Journal Articles (Medical School)

Permanent URI for this collectionhttp://hdl.handle.net/20.500.12280/257

Browse

Now showing 1 - 20 of 121

Euthymia in Diabetes
(Springer Nature, 2019-04-22) Kalra, Sanjay; Das, A.K; Baruah, M. P.; Unnikrishnan, A. G.; Dasgupta, Arundhati; Shah, Parag; Sahay, Rakesh; Shukla, Rishi; Das, Sambit; Tiwaskar, Mangesh; Vijayakumar, G.; Chawla, Manoj; Eliana, Fatimah; Suastika, Ketut; Orabi, Abbas; Abdul Rahim, Aly Ahmed; Uloko, Andrew; Lamptey, Roberta; Ngugi, Nancy; Bahendeka, Silver; Abdela, Abdurezak Ahmed; Mohammed, Fariduddin; Pathan, Mohammed Faruque; Rahman, Muhammed Hafizur; Afsana, Faria; Selim, Shajada; Moosa, Muaz; Murad, Moosa; Shreshtha, Pradeep Krishna; Shreshtha, Dina; Giri, Mimi; Hussain, Wiam; Al-Ani, Ahmed; Ramaiya, Kaushik; Singh, Surender; Raza, Syed Abbas; Aye, Than Than; Garusinghe, Chaminda; Muthukuda, Dimuthu; Weerakkody, Muditha; Kahandawa, Shyaminda; Bavuma, Charlotte; Ruder, Sundeep; Vanny, Koy; Khanolkar, Manish; Czupryniak, Leszek
Aim: To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. Background: Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient–provider communication to aid enhancement of coping skills. Results: After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. Conclusions: Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and wellbeing of affected individuals.
Consensus Recommendations on Sulfonylurea and Sulfonylurea Combinations in the Management of Type 2 Diabetes Mellitus – International Task Force
(Indian Journal of Endocrinology and Metabolism, 2018) Kalra, Sanjay; Bahendeka, Silver; Sahay, Rakesh; Ghosh, Sujoy; Md, Fariduddin; Orab, Abbas; Ramaiya, Kaushik; Shammari, Sameer Al; Shrestha, Dina; Shaikh, Khalid; Abhayaratna, Sachitha; Shrestha K, Pradeep; Mahalingam, Aravinthan; Askheta, Mazen; Rahim, Aly Ahmed A; Eliana, Fatimah; Shrestha, Hari K.; Chaudhary, Sandeep; Ngugi, Nancy; Mbanya, Jean Claude; Aye, Than Than; Latt, Tint Swe; Akanov, Zhanay A.; Syed, Abbas Raza; Tandon, Nikhil; Unnikrishnan, A. G.; Madhu, S. V.; Jawa, Ali; Chowdhury, Subhankar; Bajaj, Sarita; Das, Ashok Kumar
For decades, sulfonylureas(SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose‑lowering drugs.
EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management
(PMC, 2019-02-27) Bahendeka, Silver; Kaushik, Ramaiya; Babu Swai, Andrew; Otieno, Fredrick; Bajaj, Sarita; Kalra, Sanjay; Bavuma, Charlotte M; Karigire, Claudine
To date, insulin therapy remains the cornerstone of diabetes management; but the art of injecting insulin is still poorly understood in many health facilities. To address this gap, the Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published recommendations on injection technique after a workshop held in Rome, Italy in 2015. These recommendations are generally applicable to the majority of patients on insulin therapy, athough they do not explore alternative details that may be suitable for low- and middle-income countries. The East Africa Diabetes Study Group sought to address this gap, and furthermore to seek consensus on some of the contextual issues pertaining to insulin therapy within the East African region, specifically focusing on scarcity of resources and its adverse effect on the quality of care. A meeting of health care professionals, experts in diabetes management and patients using insulin, wasconvened in Kigali, Rwanda on 11 March 2018, and the following recommendations were made: (1) insulin should be transported safely, without undue shaking and exposure to high ([32 C) temperature environments. (2) Insulin should not be transported below 0 C. (3) If insulin is to be stored at home for over 2 months, it should be stored at the recommended temperature of 2–8 C. (4) Appropriate instructions should be given to patients while dispensing insulin. (5) Insulin in use should be kept at room temperature and should never be kept immersed under water. Immersing insulin under water after the vial has been pierced carries a high risk of contamination, leading to loss of potency and likelihood of causing injection abscesses. (6) The shortest available needles (4 mm for pen and 6 mm for insulin syringe) should be preferred for all patients. (7) In routine care, intramuscular injections should be avoided, especially with long-acting insulins, as it may result in severe hypoglycaemia. (8) The practice of slanting the needle excessively should be avoided as it results in sub-epidermal injection of insulin which leads to poor absorption and may cause ‘‘tattooing’’ of the skin and scarring. (9) In patients presenting in a wasted state, with ‘‘paperlike skin’’, injections should, if possible, be initiated with pen injection devices, so as to utilise the 4-mm needle without lifting a skin fold (pinching the skin); otherwise lifting of a skin fold is required, if longer needles are utilised. (10) Reuse of needles and syringes is not recommended. However, as the reuse of syringes and needles is practiced for various reasons, and by many patients, individuals should not be given alarming messages; and usage should be limited to discarding when injections become more painful; but at any rate not to exceed reusing a needle more than 5 times.
Perinatal death audits in a peri-urban hospital in Kampala, Uganda
(African health sciences, 2012-12) Nakibuuka, V.K.; Okong, P.; Waiswa, P.; Byaruhanga, R.N.
Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya Hospital. Methods: This was a retrospective descriptive study conducted from March – November 2008. An interdisciplinary hospital team conducted weekly perinatal death reviews. Each case was summarized and discussed, identifying gaps and cause of death. Local solutions were implemented according to the gaps identified from the audit process. Results: Of the 350 perinatal deaths which occurred, 120 perinatal deaths were audited. 34.2% were macerated still births, 31.7% fresh still births and 34.2% early neonatal deaths. Avoidable factors included: poor neonatal resuscitation skills, incorrect use of the partographs and delay in performing caesarean sections. Activities implemented included: three skills sessions of neonatal resuscitation, introduction of Continuous positive airway pressure (CPAP) for babies with respiratory distress, updates on use of partographs. Perinatal mortality rate was 47.9 deaths per 1000 total births in 2008 after introduction of the audits compared to 52.8 per 1,000 total births in 2007. Conclusion: Conducting routine perinatal audits is feasible and contributes to reduction of facility perinatal mortality rate.
Prevalence of hyperglycaemia frst detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya
(BMC, 2017-05-02) Nakabuye, Betty; Bahendeka, Silver; Byaruhanga, Romano
Background: Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to defne hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classifcation, there is yet no sufcient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia frst detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya. Methods: A prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge). Results: 251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia frst detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was signifcantly associated with hyperglycaemia. Conclusion: The prevalence of hyperglycaemia frst detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/beneft implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting.
An exploratory study of men’s companionship, perceptions and experiences during pregnancy and delivery in Uganda2017
(BMC, 2017-06-19) Lwanga, H.; Atuyambe, L.; Sempewo, H.; Lumala, A.; Byaruhanga, R. N. B.
Background: Globally, low involvement of men in maternal health care services remains a problem to health care providers and policy makers. Men’s support is essential for making women’s world better. There are increasing debates among policymakers and researchers on the role of men in maternal health programs, which is a challenge in patriarchal societies like Uganda. The aim of the study was to assess companionship during delivery; men’s perception and experiences during pregnancy and delivery. Methods: This was a descriptive exploratory study using a qualitative approach. This study involved 16 male participants who were present in the labor room during the delivery of their child. In-depth interviews (IDIs) were the main data collection methods used in the study. Purposive sampling was used to select participants who share particular characteristics with the potential of providing rich, relevant, and diverse data. The interviews were tape-recorded with the permission of the participants; in addition, the interviewer took notes. Each interview lasted between 30 and 45 min. The transcripts were entered into ATLAS.ti for analysis. Manifest content analysis was used. Results: The major themes were; feelings about attending child birth, responsibilities during child birth, positive experiences and negative experiences about child birth. Men are willing to participate in child birth and should be encouraged as many are the decision makers in the family. Admission of men into the delivery room, improves family togetherness. The women felt loved and treasured. The men reported bondage to their partners and new born. Conclusions: Men’s involvement in the child birth process was associated with a more perceived bondage with the partner and the newborn. Their presence helped to promote a calm and successful child birth process. Hospitals should work on measures encouraging male involvement.
Women’s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study
(BMC, 2020-11-25) Pilli, Patrick; Sekweyama, Peter; Kayira, Anthony
Background: Emergency peripartum hysterectomy (EPH) is a known remedy for saving women’s lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences. Methods: This was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data. Results: Three major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety. Conclusion: Women experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.
Obesity and type 2 diabetes in sub-Saharan Africans – Is the burden in today’s Africa similar to African migrants in Europe? The RODAM study
(BMC, 2016-10-21) Agyemang, Charles; Meeks, Karlijn; Beune, Erik; Dabo, Ellis Owusu; Mockenhaupt, Frank P; Addo, Juliet; Aikins, Ama de Graf; Bahendeka, Silver; Danquah, Ina; Schulze, Matthias B; Spranger, Joachim; Burr, Tom; Baffour, Peter Agyei; Amoah, Stephen K; Galbete, Cecilia; Henneman, Peter; Grobusch, Kerstin Klipstein; Nicolaou, Mary; Adeyemo, Adebowale; Straalen, Jan van; Smeeth, Liam; Stronks, Karien
Background: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. Methods: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25–70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. Results: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04–13.57; women, 33.9 %; PR: 4.11, 3.13–5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98–37.84; women, 54.2 %; PR: 6.63, 5.04–8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73–5.40; women, 9.2 %; PR: 1.81, 1.25–2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50–7.98; women, 10.2 %; PR: 2.21, 1.30–3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. Conclusion: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
Vitamin B12 Deficiency Among Patients With Diabetes Mellitus: Is Routine Screening and Supplementation Justified?
(Bio Med Central, 2013) Mwebaze, Raymond; Kibirige, Davis
Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus.
Inguinodynia and Inguinal Hernia Recurrence Amongst Ugandan Patients Who Underwent Mesh Versus Non-mesh Inguinal Hernia Repair
(CC BY-NC-ND, 2020-11) Akim, Koma; Nassali, Gorretti; Basimbe, Francis
Introduction: The prevalence of inguinal hernia recurrence dropped tremendously with the advent of mesh hernioplasty. However, the prevalence of inguinodynia has increased. Objective: To determine and compare the prevalence of chronic postoperative inguinal pain (inguinodynia) and recurrence amongst patients who underwent mesh versus no mesh inguinal hernia repair in St. Francis Hospitals Nsambya and Naggalama in Uganda. Method: This was a cohort retrospective study conducted at St Francis Hospitals Nsambya and Naggalama. The sample size was two hundred and two patients. A consecutive sampling technique with replacement of missing charts was used. The Principal Investigator and the research assistants then made telephone calls to the patients inviting them for an interview in the two hospitals, and for those who could not attend questionnaires were administered to them on phone. This was done sequentially until the sample size for each hospital was reached. If a given telephone was not available or went unanswered, we telephoned the next patient in the sequence on the register. Inguinodynia was assessed using the Numerical Rating Pain Score (NPS). Recurrence was assessed by physical examination. Results: Two hundred and two patients were enrolled in the study. The prevalence of chronic postoperative inguinal pain amongst patients who underwent mesh versus non-mesh inguinal hernia repair were 24.4% and 8.5% respectively and the recurrence rates were 3.1% and 4.2% respectively. Conclusion: The prevalence of chronic postoperative pain amongst patients who underwent hernioplasty was higher than those who underwent non-mesh inguinal hernia repair. There was statistically no difference in recurrence rates between patients who underwent mesh versus non-mesh inguinal hernia repair in both hospitals.
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.
Stigma mastery in people living with HIV: gender similarities and theory
(SPRINGER HEIDELBERG , TIERGARTENSTRASSE 17, HEIDELBERG, GERMANY, D-69121, 2021-01-26) Namisi, Patrick Charles; Munene, C. John; Wanyenze, K. Rhoda; Katahoire, R. Anne; Parkes-Ratanshi, M. Rosalinda; Kentutsi, Stella; Nannyonga, M. Maria; Ssentongo, N. Robina; Ogola, K. Mabel; Nabaggala, Sarah Maria; Amanya, Geofrey; Kiragga, N. Agnes; Batamwita, Richard; Tumwesigye, M. Nazarius
Aims This study aimed to determine the prevalence of, factors associated with, and to build a theoretical framework for understanding Internalsed HIV-related Stigma Mastery (IHSM). Methods A cross-sectional study nested within a 2014 Stigma Reduction Cohort in Uganda was used. The PLHIV Stigma Index version 2008, was used to collect data from a random sample of 666 people living with HIV (PLHIV) stratified by gender and age. SPSS24 with Amos27 softwares were used to build a sequential-mediation model. Results The majority of participants were women (65%), aged ≥ 40 years (57%). Overall, IHSM was 45.5% among PLHIV, that increased with age. Specifically, higher IHSM correlated with men and older women “masculine identities” self-disclosure of HIV-diagnosis to family, sharing experiences with peers. However, lower IHSM correlated with feminine gender, the experience of social exclusion stress, fear of future rejection, and fear of social intimacy. Thus, IHSM social exclusion with its negative effects and age-related cognition are integrated into a multidimensional IHSM theoretical framework with a good model-to-data fit. Conclusion Internalised HIV-related Stigma Mastery is common among men and older women. Specificially, “masculine identities” self-disclose their own HIV-positive diagnosis to their family, share experiences with peers to create good relationships for actualising or empowerment in stigma mastery. However, social exclusion exacerbates series of negative effects that finally undermine stigma mastery by young feminine identities. Thus, stigma mastery is best explained by an integrated empowerment framework, that has implications for future practice, policy, and stigma-related research that we discuss.
Implementation of the WHO 2011 Recommendations for Isoniazid Preventive Therapy (IPT) in Children Living With HIV/AIDS: A Ugandan Experience
(LIPPINCOTT WILLIAMS & WILKINS , TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, USA, PA, 19103, 2016) Costenaro, Paola; Massavon, William; Lundin, Rebecca; Nabachwa, M. Sandra; Fregonese, Federica; Morelli, Erika; Alowo, Agnes; Musoke, Nannyonga Maria; Namisi, Charles; Kizito, Susan; Bilardi, Davide; Mazza, Antonio; Cotton, F. Mark; Giaquinto, Carlo; Penazzato, Martina
Background: Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/ IPT clinical algorithm. Methods: Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation. Results: Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT. Conclusion: In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral–therapy-experienced children provides further support to IPT implementation in this population.
Viral Load Detection Using Dried Blood Spots in a Cohort of HIV-1- Infected Children in Uganda: Correlations with Clinical and Immunological Criteria for Treatment Failure
(AMER SOC MICROBIOLOGY , 1752 N ST NW, WASHINGTON, USA, DC, 20036-2904, 2014-07) Costenaro, Paola; Lundin, Rebecca; Petrara, Raffaella Maria; Penazzato, Martina; Massavon, William; Kizito, Susan; Nabachwa, Monica Sandra; Musoke, Nannyonga Maria; Namisi, Charles; Morelli, Erika; Bilardi, Davide; Mazza, Antonio; Zanchetta, Marisa; Giaquinto, Carlo; Rossi, De Anita
Correlations between clinical/immunological treatment failure and viral load (VL) detected by dried blood spot (DBS) sampling were explored in HIV-1-infected children in Uganda. Of 104 children on combined antiretroviral treatment (cART), 12.5% experienced clinical and/or immunological failure, while 28.8%, 44.2%, and 26.9% had VLs of <1,000, 1,000 to 5,000, and >5,000 copies/ml, respectively. Clinical/immunological failure poorly predicted virological failure.
Mentorship Needs at Academic Institutions in Resource-Limited Settings: A Survey at Makerere University College of Health Sciences
(BMC , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2011-07-29) Nakanjako, Damalie; Byakika-Kibwika, Pauline; Kintu, Kenneth; Aizire, Jim; Nakwagala, Fred; Luzige, Simon; Namisi, Charles; Mayanja-Kizza, Harriet; Kamya, R Moses
Background: Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS). Methods: Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes. Results: Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master’s-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions. Conclusions: Both mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.
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.
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
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.
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.
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

Browse

Recent Submissions