINDAWI LTD , ADAM HOUSE, 3RD FLR, 1 FITZROY SQ, LONDON, ENGLAND, W1T 5HF, 2014-03-06) Massavon, William; Mugenyi, Levi; Nsubuga, Martin; Lundin, Rebecca; Penazzato, Martina; Nannyonga, Maria; Namisi, Charles; Ingabire, Resty; Kalibbala, Daniel; Kironde, Susan; Costenaro, Paola; Bilardi, Davide; Mazza, Antonio; Criel, Bart; Tumwine, K. James; Seeley, Janet; Giaquinto, Carlo
Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala, Uganda. This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.
Predictors of 30-day and 90-day Mortality Among Hemorrhagic and Ischemic Stroke Patients in Urban Uganda: A Prospective Hospital-Based Cohort Study
(BioMed Central Ltd, 2020-10-08) Namale, Gertrude; Kamacooko, Onesmus; Makhoba, Anthony; Mugabi, Timothy; Ndagire, Maria; Ssanyu, Proscovia; Ddamulira, M. John Bosco; Yperzeele, Laetitia; Cras, Patrick; Ddumba, Edward; Seeley, Janet; Newton, Robert
Background: We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods: Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results: We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95%CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion: Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke standard of care in the country
Risk Factors for Hemorrhagic and Ischemic Stroke in Sub-Saharan Africa
(HINDAWI LTD , ADAM HOUSE, 3RD FLR, 1 FITZROY SQ, LONDON, ENGLAND, W1T 5HF, 2018-05-31) Namale, Gertrude; Kamacooko, Onesmus; Kinengyere, Alison; Yperzeele, Laetitia; Cras, Patrick; Ddumba, Edward; Seeley, Janet; Newton, Robert
Introduction. In sub-Saharan Africa (SSA), there is a significant burden of ischemic stroke (IS) and hemorrhagic stroke (HS), although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors. Methods. We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of Controlled Trials (CENTRAL)) case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS in SSA. For each risk factor we calculated random-effects pooled odds ratios (ORs) for case-control studies and pooled prevalence estimates for case series. Results. We identified 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who had diabetes (OR = 2.39; 95% CI: 1.14–5.03) and HIV (OR = 2.46 (95% CI: 1.59–3.81) were at a significantly greater risk of suffering from all stroke types. There were insufficient data to examine these factors by stroke type. Among case series, the pooled prevalence of hypertension was higher for HS than for IS (73.5% versus 62.8%), while diabetes mellitus (DM) and atrial fibrillation (AF) were more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively). Conclusions. There remain too few data from SSA to reliably estimate the effect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases were identified in hospital and so are unlikely to be representative of the totality of stroke cases in the community.