Browsing by Author "Tino, Salome"

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Adverse Pregnancy Outcomes Associated With Moderate Elevations in Blood Pressure or Blood Glucose in Ugandan Women: A Prospective Cohort Study
(Elsevier, 2021-05) Milln, Jack; Nakabuye, Betty; Natamba, Barnabas; Sekitoleko, Isaac; Mubiru, Michael; Namara, Arthur; Tumwesigire, Samuel; Tino, Salome; Mirembe, Mandy; Kakanda, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Kalema, Herbert; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annette; Webb, L. Emily; Nyirenda, J. Maffat
BACKGROUND: The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recentevidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE: This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN: This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization’s criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS: Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36−5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20−2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74−3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17−3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16−2.30). CONCLUSION: Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Antenatal Management and Maternal/fetal Outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda: A prospective cohort study
(BMC, 2021-05-19) Nakabuye, Betty; Sekitoleko, Isaac; Mubiru, Michael; Tumwesigire, Samuel; Tino, Salome; Mirembe, Sandy; Kakande, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Kalema, Herbert; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annettee; Webb, Emily L.; Nyirenda, Moffat J.; Milln, Jack; Natamba, Barnabas Kahiira
Background: Hyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women. Methods: A prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Results: Two hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM. Conclusion: HIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.
Gestational Diabetes (GDM) Does Not Predict Large Birthweight or Perinatal Death in a Relatively Untreated Population in Uganda: A Prospective Observational Cohort Study.
(Elsevier, 2021-05) Milln, Jack; Nakabuye, Betty; Natamba, Barnabas; Sekitoleko, Isaac; Mubiru, Michael; Namara, Arthur; Tumwesigire, Samuel; Tino, Salome; Wilja, Mandy; Kakande, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annettee; Webb, Emily; Nyirenda, Moffat
BACKGROUND The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recent evidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization's criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36–5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20–2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74–3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17–3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16–2.30). CONCLUSION Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Predictors of Loss to Follow up Among Patients With Type 2 Diabetes Mellitus Attending a Private Not For Profit Urban Diabetes Clinic in Uganda – A Descriptive Retrospective Study
(BMC, 2019-08-23) Tino, Salome; Wekesa, Clara; Kamacooko, Onesmus; Makhoba, Anthony; Mwebaze, Raymond; Bengo, Samuel; Nabwato, Rose; Kigongo, Aisha; Ddumba, Edward; Mayanja, N. Billy; Kaleebu, Pontiano; Newton, Rob; Nyerinda, Moffat
Background: Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. Methods: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs). Results: Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. Conclusion: We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients
Prevalence and Factors Associated with Overweight and Obesity Among Patients with Type 2 Diabetes Mellitus in Uganda—A Descriptive Retrospective Study
(BMJ Publishing Group , British Med Assoc House, Tavistock Square, London, England, Wc1h 9jr, 2020) Tino, Salome; Mayanja, Billy N; Mubiru, Michael Charles; Eling, Emmanuel; Ddumba, Edward; Kaleebu, Pontiano; Nyirenda, Moffat
Objectives To assess the prevalence and risk factors of overweight and obesity among type 2 diabetes mellitus (T2DM) patients in Uganda. Design Retrospective chart review. Setting This study was conducted in the outpatient’s T2DM clinic in St. Francis Hospital—Nsambya, Uganda between March and May 2017. Participants Type 2 diabetes patients registered in the diabetes clinic between July 2003 and September 2016. Outcome measures Overweight and obesity defined as body mass index (kg/m2) of 25.0–29.9 and obesity as 30.0 or higher. Results Of 1275T2DM patients, the median age was 54 (IQR: 44–65) years, 770 (60.40%) were females, 887 (69.6%) had hypertension, 385 (28%) had controlled glycaemia, 349 (27%) were obese, while 455 (36%) were overweight. Overweight/obesity were lower among men (OR: 0.45, 95%CI: 0.340 to 0.593, p≤0.001) and among patients aged ≥65 years (OR: 0.52, 95%CI: 0.350 to 0.770, p=0.001); patients who rarely ate fruits and vegetables (OR: 0.66, 95% CI: 0.475 to 0.921, p=0.014) but higher among patients of middle (OR: 1.83, 95%CI: 1.320 to 2.550, p≤0.001) and upper (OR: 2.10, 95%CI: 1.450 to 2.990, p≤0.001) socioeconomic status; on dual therapy (OR: 2.17, 95%CI: 1.024 to 4.604, p=0.043); with peripheral neuropathy (OR: 1.40, 95% CI: 1.039 to 1.834, p=0.026) and hypertension (OR: 1.70, 95% CI: 1.264 to 2.293, p≤0.001). Conclusions Overweight and obesity are high among T2DM patients in this population and may contribute significantly to poor outcomes of T2DM. Therefore, strategies to address this problem are urgently needed.