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Kibria GMA, Meghani A, Ssemagabo C, Wosu A, Nareeba T, Gyezaho C, Galiwango E, Nanyonga JK, Pariyo GW, Kajungu D, Rutebemberwa E, Gibson DG. Geographical, sex, and socioeconomic differences in non-communicable disease indicators: A cross-sectional survey in Eastern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003308. [PMID: 38865350 PMCID: PMC11168612 DOI: 10.1371/journal.pgph.0003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
The prevalence of non-communicable diseases (NCDs) is increasing in many low- and middle-income countries (LMICs). This study examined differences in the burden of NCDs and their risk factors according to geographic, sex, and sociodemographic characteristics in a rural and peri-urban community in Eastern Uganda. We compared the prevalence by sex, location, wealth, and education. Unadjusted and adjusted prevalence ratios (PR) were reported. Indicators related to tobacco use, alcohol use, salt consumption, fruit/vegetable consumption, physical activity, body weight, and blood pressure were assessed. Among 3220 people (53.3% males, mean age: 35.3 years), the prevalence of NCD burden differed by sex. Men had significantly higher tobacco (e.g., current smoking: 7.6% vs. 0.7%, adjusted PR (APR): 12.8, 95% CI: 7.4-22.3), alcohol use (e.g., current drinker: 11.1% vs. 4.6%, APR: 13.4, 95% CI: 7.9-22.7), and eat processed food high in salt (13.4% vs. 7.1, APR: 1.8, 95% CI: 1.8, 95% CI: 1.4-2.4) than women; however, the prevalence of overweight (23.1% vs 30.7%, APR: 0.7, 95% CI: 0.6-0.9) and obesity (4.1% vs 14.7%, APR: 0.3, 95% CI: 0.2-0.3) was lower among men than women. Comparing locations, peri-urban residents had a higher prevalence of current alcohol drinking, heavy episodic drinking, always/often adding salt while cooking, always eating processed foods high in salt, poor physical activity, obesity, prehypertension, and hypertension than rural residents (p<0.5). When comparing respondents by wealth and education, we found people who have higher wealth or education had a higher prevalence of always/often adding salt while cooking, poor physical activity, and obesity. Although the findings were inconsistent, we observed significant sociodemographic and socioeconomic differences in the burden of many NCDs, including differences in the distributions of behavioral risk factors. Considering the high burden of many risk factors, we recommend appropriate prevention programs and policies to reduce these risk factors' burden and future negative consequences.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ankita Meghani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Charles Ssemagabo
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Adaeze Wosu
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tryphena Nareeba
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Collins Gyezaho
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Edward Galiwango
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Judith Kaija Nanyonga
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - George W. Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dan Kajungu
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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Montgomery L, Misinde C, Komuhangi A, Kawooya AN, Agaba P, McShane CM, Santin O, Apio J, Jenkins C, Githinji F, MacDonald M, Nakaggwa F, Nanyonga RC. Tackling the escalating burden of care in Uganda: a qualitative exploration of the challenges experienced by family carers of patients with chronic non-communicable diseases. BMC Health Serv Res 2023; 23:1356. [PMID: 38053176 PMCID: PMC10696811 DOI: 10.1186/s12913-023-10337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Family carers face challenges that could significantly affect their health and the health of those they care for. However, these challenges are not well documented in low-income settings, including Uganda. We explored the challenges of caring for someone with chronic non-communicable disease (NCD) in Uganda. METHODS We conducted a qualitative exploratory study at Hospice Africa, Uganda (an urban setting) and Hampton Health Center (a rural setting) in Uganda in February and March 2021. Family carers (n = 44) were recruited using snowball and purposive sampling techniques. Data were collected using focus group discussions and in-depth interviews, gathering family carer perspectives of (a) their caring role (b) their support needs, and (c) attitudes of the wider community. In total, four focus group discussions and 10 individual interviews were completed. RESULTS The average age of carers was 46 years old. The majority of family care was provided by female relatives, who also experienced intersectional disadvantages relating to economic opportunities and employment. Family carers carried a huge burden of care, experiencing significant challenges that affected their physical health, and material and emotional well-being. These challenges also affected the quality of care of the patients for whom they cared. Carers struggled to provide for the basic needs of the patient including the provision of medication and transport to health facilities. Carers received no formal training and limited support to carry out the caring role. They reported that they had little understanding of the patient's illness, or how best to provide care. CONCLUSIONS As NCDs continue to rise globally, the role of family caregivers is becoming more prominent. The need to support carers is an urgent concern. Family carer needs should be prioritised in policy and resource allocation. The need for a carer's toolkit of resources, and the enhancement of community support, have been identified.
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Affiliation(s)
- Lorna Montgomery
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK.
| | - Cyprian Misinde
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Alimah Komuhangi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Angela N Kawooya
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Peninah Agaba
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Judith Apio
- School of Nursing and Midwifery, Clarke International University, Kampala, Uganda
| | | | - Florence Githinji
- Quality Assurance Office, Clarke International University, Kampala, Uganda
| | - Mandi MacDonald
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Florence Nakaggwa
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Rose C Nanyonga
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Office of the Vice Chancellor, Clarke International University, Kampala, Uganda
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Wali S, Ssinabulya I, Muhangi CN, Kamarembo J, Atala J, Nabadda M, Odong F, Akiteng AR, Ross H, Mashford-Pringle A, Cafazzo JA, Schwartz JI. Bridging community and clinic through digital health: Community-based adaptation of a mobile phone-based heart failure program for remote communities in Uganda. BMC DIGITAL HEALTH 2023; 1:20. [PMID: 38800672 PMCID: PMC11116269 DOI: 10.1186/s44247-023-00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2024]
Abstract
Background In Uganda, limited healthcare access has created a significant burden for patients living with heart failure. With the increasing use of mobile phones, digital health tools could offer an accessible platform for individualized care support. In 2016, our multi-national team adapted a mobile phone-based program for heart failure self-care to the Ugandan context and found that patients using the system showed improvements in their symptoms and quality of life. With approximately 84% of Ugandans residing in rural communities, the Medly Uganda program can provide greater benefit for communities in rural areas with limited access to care. To support the implementation of this program within rural communities, this study worked in partnership with two remote clinics in Northern Uganda to identify the cultural and service level requirements for the program. Methods Using the principles from community-based research and user-centered design, we conducted a mixed-methods study composed of 4 participatory consensus cycles, 60 semi-structured interviews (SSI) and 8 iterative co-design meetings at two remote cardiac clinics. Patient surveys were also completed during each SSI to collect data related to cell phone access, community support, and geographic barriers. Qualitative data was analyzed using inductive thematic analysis. The Indigenous method of two-eyed seeing was also embedded within the analysis to help promote local perspectives regarding community care. Results Five themes were identified. The burden of travel was recognized as the largest barrier for care, as patients were travelling up to 19 km by motorbike for clinic visits. Despite mixed views on traditional medicine, patients often turned to healers due to the cost of medication and transport. With most patients owning a non-smartphone (n = 29), all participants valued the use of a digital tool to improve equitable access to care. However, to sustain program usage, integrating the role of village health teams (VHTs) to support in-community follow-ups and medication delivery was recognized as pivotal. Conclusion The use of a mobile phone-based digital health program can help to reduce the barrier of geography, while empowering remote HF self-care. By leveraging the trusted role of VHTs within the delivery of the program, this will help enable more culturally informed care closer to home. Supplementary Information The online version contains supplementary material available at 10.1186/s44247-023-00020-5.
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Affiliation(s)
- Sahr Wali
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, R. Fraser Elliott Building, 4th floor, 190 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Isaac Ssinabulya
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, MulagoNational Referral Hospital, Kampala, Uganda
| | | | | | | | - Martha Nabadda
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | | | - Ann R. Akiteng
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, MulagoNational Referral Hospital, Kampala, Uganda
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Angela Mashford-Pringle
- Dalla Lana School of Public Health, Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, Toronto, ON Canada
| | - Joseph A. Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, R. Fraser Elliott Building, 4th floor, 190 Elizabeth St, Toronto, ON M5G 2C4 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON Canada
- Department of Computer Science, University of Toronto, Toronto, ON Canada
| | - Jeremy I. Schwartz
- Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, USA
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Tadege M, Misganaw A, Truneh Z, Tegegne AS. Predictors for the Longevity of People with Diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Diabetes Metab Syndr Obes 2023; 16:1449-1457. [PMID: 37223494 PMCID: PMC10202116 DOI: 10.2147/dmso.s403556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Currently, diabetes is a global health problem and it affects many people, especially in the developing continents. As patients' living conditions improve and the science of medicine advances, the longevity of such patients has increased greatly. Therefore, the purpose of this study was to identify predictors for the association of the longevity of people with diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Methods The study applied a retrospective cohort study design approach. In particular, long rank tests for longevity experience and Cox semi-parametric regression were implemented to compare and investigate the predictors associated with the longevity of patients with diabetes. Results Among all the patients who participated in this study, 56.9% were females and the rest were males. From the Cox regression result, age (AHR = 1.0550, 95% CI: (1.0250, 1.0860), p-value = 0.001), female patients (AHR = 0.2200, 95% CI: (0.0390, 0.5290)), rural patients (AHR = 0.2200, 95% CI: (0.1000, 0.4890), p-value = 0.001), the existence of fasting blood glucose complication (AHR = 1.2040, 95% CI: (1.0930, 1.4460), p-value = 0.001), the existence of blood pressure (AHR = 1.2480, 95% CI: (1.1390, 1.5999), p-value = 0.0180), treatment type, Sulfonylureas (AHR = 4.9970, 95% CI: (1.4140, 17.6550), p-value = 0.0120), treatment type, Sulfonylurea and Metformin (AHR = 5.7200, 95% CI: (1.7780, 18.3990), p-value = 0.0030) were significantly affected the longevity of people with diabetes. Conclusion The findings of the current study showed that the patient's age, sex of patients, residence area, the existence of complications, existence of pressure, and treatment type were major risk factors related to the longevity of people with diabetes. Hence, health-related education should be given to patients who come to take treatment to have better longevity for people with diabetes. More attention should be given to aged patients, male and urban patients, patients under complication treatment, and patients under treatment with single-treatment medication.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
| | - Azmeraw Misganaw
- Department of Statistics, Mettu University, Mettu, Oromia, Ethiopia
| | - Zemenay Truneh
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
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Ingenhoff R, Munana R, Weswa I, Gaal J, Sekitoleko I, Mutabazi H, Bodnar BE, Rabin TL, Siddharthan T, Kalyesubula R, Knauf F, Nalwadda CK. Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda. BMC Public Health 2023; 23:881. [PMID: 37173687 PMCID: PMC10176286 DOI: 10.1186/s12889-023-15704-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Richard Munana
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hillary Mutabazi
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christine K Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Ssekubugu R, Makumbi F, Enriquez R, Lagerström SR, Yeh PT, Kennedy CE, Gray RH, Negesa L, Serwadda DM, Kigozi G, Ekström AM, Nordenstedt H. Cardiovascular (Framingham) and type II diabetes (Finnish Diabetes) risk scores: a qualitative study of local knowledge of diet, physical activity and body measurements in rural Rakai, Uganda. BMC Public Health 2022; 22:2214. [PMID: 36447173 PMCID: PMC9706863 DOI: 10.1186/s12889-022-14620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Non-communicable diseases such as cardiovascular conditions and diabetes are rising in sub-Saharan Africa. Prevention strategies to mitigate non-communicable diseases include improving diet, physical activity, early diagnosis, and long-term management. Early identification of individuals at risk based on risk-score models - such as the Framingham Risk Score (FRS) for 10-year risk of cardiovascular disease and the Finnish type 2 Diabetes risk score (FINDRISC) for type 2 diabetes which are used in high-income settings - have not been well assessed in sub-Saharan Africa. The purpose of this study was to qualitatively assess local knowledge of components of these risk scores in a rural Ugandan setting. METHODS Semi-structured qualitative in-depth interviews were conducted with a purposively selected sample of 15 participants who had responded to the FRS and FINDRISC questionnaires and procedures embedded in the Rakai Community Cohort Study. Data were summarized and categorized using content analysis, with support of Atlas.ti. RESULTS Participants described local terms for hypertension ("pulessa") and type 2 diabetes ("sukaali"). Most participants understood physical activity as leisure physical activity, but when probed would also include physical activity linked to routine farm work. Vegetables were typically described as "plants", "leafy greens", and "side dish". Vegetable and fruit consumption was described as varying seasonally, with peak availability in December after the rainy season. Participants perceived themselves to have good knowledge about their family members' history of type 2 diabetes and hypertension. CONCLUSIONS While most items of the FRS and FINDRISC were generally well understood, physical activity needs further clarification. It is important to consider the seasonality of fruits and vegetables, especially in rural resource-poor settings. Current risk scores will need to be locally adapted to estimate the 10-year risk of cardiovascular diseases and type 2 diabetes in this setting.
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Affiliation(s)
- Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fredrick Makumbi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics-School of Public Health, College of Health Sciences, Makerere University-Kampala, Kampala, Uganda
| | - Rocio Enriquez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Ping Teresa Yeh
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Caitlin E. Kennedy
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ronald H. Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - David M. Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology and Biostatistics-School of Public Health, College of Health Sciences, Makerere University-Kampala, Kampala, Uganda
| | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease Clinic/Venhälsan, South General Hospital Stockholm, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
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Zhang W, Azibani F, Libhaber E, Okello E, Kayima J, Ssinabulya I, Leeta J, Orem J, Sliwa K. Detecting subclinical anthracycline therapy-related cardiac dysfunction in patients attending Uganda Cancer Institute. Future Oncol 2022; 18:2675-2685. [PMID: 35796280 DOI: 10.2217/fon-2022-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To investigate the incidence of anthracycline therapy-related cardiac dysfunction (ATRCD) and its predictors among Ugandan cancer patients. Patients & methods: The study recruited 207 cancer patients who were followed for 6 months after ending anthracycline therapy. Global longitudinal strain and troponin-I were the diagnostic tools. Results & conclusions: The cumulative incidences of subclinical and clinical ATRCD were 35.0 and 8.8% respectively. The predictors of clinical ATRCD were HIV infection (hazard ratio [HR]: 3.04; 95% CI: 1.26-7.32; p = 0.013), lower baseline global longitudinal strain (HR: 0.61; 95% CI: 0.53-0.71; p < 0.001) and development of subclinical ATRCD at the end of anthracycline therapy (HR: 6.61; 95% CI: 2.60-16.82; p < 0.001). Cardiac surveillance at baseline and at ending of anthracycline therapy is essential to identify high-risk patients.
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Affiliation(s)
- Wanzhu Zhang
- Cape Heart Institute, Department of Medicine & Cardiology, Faculty of Health Science, University of Cape Town, Cape Town, 7700, South Africa.,Department of Adult Cardiology, Uganda Heart Institute, Kampala, 7051, Uganda.,Department of Medicine, College of Health Science, Makerere University, Kampala, 7072, Uganda
| | | | - Elena Libhaber
- Cape Heart Institute, Department of Medicine & Cardiology, Faculty of Health Science, University of Cape Town, Cape Town, 7700, South Africa.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Juhanasberg, 2050, South Africa
| | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, 7051, Uganda.,Department of Medicine, College of Health Science, Makerere University, Kampala, 7072, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, 7051, Uganda.,Department of Medicine, College of Health Science, Makerere University, Kampala, 7072, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, 7051, Uganda.,Department of Medicine, College of Health Science, Makerere University, Kampala, 7072, Uganda
| | | | - Jackson Orem
- Department of Medicine, College of Health Science, Makerere University, Kampala, 7072, Uganda.,Uganda Cancer Institute, Kampala, 7242, Uganda
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine & Cardiology, Faculty of Health Science, University of Cape Town, Cape Town, 7700, South Africa
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Ingenhoff R, Nandawula J, Siddharthan T, Ssekitoleko I, Munana R, Bodnar BE, Weswa I, Kirenga BJ, Mutungi G, van der Giet M, Kalyesubula R, Knauf F. Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial. Trials 2022; 23:440. [PMID: 35610712 PMCID: PMC9128241 DOI: 10.1186/s13063-022-06403-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension. METHODS We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. CONCLUSION The results of this study will inform community delivered HTN management across a range of LMIC settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05068505 . Registered on October 6, 2021.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Juliet Nandawula
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Isaac Ssekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | | | - Markus van der Giet
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Uganda Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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10
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Wilkinson R, Garden E, Nanyonga RC, Squires A, Nakaggwa F, Schwartz JI, Heller DJ. Causes of medication non-adherence and the acceptability of support strategies for people with hypertension in Uganda: A qualitative study. Int J Nurs Stud 2021; 126:104143. [PMID: 34953374 DOI: 10.1016/j.ijnurstu.2021.104143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is the most common non-communicable disease in Uganda and its prevalence is predicted to grow substantially over the next several years. Rates of hypertension control remain suboptimal, however, due in part to poor medication adherence. There is a significant need to better understand the drivers of poor medication adherence for patients with non-communicable diseases and to implement appropriate interventions to improve adherence. OBJECTIVE The purpose of this study was two-fold. First, this study sought to understand what factors support or undermine patients' efforts to adhere to their hypertensive medications at baseline. Second, this study sought to explore the acceptability and feasibility of adherence interventions to both providers and patients. METHODS This study was conducted at a large, urban private hospital in Kampala, Uganda. We conducted key informant interviews with both providers and patients. We explored their beliefs about the causes of medication non-adherence while examining the acceptability of support strategies validated in similar contexts, such as: daily text reminders, educational materials on hypertension, monthly group meetings (i.e. "adherence clubs") led by patients or providers, one-on-one appointments with providers, and modified drug dispensing at the hospital pharmacy. STUDY DESIGN AND PARTICIPANTS Fifteen healthcare providers and forty-two patients were interviewed. All interviews were transcribed, and these transcripts were analyzed using the NVIVO software. We utilized a conventional content analysis approach informed by the Health Belief Model. RESULTS Of the proposed interventions, participants expressed particularly strong interest in adherence clubs and educational materials. Participants drew connections between these interventions and previously underexplored drivers of non-adherence, which included the lack of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support. CONCLUSIONS Both providers and patients at the facility recognized medication non-adherence as a major barrier to hypertension control and expressed interest in improving adherence through interventions that addressed context-specific barriers.
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Affiliation(s)
- Rachel Wilkinson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Evan Garden
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Rose Clarke Nanyonga
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | - Allison Squires
- NYU Rory Meyers College of Nursing, 433 1st Avenue New York, NY 10010 USA
| | - Florence Nakaggwa
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | | | - David J Heller
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA.
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11
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Improving Decision-Making for Population Health in Nonhealth Sectors in Urban Environments: the Example of the Transportation Sector in Three Megacities-the 3-D Commission. J Urban Health 2021; 98:60-68. [PMID: 34435262 PMCID: PMC8440744 DOI: 10.1007/s11524-021-00561-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
Abstract
Noncommunicable diseases (NCDs) represent a significant global public health burden. As more countries experience both epidemiologic transition and increasing urbanization, it is clear that we need approaches to mitigate the growing burden of NCDs. Large and growing urban environments play an important role in shaping risk factors that influence NCDs, pointing to the ineluctable need to engage sectors beyond the health sector in these settings if we are to improve health. By way of one example, the transportation sector plays a critical role in building and sustaining health outcomes in urban environments in general and in megacities in particular. We conducted a qualitative comparative case study design. We compared Bus Rapid Transit (BRT) policies in 3 megacities-Lagos (Africa), Bogotá (South America), and Beijing (Asia). We examined the extent to which data on the social determinants of health, equity considerations, and multisectoral approaches were incorporated into local politics and the decision-making processes surrounding BRT. We found that all three megacities paid inadequate attention to health in their agenda-setting, despite having considerable healthy transportation policies in principle. BRT system policies have the opportunity to improve lifestyle choices for NCDs through a focus on safe, affordable, and effective forms of transportation. There are opportunities to improve decision-making for health by involving more available data for health, building on existing infrastructures, building stronger political leadership and commitments, and establishing formal frameworks to improve multisectoral collaborations within megacities. Future research will benefit from addressing the political and bureaucratic processes of using health data when designing public transportation services, the political and social obstacles involved, and the cross-national lessons that can be learned from other megacities.
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12
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Namisango E, Ramsey L, Dandadzi A, Okunade K, Ebenso B, Allsop MJ. Data and information needs of policymakers for palliative cancer care: a multi-country qualitative study. BMC Med Inform Decis Mak 2021; 21:189. [PMID: 34130668 PMCID: PMC8204555 DOI: 10.1186/s12911-021-01555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022] Open
Abstract
Background Despite regional efforts to address concerns regarding the burden of advanced cancer in Africa, urgent attention is still required. Widespread issues include late symptom presentation, inaccessibility of palliative care services, limited resources, poor data quality, disparity in data availability, and lack of stakeholder engagement. One way of helping to address these issues is by understanding and meeting the data and information needs of policymakers in palliative cancer care. Aims To explore the views of policymakers regarding data availability, data gaps and preferred data formats to support policy and decision making for palliative cancer care in Nigeria, Uganda and Zimbabwe. Methods A secondary analysis of interview data collected as part of a cross-sectional qualitative study that aimed to explore the data and information needs of patients, policymakers and caregivers in Nigeria, Uganda and Zimbabwe. Framework analysis, guided by the MEASURE evaluation framework, was used to qualitatively analyse the data. Results Twenty-six policymakers were recruited. The policymakers data and information concerns are aligned to the MEASURE evaluation framework of data and information use and include; assessing and improving data use (e.g. low prioritisation of cancer); identifying and engaging the data user (e.g. data processes); improving data quality (e.g. manual data collection processes); improving data availability (e.g. the accessibility of data); identifying information needs (e.g. what is ‘need to know’?); capacity building in core competencies (e.g. skills gaps); strengthening organisational data demand and use (e.g. policy frameworks); monitoring, evaluating and communicating of data demand and use (e.g. trustworthiness of data). Conclusions We present evidence of data sources, challenges to their access and use, guidance on data needs for policymakers, and opportunities for better engagement between data producers, brokers and users. This framework of evidence should inform the development of strategies to improve data access and use for policy and decision making to improve palliative cancer services in participating countries with relevance to the wider region.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford, UK
| | - Adlight Dandadzi
- University of Zimbabwe-Clinical Trials Research Centre ZW, Harare, Zimbabwe
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
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Zhang W, Azibani F, Okello E, Kayima J, Sinabulya I, Leeta J, Walusansa V, Orem J, Sliwa K. Clinical characterization, cardiovascular risk factor profile and cardiac strain analysis in a Uganda cancer population: The SATRACD study. PLoS One 2021; 16:e0249717. [PMID: 33826674 PMCID: PMC8026039 DOI: 10.1371/journal.pone.0249717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The link between cancer and cardiovascular disease is firmly established. We sought to investigate the prevalence of cardiovascular disease (CVD) risk factors in Uganda cancer patients, their pre-chemotherapy left ventricular strain echocardiographic pattern and its associations with the CVD risk factors. METHODS AND RESULTS Baseline pre-chemotherapy data of patients who were enrolled in the SATRACD study (a cancer cohort, who were planned for anthracycline therapy), were analyzed. The prevalence of cardiovascular risk factors and baseline strain echocardiographic images were assessed. Among the 355 patients who were recruited over a period of 15 months, 283 (79.7%) were female, with a mean age of 43 years. The types of cancer of the study patients included breast cancer (70.6%), lymphomas, sarcomas, leukemias and hepatocellular carcinoma. Hypertension was the most common comorbidity (27.0%). The prevalence of obesity was 12.1% and that of HIV was 18.3%. All patients had a normal left ventricular ejection fraction (LVEF). The mean global longitudinal strain (GLS) was -20.92 ±2.43%, with females having a significantly higher GLS than males (-21.09±2.42 vs -20.25±2.39, p = 0.008). Fifty-three patients (14.9%) had suboptimal GLS (absolute GLS≤18.00%), which was associated with obesity (POR = 3.07; 95% CI, 1.31-6.98; p = 0.003), alcohol use (POR = 1.94; 95% CI, 1.01-3.74; p = 0.044), long QTc interval in electrocardiogram (POR = 2.54; 95% CI, 1.06-5.74; p = 0.015,) and impaired left ventricular relaxation (POR = 2.24; 95% CI, 1.17-4.25; p = 0.007). On multivariable logistic regression analysis, obesity (POR = 2.95; 95% CI, 1.24-7.03; p = 0.014) was the only independent factor associated with suboptimal GLS. CONCLUSION There is high prevalence and a unique pattern of cardiovascular risk factors in Uganda cancer patients. In cancer patients with cardiovascular risk conditions, there is reduction in GLS despite preserved LVEF. Longitudinal research is needed to study the predictive value of cardiovascular risk factors and baseline GLS for post chemotherapy cardiac dysfunction.
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Affiliation(s)
- Wanzhu Zhang
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa
- Uganda Heart Institute, Kampala, Uganda
- College of Health Science, Makerere University, Kampala, Uganda
- * E-mail:
| | - Feriel Azibani
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa
- UMRS 942 Inserm, Paris, France
| | - Emmy Okello
- Uganda Heart Institute, Kampala, Uganda
- College of Health Science, Makerere University, Kampala, Uganda
| | - James Kayima
- Uganda Heart Institute, Kampala, Uganda
- College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Sinabulya
- Uganda Heart Institute, Kampala, Uganda
- College of Health Science, Makerere University, Kampala, Uganda
| | | | | | | | - Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa
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Kintu A, Sando D, Okello S, Mutungi G, Guwatudde D, Menzies NA, Danaei G, Verguet S. Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa. J Int AIDS Soc 2021; 23 Suppl 1:e25508. [PMID: 32562370 PMCID: PMC7305410 DOI: 10.1002/jia2.25508] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. DISCUSSION Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. CONCLUSIONS An expanded agenda for addressing HIV-NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.
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Affiliation(s)
- Alexander Kintu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gerald Mutungi
- Department of Non-Communicable Diseases Prevention and Control, Ministry of Health, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Boudreaux C, Noble C, Coates MM, Kelley J, Abanda M, Kintu A, McLaughlin A, Marx A, Bukhman G. Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response. Glob Health Action 2021; 13:1805165. [PMID: 32873212 PMCID: PMC7782517 DOI: 10.1080/16549716.2020.1805165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Global efforts to address NCDs focus primarily on 4-by-4 interventions – interventions to prevent and treat four groups of conditions affecting mainly older adults (some cardiovascular disease and cancers, type 2 diabetes, chronic respiratory disease) and four associated risk factors (alcohol, tobacco, poor diets, and physical inactivity). However, the NCD burden in Sub-Saharan Africa (SSA) is composed of a more diverse set of conditions, driven by a more complex group of risks, and impacting all segments of the population. Objective To document the NCD priorities identified by NCD strategic plans, to characterize the proposed policy response, and to assess the alignment between the two. Methods Using a two-part conceptual framework, we undertook a descriptive study to characterize the framing and overall policy response of strategic plans from 24 low- and lower-middle-income countries across SSA. Results The national situation assessments that ground strategic plans emphasize a diversity of conditions that range in terms of severity and frequency. These assessments also highlight a wide diversity of factors that shape this burden. Most include discussions of a broad range of behavioral, structural, genetic, and infectious risk factors. Plans endorse a more narrow response to this diverse burden, with a focus on primary and secondary prevention that is generally convergent with the objectives established in global policy documents. Conclusions Broadly, we observe that plans developed by countries in SSA recognize the heterogeneity of the NCD burden in this region. However, they emphasize interventions that are consistent with global strategies focused on preventing a narrower set of cardiometabolic risk factors and their associated diseases. In comparison, relatively few countries detail plans to prevent, treat, and palliate the full scope of the needs they identify. There is a need for increased support for bottom-up planning efforts to address local priorities.
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Affiliation(s)
- Chantelle Boudreaux
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School , Boston, MA, USA
| | - Christopher Noble
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School , Boston, MA, USA
| | - Matthew M Coates
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital , Boston, MA, USA
| | - Jason Kelley
- NCD Synergies Project, Partners in Health , Boston, MA, USA
| | - Martin Abanda
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School , Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, MA, USA
| | - Alexander Kintu
- Department of Global Health, Harvard T.H. Chan School of Public Health , Boston, MA, USA
| | - Amy McLaughlin
- NCD Synergies Project, Partners in Health , Boston, MA, USA
| | - Andrew Marx
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School , Boston, MA, USA
| | - Gene Bukhman
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School , Boston, MA, USA.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital , Boston, MA, USA.,NCD Synergies Project, Partners in Health , Boston, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, MA, USA
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16
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Stephens JH, Addepalli A, Chaudhuri S, Niyonzima A, Musominali S, Uwamungu JC, Paccione GA. Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda. PLoS One 2021; 16:e0247464. [PMID: 33630935 PMCID: PMC7906377 DOI: 10.1371/journal.pone.0247464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Aravind Addepalli
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Shombit Chaudhuri
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Abel Niyonzima
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Sam Musominali
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Jean Claude Uwamungu
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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Vancampfort D, Kimbowa S, Basangwa D, Hallgren M, Van Damme T, Rosenbaum S, Mugisha J. Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with alcohol use disorder. Alcohol 2021; 90:74-79. [PMID: 33422571 DOI: 10.1016/j.alcohol.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
We investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan outpatients with alcohol use disorder (AUD). We also explored practice effects, and assessed the minimal detectable change (MDC) and correlations with the 2MWT. Fifty outpatients [7 women; median age = 32.0 years] performed the 2MWT twice, the 6MWT once, and completed the Simple Physical Activity Questionnaire, Brief Symptoms Inventory-18 (BSI-18), and Alcohol Use Disorders Identification Test. The median (interquartile) 2MWT score on the first and second test were 162.0 (49.0) meters and 161.0 (58.0) meters, respectively, without significant difference between the two trials (p = 0.20). The intraclass correlation between the two 2MWTs was 0.96 (95% confidence interval = 0.94-0.98). The Spearman Rho correlation between the second 2MWT and the 6MWT was 0.91 (p < 0.001). The MDC for the 2MWT was 18 m. There was no evidence of a practice effect. Variance in BSI-18 depression and the presence of leg pain following the 2MWT explained 18.7% of 2MWT score variance. The 2MWT is a reliable and valid fitness test, which can be conducted without any special equipment or substantial time demands in outpatients with AUD.
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Musoke D, Atusingwize E, Ikhile D, Nalinya S, Ssemugabo C, Lubega GB, Omodara D, Ndejjo R, Gibson L. Community health workers' involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda. Global Health 2021; 17:7. [PMID: 33413500 PMCID: PMC7791672 DOI: 10.1186/s12992-020-00653-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-020-00653-5.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Deborah Ikhile
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Damilola Omodara
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Ajisegiri WS, Abimbola S, Tesema AG, Odusanya OO, Ojji DB, Peiris D, Joshi R. Aligning policymaking in decentralized health systems: Evaluation of strategies to prevent and control non-communicable diseases in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000050. [PMID: 36962096 PMCID: PMC10022121 DOI: 10.1371/journal.pgph.0000050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria's health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria's decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are 'top down' in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation.
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Affiliation(s)
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One 2020; 15:e0241555. [PMID: 33362249 PMCID: PMC7757794 DOI: 10.1371/journal.pone.0241555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.
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Affiliation(s)
- Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, United States of America
- * E-mail:
| | - Srish Sharma
- Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Young Professionals Chronic Disease Network, New York, New York, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Stephens JH, Alizadeh F, Bamwine JB, Baganizi M, Chaw GF, Yao Cohen M, Patel A, Schaefle KJ, Mangat JS, Mukiza J, Paccione GA. Managing hypertension in rural Uganda: Realities and strategies 10 years of experience at a district hospital chronic disease clinic. PLoS One 2020; 15:e0234049. [PMID: 32502169 PMCID: PMC7274420 DOI: 10.1371/journal.pone.0234049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
The literature on the global burden of noncommunicable diseases (NCDs) contrasts a spiraling epidemic centered in low-income countries with low levels of awareness, risk factor control, infrastructure, personnel and funding. There are few data-based reports of broad and interconnected strategies to address these challenges where they hit hardest. Kisoro district in Southwest Uganda is rural, remote, over-populated and poor, the majority of its population working as subsistence farmers. This paper describes the 10-year experience of a tri-partite collaboration between Kisoro District Hospital, a New York teaching hospital, and a US-based NGO delivering hypertension services to the district. Using data from patient and pharmacy registers and a random sample of charts reviewed manually, we describe both common and often-overlooked barriers to quality care (clinic overcrowding, drug stockouts, provider shortages, visit non-adherence, and uninformative medical records) and strategies adopted to address these barriers (locally-adapted treatment guidelines, patient-clinic-pharmacy cost sharing, appointment systems, workforce development, patient-provider continuity initiatives, and ongoing data monitoring). We find that: 1) although following CVD risk-based treatment guidelines could safely allocate scarce medications to the highest-risk patients first, national guidelines emphasizing treatment at blood pressures over 140/90 mmHg ignore the reality of "stockouts" and conflict with this goal; 2) often-overlooked barriers to quality care such as poor quality medical records, clinic disorganization and local employment practices are surmountable; 3) cost-sharing initiatives partially fill the gap during stockouts of government supplied medications, but still may be insufficient for the poorest patients; 4) frequent prolonged lapses in care may be the norm for most known hypertensives in rural SSA, and 5) ongoing data monitoring can identify local barriers to quality care and provide the impetus to ameliorate them. We anticipate that our 10-year experience adapting to the complex challenges of hypertension management and a granular description of the solutions we devised will be of benefit to others managing chronic disease in similar rural African communities.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Faraz Alizadeh
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Medical Center/Boston University, Boston, Massachusetts, United States of America
| | - John Bosco Bamwine
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | | | - Gloria Fung Chaw
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Morgen Yao Cohen
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Amit Patel
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - K. J. Schaefle
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Jasdeep Singh Mangat
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | - Joel Mukiza
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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22
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Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, Leung J, Santamauro D, Lund C, Aminde LN, Mayosi BM, Kengne AP, Harris M, Achoki T, Wiysonge CS, Stein DJ, Whiteford H. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017. LANCET GLOBAL HEALTH 2020; 7:e1375-e1387. [PMID: 31537368 DOI: 10.1016/s2214-109x(19)30374-2] [Citation(s) in RCA: 408] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/19/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of non-communicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017. METHODS We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)-with crude counts as well as all-age and age-standardised rates per 100 000 population-with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country's Socio-demographic Index. FINDINGS All-age total DALYs due to NCDs increased by 67·0% between 1990 (90·6 million [95% UI 81·0-101·9]) and 2017 (151·3 million [133·4-171·8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18·6% [95% UI 17·1-20·4] to 29·8% [27·6-32·0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100 000 population) due to NCDs in 2017 (21 757·7 DALYs [95% UI 19 377·1-24 380·7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26 491·6 DALYs [25 165·2-28 129·8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22·9 million (21·5-24·3) DALYs (15·1% of the total NCD burden), after the group of disorders categorised as other NCDs (28·8 million [25·1-33·0] DALYs, 19·1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer). INTERPRETATION NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs. FUNDING Bill & Melinda Gates Foundation, National Health and Medical Research Centre (Australia).
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Affiliation(s)
- Hebe N Gouda
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - Fiona Charlson
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katherine Sorsdahl
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sanam Ahmadzada
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Holly Erskine
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Janni Leung
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian Santamauro
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Crick Lund
- Centre for Global Mental Health, King's Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Bongani M Mayosi
- Dean's Office and Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Andre Pascal Kengne
- Dean's Office and Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Meredith Harris
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Tom Achoki
- MIT Sloan School of Management, Boston, MA, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; South Africa Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Harvey Whiteford
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Nantanda R, Kayingo G, Jones R, van Gemert F, Kirenga BJ. Training needs for Ugandan primary care health workers in management of respiratory diseases: a cross sectional survey. BMC Health Serv Res 2020; 20:402. [PMID: 32393227 PMCID: PMC7212561 DOI: 10.1186/s12913-020-05135-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes. This survey assessed gaps in knowledge and skills among healthcare workers in managing respiratory illnesses. Methods A cross sectional study was conducted among primary care health workers, specialist physicians and healthcare planners to assess gaps in knowledge and skills and, training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians and nurses. Survey Monkey was used to collect data and descriptive statistical analysis was undertaken for quantitative data, while thematic content analysis techniques were utilized to analyze qualitative data. Results A total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialist clinicians and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of the patients in their clinics presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared health workers to manage respiratory diseases. The patients were unsatisfied with the care in primary care and reported that they were often treated for the wrong illnesses. Conclusions Respiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended.
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Affiliation(s)
- Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | | | - Rupert Jones
- Peninsula Medical School, Plymouth University, Plymouth, UK
| | - Frederik van Gemert
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Bruce J Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Muddu M, Tusubira AK, Nakirya B, Nalwoga R, Semitala FC, Akiteng AR, Schwartz JI, Ssinabulya I. Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2020; 1:45. [PMID: 32885202 PMCID: PMC7427847 DOI: 10.1186/s43058-020-00033-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. METHODS We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, healthcare providers, and hypertensive PLHIV (n = 83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. RESULTS Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives and rewards, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy, and planning. The barriers include lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV's inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN, and inadequate planning for integrated HTN/HIV services.Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability, and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. CONCLUSION Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers, and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.
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Affiliation(s)
- Martin Muddu
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), P.O. Box 7587, Kampala, Uganda
| | - Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Brenda Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Rita Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), P.O. Box 7587, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.47100.320000000419368710Section of General Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06511 USA
| | - Isaac Ssinabulya
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.416252.60000 0000 9634 2734Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
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25
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Seeley A, Prynn J, Perera R, Street R, Davis D, Etyang AO. Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis. BMC Med 2020; 18:75. [PMID: 32216794 PMCID: PMC7099775 DOI: 10.1186/s12916-020-01530-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA. METHODS We used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity. RESULTS Thirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes. CONCLUSION Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent. TRIAL REGISTRATION PROSPERO, CRD42019122490. This review was registered in January 2019.
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Affiliation(s)
- Anna Seeley
- Medical Research Council Unit Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK.
- Nuffiend Department of Primary Health Care Sciences, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | - Rachel Perera
- Medical Research Council Unit Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Rebecca Street
- Medical Research Council Unit Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Daniel Davis
- Medical Research Council Unit Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Anthony O Etyang
- Department of Epidemiology and Demography, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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Abstract
AbstractTo tackle malnutrition more effectively, Sub-Saharan African governments have developed overarching, integrative policy strategies over the past decade. Despite their popularity, little is known about their follow-up and ultimately their success (or failure). Consequently, tracking the progress of such political commitment has gained global importance. Various studies provide insights into changes in nutrition-related policies. Nevertheless, it is generally acknowledged that we have limited understanding of how nutrition concerns are explicitly addressed in policies of different ministries. This study uses a novel policy integration perspective to investigate the extent to which eight ministries in Uganda integrated nutrition concerns across their policy outputs between 2001 and 2017. The approach used assumes nutrition policy integration is a dynamic process occurring in different policy dimensions. We performed a qualitative content analysis to assess 103 policy outputs for changes in subsystems involved, policy goals, and instruments used. Overall, we found a shift towards increased integrated government action on nutrition over time. The 2011–2015 analysis period was a critical juncture where increased integration of nutrition was observed in all policy integration dimensions across all ministries. However, considerable variations in actor networks, goals, and instruments exist across sectors and over time. The sustainability of nutrition integration efforts remains contentious, because of which continuous monitoring will be essential.
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Ario AR, Makumbi I, Bulage L, Kyazze S, Kayiwa J, Wetaka MM, Kasule JN, Ocom F. The logic model for Uganda's health sector preparedness for public health threats and emergencies. Glob Health Action 2020; 12:1664103. [PMID: 31526179 PMCID: PMC6758612 DOI: 10.1080/16549716.2019.1664103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Uganda is an ecological hot-spot with infectious disease transmission belts which exacerbates its vulnerability to epidemics. Its proximity to the Congo Basin, climate change pressure on eco-systems, increased international travel and globalization, and influx of refugees due to porous borders, has compounded the problem. Public Health Events are a major challenge in the region with significant impact on Global Health Security. Objective: The country developed a multi-hazard plan with the purpose of harmonizing processes and guiding stakeholders on strengthening emergency preparedness and response. Method: Comprehensive risk profiling, identification of preparedness gaps and capacities were developed using a preparedness logic model, which is a step by step process. A multidisciplinary team was constituted; the Strategic Tool for Analysis of Risks was used for risk profiling and identification of hazards; a desk review of relevant documents informed the process and finally, approval was sought from the National Task Force for public health emergencies. Results: Target users and key public health preparedness and response functions of the multi-hazard plan were identified. The key capabilities identified were: coordination; epidemiology and surveillance; laboratory; risk communication and social mobilization. In each of these capabilities, key players were identified. Risk profiling classified road traffic accident, cholera, malaria and typhoid as very high risk. Meningitis, VHF, drought, industrial accidents, terrorism, floods and landslides were high risk. Hepatitis E, avian influenza and measles were low risk and the only plague fell into the category of very low risk. Risk profiling using STAR yielded good results. All risk categories required additional preparedness activities, and very high and high-risk categories required improved operational response capacity and risk mitigation measures. Conclusion: Uganda successfully developed a national multi-hazard emergency preparedness and response plan using the preparedness logic model. The plan is now ready for implementation by the Uganda MoH and partners.
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Affiliation(s)
- Alex Riolexus Ario
- Ministry of Health of Uganda , Kampala , Uganda.,Uganda Public Health Fellowship Program, Ministry of Health, Kampala , Kampala , Uganda.,Uganda National Institute of Public Health , Kampala , Uganda
| | - Issa Makumbi
- Ministry of Health of Uganda , Kampala , Uganda.,Uganda National Institute of Public Health , Kampala , Uganda.,Public Health Emergency Operations Program , Kampala , Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala , Kampala , Uganda.,African Field Epidemiology Network , Kampala , Uganda
| | - Simon Kyazze
- Ministry of Health of Uganda , Kampala , Uganda.,Public Health Emergency Operations Centre , Kampala , Uganda
| | - Joshua Kayiwa
- Ministry of Health of Uganda , Kampala , Uganda.,Public Health Emergency Operations Centre , Kampala , Uganda
| | - Milton Makoba Wetaka
- Ministry of Health of Uganda , Kampala , Uganda.,Public Health Emergency Operations Centre , Kampala , Uganda
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Nutritional potential of tamarind (Tamarindus indica L.) from semi-arid and subhumid zones of Uganda. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2020. [DOI: 10.1007/s11694-019-00362-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mugisha JO, Seeley J. "We shall have gone to a higher standard": Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care. AAS Open Res 2020; 3:25. [PMID: 35036832 PMCID: PMC8729021 DOI: 10.12688/aasopenres.13049.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones and whether VHTs could be effectively trained to use a smartphone-guided intervention to link older adults with hypertension and diabetes mellitus to care. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.
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Affiliation(s)
- Joseph Okello Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
- Department of Global Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Mugisha JO, Seeley J. "We shall have gone to a higher standard": Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care. AAS Open Res 2020; 3:25. [PMID: 35036832 PMCID: PMC8729021 DOI: 10.12688/aasopenres.13049.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish if VHTs could be effectively trained to use a smart phone guided intervention to link older people with hypertension and diabetes to care. We also explored the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.
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Affiliation(s)
- Joseph Okello Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
- Department of Global Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Ssemugabo C, Rutebemberwa E, Kajungu D, Pariyo GW, Hyder AA, Gibson DG. Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study. JMIR Form Res 2019; 3:e15000. [PMID: 31793889 PMCID: PMC6918213 DOI: 10.2196/15000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Dan Kajungu
- Iganga Mayuge Health and Demographic Surveillance Site, Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Birabwa C, Bwambale MF, Waiswa P, Mayega RW. Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study. BMC Health Serv Res 2019; 19:706. [PMID: 31619234 PMCID: PMC6796349 DOI: 10.1186/s12913-019-4535-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Mulekya F. Bwambale
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Roy W. Mayega
- Department of Epidemiology and Biostatistics, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
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Ssensamba JT, Mukuru M, Nakafeero M, Ssenyonga R, Kiwanuka SN. Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study. BMC Geriatr 2019; 19:256. [PMID: 31533635 PMCID: PMC6749715 DOI: 10.1186/s12877-019-1272-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.
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Affiliation(s)
- Jude Thaddeus Ssensamba
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda. .,Center for Innovations in Health Africa, Plot 1-3 School Road Namuwongo, P.O. Box 220, Kampala, Uganda.
| | - Moses Mukuru
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda
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Dietary patterns and practices in rural eastern Uganda: Implications for prevention and management of type 2 diabetes. Appetite 2019; 143:104409. [PMID: 31445996 DOI: 10.1016/j.appet.2019.104409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 07/30/2019] [Accepted: 08/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The burden of type 2 diabetes in Sub-Saharan Africa is projected to double by 2040, partly attributable to rapidly changing diets. In this paper, we analysed how community members in rural Uganda understood the concept of a healthy or unhealthy diet, food preparation and serving practices to inform the process of facilitating knowledge and skill necessary for self-management and care for type 2 diabetes. This was a qualitative study involving 20 focus group discussions and eight in-depth interviews among those at risk, patients with type 2 diabetes and the general community members without diabetes mellitus. Data was coded and entered into Atlas ti version 7.5.12 and interpreted using thematic analysis. We identified three main themes, which revealed, the perceptions on food and diet concerning health; the social dimensions of food and influence on diet practices; and food as a gendered activity. Participants noted that eating and cooking practices resulted in unhealthy diets. Their practices were affected by beliefs, poverty and food insecurity. Women determined which foods to prepare, but men prepared only some of the foods such as delicacies like a rice dish "pilau." New commercial and processed foods were increasingly available and consumed even in rural areas. Participants linked signs and symptoms of illness to diet as they narrated changes from past to current food preparation behaviours. Their view of overweight and obesity was also gendered and linked to social status. Participants' perception of disease influenced by diet was similar among those with and without type 2 diabetes, and those at risk. People described what is a healthy diet was as recommended by the health workers, but stated that their practices differed greatly from their knowledge. There was high awareness about healthy and balanced diets, but food is entrenched within social and gendered paradigms, which are slowly changing. Social and gender dimensions of food will need to be addressed through interventions in communities to promote change on a society level.
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Ario AR, Bulage L, Kadobera D, Kwesiga B, Kabwama SN, Tusiime P, Wanyenze RK. Uganda public health fellowship program's contribution to building a resilient and sustainable public health system in Uganda. Glob Health Action 2019; 12:1609825. [PMID: 31117889 PMCID: PMC6534252 DOI: 10.1080/16549716.2019.1609825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Low-income countries with relatively weak-health systems are highly vulnerable to public health threats. Effective public health system with a workforce to investigate outbreaks can reduce disease impact on livelihoods and economic development. Building effective public health partnerships is critical for sustainability of such a system. Uganda has made significant progress in responding to emergencies during the past quarter century, but its public health workforce is still inadequate in number and competency. Objectives: To reinforce implementation of priority public health programs in Uganda and cultivate core capacities for compliance with International Health Regulations. Methods: To develop a competent workforce to manage epidemics and improve disease surveillance, Uganda Ministry of Health (MoH) established an advanced-level Field Epidemiology Training Program, called Public Health Fellowship Program (PHFP); closely modelled after the US CDC’s Epidemic Intelligence Service. PHFP is a 2-year, full-time, non-degree granting program targeting mid-career public health professionals. Fellows spend 85% of their field time in MoH placements learning through service delivery and gaining competencies in major domains. Results: During 2015–2018, PHFP enrolled 41 fellows, and graduated 30. Fellows were placed in 19 priority areas at MoH and completed 235 projects (91 outbreaks, 12 refugee assessments, 50 surveillance, and 60 epidemiologic studies, 3 cost analysis and 18 quality improvement); made 194 conference presentations; prepared 63 manuscripts for peer-reviewed publications (27 published as of December 2018); produced MoH bulletins, and developed three case studies. Projects have resulted in public health interventions with improvements in surveillance systems and disease control. Conclusion: During the 4 years of existence, PHFP has contributed greatly to improving real-time disease surveillance and outbreak response core capacities. Enhanced focus on evidence-based targeted approaches has increased effectiveness in outbreak response and control, and integration of PHFP within MoH has contributed to building a resilient and sustainable health system in Uganda.
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Affiliation(s)
- Alex Riolexus Ario
- a Ministry of Health of Uganda , Kampala , Uganda.,b Uganda National Institute of Public Health , Kampala , Uganda.,c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Lilian Bulage
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda.,d African Field Epidemiology Network , Kampala , Uganda
| | - Daniel Kadobera
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Benon Kwesiga
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Steven N Kabwama
- e Uganda Public Health Fellowship Program and Makerere University School of Public Health , Kampala , Uganda
| | - Patrick Tusiime
- a Ministry of Health of Uganda , Kampala , Uganda.,c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Rhoda K Wanyenze
- e Uganda Public Health Fellowship Program and Makerere University School of Public Health , Kampala , Uganda
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Musinguzi G, Wanyenze RK, Ndejjo R, Ssinabulya I, van Marwijk H, Ddumba I, Bastiaens H, Nuwaha F. An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design. BMC Health Serv Res 2019; 19:253. [PMID: 31023311 PMCID: PMC6482572 DOI: 10.1186/s12913-019-4095-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. METHODS The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. DISCUSSION The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.
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Affiliation(s)
- Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harm van Marwijk
- Department of Primary and Interdisciplinary Care, Briton and Sussex University Medical School, Sussex, UK
| | - Isaac Ddumba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Health, Mukono, District, Uganda
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Chang H, Hawley NL, Kalyesubula R, Siddharthan T, Checkley W, Knauf F, Rabin TL. Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals. Int J Equity Health 2019; 18:38. [PMID: 30819193 PMCID: PMC6394065 DOI: 10.1186/s12939-019-0934-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda. METHODS We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. RESULTS The results replicated several findings from other settings, and identified some previously undocumented challenges including patients' knowledge gaps regarding the preventable aspects of HTN and DM, patients' mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management. CONCLUSIONS In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.
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Affiliation(s)
- Haeyoon Chang
- Department of Epidemiology (Chronic Disease), Yale University School of Public Health, New Haven, CT USA
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Disease), Yale University School of Public Health, New Haven, CT USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center for Global Noncommunicable Disease Training and Research, Johns Hopkins University, Baltimore, MD USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center for Global Noncommunicable Disease Training and Research, Johns Hopkins University, Baltimore, MD USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT USA
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
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Rutebemberwa E, Bagonza J, Tweheyo R. Pathways to diabetic care at hospitals in rural Eastern Uganda: a cross sectional study. BMC Health Serv Res 2019; 19:33. [PMID: 30642309 PMCID: PMC6332678 DOI: 10.1186/s12913-019-3873-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prompt access to appropriate treatment reduces early onset of complications to chronic illnesses. Our objective was to document the health providers that patients with diabetes in rural areas seek treatment from before reaching hospitals. Methods Patients attending diabetic clinics in two hospitals of Iganga and Bugiri in rural Eastern Uganda were asked the health providers they went to for treatment before they started attending the diabetic clinics at these hospitals. An exploratory sequential data analysis was used to evaluate the sequential pattern of the types of providers whom patients went to and how they transitioned from one type of provider to another. Results Out of 496 patients assessed, 248 (50.0%) went first to hospitals, 104 (21.0%) to private clinics, 73 (14.7%) to health centres, 44 (8.9%) to drug shops and 27 (5.4%) to other types of providers like community health workers, neighbours and traditional healers. However, a total of 295 (59.5%) went to a second provider, 99 (20.0%) to a third, 32 (6.5%) to a fourth and 15 (3.0%) to a fifth before being enrolled in the hospitals’ diabetic clinics. Although community health workers, drug shops and household neighbours were utilized by 65 (13.1%) patients for treatment first, nobody went to these as a second provider. Instead patients went to hospitals, private clinics and health centres with very few patients going to herbalists. There is no clear pathway from one type of provider to another. Conclusions Patients consult many types of providers before appropriate medical care is received. Communities need to be sensitized on seeking care early from hospitals. Health centres and private clinics need to be equipped to manage diabetes or at least diagnose it and refer patients to hospitals early enough since some patients go to these health centres first for treatment.
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Affiliation(s)
- Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. .,African Centre for Health and Environmental Studies, Kampala, Uganda.
| | - James Bagonza
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Migration Health Department, International Organization for Migration, Freetown, Sierra Leone
| | - Raymond Tweheyo
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health, Lira University, Lira, Uganda
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Measuring health facility readiness and its effects on severe malaria outcomes in Uganda. Sci Rep 2018; 8:17928. [PMID: 30560884 PMCID: PMC6298957 DOI: 10.1038/s41598-018-36249-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
There is paucity of evidence for the role of health service delivery to the malaria decline in Uganda We developed a methodology to quantify health facility readiness and assessed its role on severe malaria outcomes among lower-level facilities (HCIIIs and HCIIs) in the country. Malaria data was extracted from the Health Management Information System (HMIS). General service and malaria-specific readiness indicators were obtained from the 2013 Uganda service delivery indicator survey. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models assessed the effect of facility readiness on malaria deaths and severe cases. Malaria readiness was achieved in one-quarter of the facilities. The composite readiness score explained 48% and 46% of the variation in the original indicators compared to 23% and 27%, explained by the first axis alone for HCIIIs and HCIIs, respectively. Mortality rate was 64% (IRR = 0.36, 95% BCI: 0.14–0.61) and 68% (IRR = 0.32, 95% BCI: 0.12–0.54) lower in the medium and high compared to low readiness groups, respectively. A composite readiness index is more informative and consistent than the one based on the first MCA factorial axis. In Uganda, higher facility readiness is associated with a reduced risk of severe malaria outcomes.
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40
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Ssebuufu R. Double Burden of Disease: A Global Health Challenge. Ann Thorac Surg 2018; 107:1286. [PMID: 30414832 DOI: 10.1016/j.athoracsur.2018.09.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, Ishaka-Bushenyi, PO Box 71, Bushenyi, Uganda.
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Juma PA, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Mapa-tassou C, Oluwasanu M, Oladepo O, Abiona O, Nkhata MJ, Wisdom JP, Mbanya JC. Non-communicable disease prevention policy process in five African countries. BMC Public Health 2018; 18:961. [PMID: 30168393 PMCID: PMC6117619 DOI: 10.1186/s12889-018-5825-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing further burden to the health care systems that are least equipped to deal with the challenge. Countries are developing policies to address major NCD risk factors including tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. This paper describes NCD prevention policy development process in five African countries (Kenya, South Africa, Cameroon, Nigeria, Malawi), including the extent to which WHO "best buy" interventions for NCD prevention have been implemented. METHODS The study applied a multiple case study design, with each country as a separate case study. Data were collected through document reviews and key informant interviews with national-level decision-makers in various sectors. Data were coded and analyzed thematically, guided by Walt and Gilson policy analysis framework that examines the context, content, processes and actors in policy development. RESULTS Country-level policy process has been relatively slow and uneven. Policy process for tobacco has moved faster, especially in South Africa but was delayed in others. Alcohol policy process has been slow in Nigeria and Malawi. Existing tobacco and alcohol policies address the WHO "best buy" interventions to some extent. Food-security and nutrition policies exist in almost all the countries, but the "best buy" interventions for unhealthy diet have not received adequate attention in all countries except South Africa. Physical activity policies are not well developed in any study countries. All have recently developed NCD strategic plans consistent with WHO global NCD Action Plan but these policies have not been adequately implemented due to inadequate political commitment, inadequate resources and technical capacity as well as industry influence. CONCLUSION NCD prevention policy process in many African countries has been influenced both by global and local factors. Countries have the will to develop NCD prevention policies but they face implementation gaps and need enhanced country-level commitment to support policy NCD prevention policy development for all risk factors and establish mechanisms to attain better policy outcomes while considering other local contextual factors that may influence policy implementation such as political support, resource allocation and availability of local data for monitoring impacts.
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Affiliation(s)
- Pamela A. Juma
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Clarisse Mapa-tassou
- African Regional Health Education Centre, Department of Health Promotion and Education, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Mojisola Oluwasanu
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | | | - Opeyemi Abiona
- Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Misheck J. Nkhata
- Anthropology Department, Catholic University of Malawi, Blantyre, Malawi
| | | | - Jean-Claude Mbanya
- African Regional Health Education Centre, Department of Health Promotion and Education, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
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Juma PA, Mapa-tassou C, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Oluwasanu M, Mbanya JC, Nkhata MJ, Asiki G, Kyobutungi C. Multi-sectoral action in non-communicable disease prevention policy development in five African countries. BMC Public Health 2018; 18:953. [PMID: 30168391 PMCID: PMC6117629 DOI: 10.1186/s12889-018-5826-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors. METHODS The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process. RESULTS The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources. CONCLUSION MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes.
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Affiliation(s)
- Pamela A. Juma
- African Population and Health Research Center, Nairobi, Kenya
| | - Clarisse Mapa-tassou
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | | | | | | | | | - Jean-Claude Mbanya
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Misheck J. Nkhata
- Anthropology Department, Catholic University of Malawi, Chiradzulu, Malawi
- Department of Anthropology, Durham University, Durham, England
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
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Rogers HE, Akiteng AR, Mutungi G, Ettinger AS, Schwartz JI. Capacity of Ugandan public sector health facilities to prevent and control non-communicable diseases: an assessment based upon WHO-PEN standards. BMC Health Serv Res 2018; 18:606. [PMID: 30081898 PMCID: PMC6080524 DOI: 10.1186/s12913-018-3426-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing in prevalence in low-income countries including Uganda. The Uganda Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the capacity of public sector health facilities to address NCDs is limited. Methods We developed a survey guided by the literature and the standards of the World Health Organization Pacakage of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings. We used this tool to conduct a needs assessment in 53 higher-level public sector facilities throughout Uganda, including all Regional Referral Hospitals (RRH) and a purposive sample of General Hospitals (GH) and Health Centre IVs (HCIV), to: (1) assess their capacity to detect and manage NCDs; (2) describe provider knowledge and practices regarding the management of NCDs; and (3) identify areas in need of focused improvement. We collected data on human resources, equipment, NCD screening and management, medicines, and laboratory tests. Descriptive statistics were used to summarize our findings. Results We identified significant resource gaps at all sampled facilities. All facilities reported deficiencies in NCD screening and management services. Less than half of all RRH and GH had an automated blood pressure machine. The only laboratory test uniformly available at all surveyed facilities was random blood glucose. Sub-specialty NCD clinics were available in some facilities with the most common type being a diabetes clinic present at eleven (85%) RRHs. These facilities offered enhanced services to patients with diabetes. Surveyed facilities had limited use of NCD patient registries and NCD management guidelines. Most facilities (46% RRH, 23% GH, 7% HCIV) did not track patients with NCDs by using registries and only 4 (31%) RRHs, 4 (15%) GHs, and 1 (7%) HCIVs had access to diabetes management guidelines. Conclusions Despite inter-facility variability, none of the facilities in our study met the WHO-PEN standards for essential tools and medicines to implement effective NCD interventions. In Uganda, improvements in the allocation of human resources and essential medicines and technologies, coupled with uptake in the use of quality assurance modalities are desperately needed in order to adequately address the rapidly growing NCD burden. Electronic supplementary material The online version of this article (10.1186/s12913-018-3426-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilary E Rogers
- The Heller School for Social Policy and Management at Brandeis University, Tufts University School of Medicine, Boston, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communiable Diseases, Kampala, Uganda
| | - Gerald Mutungi
- Uganda Initiative for Integrated Management of Non-Communiable Diseases, Kampala, Uganda.,Programme for the Prevention and Control of Non-Communicable Diseases, Department of Community Health, Government of Uganda Ministry of Health, Kampala, Uganda
| | - Adrienne S Ettinger
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-Communiable Diseases, Kampala, Uganda. .,Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
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Factors Contributing to Late-Stage Breast Cancer Presentation in sub-Saharan Africa. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0278-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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45
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Namuyimbwa L, Atuheire C, Okullo J, Kalyesubula R. Prevalence and associated factors of protein- energy wasting among patients with chronic kidney disease at Mulago hospital, Kampala-Uganda: a cross-sectional study. BMC Nephrol 2018; 19:139. [PMID: 29902980 PMCID: PMC6003131 DOI: 10.1186/s12882-018-0920-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/15/2018] [Indexed: 12/04/2022] Open
Abstract
Background Chronic kidney disease (CKD) is global health concern and priority. It is the 12th leading cause of death worldwide. Protein Energy Wasting occurs in 20–25% of patients with chronic kidney disease and can lead to a high morbidity and mortality rate. We determined the prevalence of protein energy wasting and factors associated among patients with chronic kidney disease at Mulago National Referral Hospital, Kampala, Uganda. Methods We conducted a cross-sectional study recruiting 182 (89 non-CKD patients and 93 CKD patients) consecutively from the outpatient clinic and wards on New Mulago Hospital complex. We took anthropometric measurements including heights, weights, Triceps skin fold (TSF), Mid- Upper Arm circumference (MUAC), Body Mass Index (BMI) and Mid-arm muscle circumference (MAMC). Serum albumin levels and lipid profile levels were also obtained. Following consent of study participants, Data was collected using questionnaires and analyzed using STATA 14.1. Percentages, frequencies, means, medians, standard deviation and interquartile range were used to summarise data. Crude and adjusted binary logistic regression was performed to assess unadjusted and adjusted effect measures of protein energy wasting due to several factors. Stratification by CKD status was performed during the analysis to minimize confounding. Results The median age for CKD patients was 39 years compared to 27 years for non-CKD participants (p < 0.001). The prevalence of protein energy wasting (PEW) was 68.6% in this study with 47.3 and 21.3% among CKD and non-CKD participants respectively. Factors which were associated with PEW included CKD age between 18 and 24, being single, catholic religion, CKD stage 4, Hb < 11.5 g/dl and LDL > 160 mg/dl. Conclusion Protein energy Wasting is prevalent among patients with chronic kidney disease and clinicians should routinely screen for it during patient care. Electronic supplementary material The online version of this article (10.1186/s12882-018-0920-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Namuyimbwa
- Department of Physiology, College of Health Sciences, School of Biomedical sciences, Makerere University, P.O Box 7076, Kampala, Uganda.
| | - Collins Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity (BEP), Makerere University, Kampala, Uganda.,Department of Public Health, School of Allied Health Sciences, Kampala International University, Bushenyi, Kampala, Uganda
| | - Joel Okullo
- Department of Physiology, College of Health Sciences, School of Biomedical sciences, Makerere University, P.O Box 7076, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, College of Health Sciences, School of Biomedical sciences, Makerere University, P.O Box 7076, Kampala, Uganda
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Longenecker CT, Kalra A, Okello E, Lwabi P, Omagino JO, Kityo C, Kamya MR, Webel AR, Simon DI, Salata RA, Costa MA. A Human-Centered Approach to CV Care: Infrastructure Development in Uganda. Glob Heart 2018; 13:347-354. [PMID: 29685638 PMCID: PMC6258347 DOI: 10.1016/j.gheart.2018.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/19/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022] Open
Abstract
In this case study, we describe an ongoing approach to develop sustainable acute and chronic cardiovascular care infrastructure in Uganda that involves patient and provider participation. Leveraging strong infrastructure for HIV/AIDS care delivery, University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University have partnered with U.S. and Ugandan collaborators to improve cardiovascular capabilities. The collaboration has solicited innovative solutions from patients and providers focusing on education and advanced training, penicillin supply, diagnostic strategy (e.g., hand-held ultrasound), maternal health, and community awareness. Key outcomes of this approach have been the completion of formal training of the first interventional cardiologists and heart failure specialists in the country, establishment of 4 integrated regional centers of excellence in rheumatic heart disease care with a national rheumatic heart disease registry, a penicillin distribution and adherence support program focused on retention in care, access to imaging technology, and in-country capabilities to treat advanced rheumatic heart valve disease.
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Affiliation(s)
- Christopher T Longenecker
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Ankur Kalra
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Moses R Kamya
- Department of Medicine, Makerere University School of Medicine, Mulago Hill, Kampala, Uganda
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel I Simon
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert A Salata
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Marco A Costa
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Muddu M, Mutebi E, Ssinabulya I, Kizito S, Mondo CK. Hypertension among newly diagnosed diabetic patients at Mulago National Referral Hospital in Uganda: a cross sectional study. Cardiovasc J Afr 2018; 29:218-224. [PMID: 29750228 PMCID: PMC6421551 DOI: 10.5830/cvja-2018-015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 03/05/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of hypertension in patients with diabetes is approximately two-fold higher than in age-matched subjects without the disease and, conversely, individuals with hypertension are at increased risk of developing diabetes compared with normotensive persons. Up to 75% of cases of cardiovascular disease (CVD) in patients with diabetes are attributed to hypertension. Diabetics who have hypertension are more likely to develop complications and die, and appropriate blood pressure control in these individuals reduces the risk. This study sought to determine the prevalence and factors associated with hypertension among newly diagnosed adult diabetic patients in a national referral hospital in Uganda. METHODS In this cross-sectional study, conducted between June 2014 and January 2015, we recruited 201 newly diagnosed adult diabetic patients. Information on patients' socio-demographics was obtained using a pre-tested questionnaire, while biophysical profile, blood pressure measurement, biochemical testing and echocardiographic findings were obtained by the research team for all the participants. Bivariate and multivariate logistic regression analyses were used to investigate the association of several factors with hypertension. RESULTS Of the 201 patients recruited, 102 were male (50.8%) and the mean age was 46 ± 15 years. The majority of patients (159) had type 2 diabetes mellitus (DM) (79.1%) with a mean HbA1c level of 13.9 ± 5.3%. The prevalence of hypertension was 61.9% (95% CI: 54.8-68.6%). Knowledge of hypertension status was at 56 (27.7%) patients, 24 (44.4%) hypertensives were on treatment, and 19 (33.9%) were using ACE inhibitors/angiotensin receptor blockers. The independent factors associated with hypertension were being employed (OR 0.37, 95% CI: 0.16-0.90, p = 0.029) and being overweight or obese (OR 11.6, 95% CI: 4.29-31.2, p < 0.0001). CONCLUSION The prevalence of hypertension was high in this population of newly diagnosed diabetics, few patients had knowledge of their hypertension status and few were on appropriate treatment. Both modifiable and non-modifiable risk factors were associated with hypertension in this group. Therefore routine assessment, treatment and control of hypertension among diabetics is necessary to prevent cardiovascular complications and death. There is also a need to address the modifiable risk factors.
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Affiliation(s)
- Martin Muddu
- Department of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Mulago, Uganda.
| | - Edrisa Mutebi
- Department of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Mulago, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Mulago, Uganda
| | - Samuel Kizito
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Mulago, Uganda
| | - Charles Kiiza Mondo
- Department of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Mulago, Uganda
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Essue BM, Kapiriri L. The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda. Global Health 2018; 14:22. [PMID: 29463270 PMCID: PMC5819649 DOI: 10.1186/s12992-018-0324-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful. METHODS A mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005-2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework. RESULTS Priority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement. CONCLUSIONS This evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.
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Affiliation(s)
- Beverley M. Essue
- University of Sydney, Sydney, NSW 2006 Australia
- McMaster University, 1280 Main Street W, Hamilton, ON L8S 4K1 Canada
| | - Lydia Kapiriri
- McMaster University, 1280 Main Street W, Hamilton, ON L8S 4K1 Canada
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Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment. PLoS One 2018; 13:e0192332. [PMID: 29420640 PMCID: PMC5805288 DOI: 10.1371/journal.pone.0192332] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Although the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD). Methods We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables. Findings In multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities’ EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048). Conclusion We identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.
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Ojo TT, Hawley NL, Desai MM, Akiteng AR, Guwatudde D, Schwartz JI. Exploring knowledge and attitudes toward non-communicable diseases among village health teams in Eastern Uganda: a cross-sectional study. BMC Public Health 2017; 17:947. [PMID: 29233114 PMCID: PMC5727968 DOI: 10.1186/s12889-017-4954-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community health workers are essential personnel in resource-limited settings. In Uganda, they are organized into Village Health Teams (VHTs) and are focused on infectious diseases and maternal-child health; however, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (NCDs). We sought to assess the knowledge of, and attitudes toward NCDs and NCD care among VHTs in Uganda as a step toward identifying their potential role in community NCD prevention and management. METHODS We administered a knowledge, attitudes and practices questionnaire to 68 VHT members from Iganga and Mayuge districts in Eastern Uganda. In addition, we conducted four focus group discussions with 33 VHT members. Discussions focused on NCD knowledge and facilitators of and barriers to incorporating NCD prevention and care into their role. A thematic qualitative analysis was conducted to identify salient themes in the data. RESULTS VHT members possessed some knowledge and awareness of NCDs but identified a lack of knowledge about NCDs in the communities they served. They were enthusiastic about incorporating NCD care into their role and thought that they could serve as effective conduits of knowledge about NCDs to their communities if empowered through NCD education, the availability of proper reporting and referral tools, and visible collaborations with medical personnel. The lack of financial remuneration for their role did not emerge as a major barrier to providing NCD services. CONCLUSIONS Ugandan VHTs saw themselves as having the potential to play an important role in improving community awareness of NCDs as well as monitoring and referral of community members for NCD-related health issues. In order to accomplish this, they anticipated requiring context-specific and culturally adapted training as well as strong partnerships with facility-based medical personnel. A lack of financial incentivization was not identified to be a major barrier to such role expansion. Developing a role for VHTs in NCD prevention and management should be a key consideration as local and national NCD initiatives are developed.
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Affiliation(s)
- Temitope Tabitha Ojo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Upper Mulago Hill, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Upper Mulago Hill, Kampala, Uganda. .,Section of General Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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