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Izudi J, Bajunirwe F, Cattamanchi A. Negative effects of undernutrition on sputum smear conversion and treatment success among retreatment cases in Uganda: A quasi-experimental study. J Clin Tuberc Other Mycobact Dis 2024; 35:100422. [PMID: 38434999 PMCID: PMC10907175 DOI: 10.1016/j.jctube.2024.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Rationale The causal relationship between undernutrition and response to anti-tuberculosis (TB) treatment and TB treatment outcomes among people with retreatment TB is understudied. Objective To evaluate the effect of undernutrition on treatment success and sputum smear conversion among people with retreatment drug-susceptible TB in Kampala, Uganda. Methods We conducted a quasi-experimental study utilizing propensity score weighting among people with retreatment drug-susceptible TB aged ≥ 15 years treated between 2012 and 2022 in Kampala. The primary exposure was undernutrition assessed using the mid-upper arm circumference at the time of TB diagnosis. The primary outcome was treatment success defined as cure or treatment completion at month 6. Sputum smear conversion was the secondary outcome and was measured as a change in sputum smear status from positive to negative at months 2, 5, and 6. We estimated the causal effect of undernutrition on the outcomes using a propensity-score weighted modified Poisson regression model with robust error variance. Measurements and main results Of the 605 participants, 432 (71.4 %) were male, 215 (35.5 %) were aged 25-34 years, 427 (70.6 %) had bacteriologically confirmed pulmonary TB, 133 (22.0 %) were undernourished and 398 (65.8 %) achieved treatment success. Of participants with bacteriologically confirmed pulmonary TB, 232 (59.0 %), 327 (59.3 %), and 360 (97.6 %) achieved sputum smear conversion at months 2, 5, and 6, respectively. Undernutrition reduced treatment success (RR 0.42, 95 % CI 0.32-0.55) as well as sputum smear conversion at months 2 (RR 0.45, 95 % CI 0.42-0.49) and 5 (RR 0.46, 95 % CI 0.43-0.51) but not month 6 (RR 0.99, 95 % CI 0.97-1.02). Conclusion Undernutrition negatively impacts treatment outcomes. Therefore, nutritional assessment should be an integral component of TB care, with nutritional counseling and support offered to those undernourished to optimize their TB treatment response and outcomes.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
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Makumbi S, Bajunirwe F, Ford D, Turkova A, South A, Lugemwa A, Musiime V, Gibb D, Tamwesigire IK. Voluntariness of consent in paediatric HIV clinical trials: a mixed-methods, cross-sectional study of participants in the CHAPAS-4 and ODYSSEY trials in Uganda. BMJ Open 2024; 14:e077546. [PMID: 38431301 PMCID: PMC10910635 DOI: 10.1136/bmjopen-2023-077546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To examine the voluntariness of consent in paediatric HIV clinical trials and the associated factors. DESIGN Mixed-methods, cross-sectional study combining a quantitative survey conducted concurrently with indepth interviews. SETTING AND PARTICIPANTS From January 2021 to April 2021, we interviewed parents of children on first-line or second-line Anti-retroviral therapy (ART) in two ongoing paediatric HIV clinical trials [CHAPAS-4 (ISRCTN22964075) and ODYSSEY (ISRCTN91737921)] at the Joint Clinical Research Centre Mbarara, Uganda. OUTCOME MEASURES The outcome measures were the proportion of parents with voluntary consent, factors affecting voluntariness and the sources of external influence. Parents rated the voluntariness of their consent on a voluntariness ladder. Indepth interviews described participants' lived experiences and were aimed at adding context. RESULTS All 151 parents randomly sampled for the survey participated (84% female, median age 40 years). Most (67%) gave a fully voluntary decision, with a score of 10 on the voluntariness ladder, whereas 8% scored 9, 9% scored 8, 6% scored 7, 8% scored 6 and 2.7% scored 4. Trust in medical researchers (adjusted OR 9.90, 95% CI 1.01 to 97.20, p=0.049) and male sex of the parent (adjusted OR 3.66, 95% CI 1.00 to 13.38, p=0.05) were positively associated with voluntariness of consent. Prior research experience (adjusted OR 0.31, 95% CI 0.12 to 0.78, p=0.014) and consulting (adjusted OR 0.25. 95% CI 0.10 to 0.60, p=0.002) were negatively associated with voluntariness. Consultation and advice came from referring health workers (36%), spouses (29%), other family members (27%), friends (15%) and researchers (7%). The indepth interviews (n=14) identified the health condition of the child, advice from referring health workers and the opportunity to access better care as factors affecting the voluntariness of consent. CONCLUSIONS This study demonstrated a high voluntariness of consent, which was enhanced among male parents and by parents' trust in medical researchers. Prior research experience of the child and advice from health workers and spouses were negatively associated with the voluntariness of parents' consent. Female parents and parents of children with prior research experience may benefit from additional interventions to support voluntary participation.
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Affiliation(s)
- Shafic Makumbi
- Joint Clinical Research Centre, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Annabelle South
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Victor Musiime
- Joint Clinical Research Centre, Mbarara, Uganda
- Makerere University, Kampala, Uganda
| | - Diana Gibb
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Imelda K Tamwesigire
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Kajabwangu R, Bajunirwe F, Izudi J, Bazira J, Farjardo Y, Ssedyabane F, Lugobe HM, Muhumuza J, Kayondo M, Turanzomwe S, Randall TC, Ngonzi J. Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017-2022. PLOS Glob Public Health 2024; 4:e0002848. [PMID: 38241290 PMCID: PMC10798516 DOI: 10.1371/journal.pgph.0002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024]
Abstract
High-income countries have documented a significant decline in the incidence and mortality of cervical cancer over the past decade but such data from low and middle-income countries such as Uganda is limited to ascertain trends. There is also paucity of data on the burden of cervical cancer in comparison to other gynaecologic malignancies and there is a likelihood that the incidence might be on the rise. To describe the current trends and magnitude of cervical cancer in comparison to other gynaecological malignancies histological types, we conducted a retrospective records review of charts of patients admitted with gynaecological malignancies on the gynaecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022. Of 875 patients with gynaecological malignancies admitted to the MRRH in the 6-year review period, 721 (82.4%) had cervical cancer. Patients with cervical cancer were significantly older than those with other gynaecological malignancies: (50.2±11.5 versus 43.8± 15.0 respectively, p<0.001). Between 2017 and 2022, cervical cancer rates increased by 17% annually compared to other gynaecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046), with the majority of patients of cervical cancer patients (92.7%, n = 668) having squamous cell carcinoma. Most patients (87.9%, n = 634) had late-stage disease (stage 2 and above) and were referred to the Uganda Cancer Institute for chemoradiation. These results imply that there is a need to scale up screening services and other preventive measures such as vaccination against human papilloma virus.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Farjardo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Thomas C. Randall
- Department of Obstetrics and Gynecology, Gynecological Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Kiwanuka GN, Bajunirwe F, Alele PE, Oloro J, Mindra A, Marshall P, Loue S. Public health and research ethics education: the experience of developing a new cadre of bioethicists at a Ugandan institution. BMC Med Educ 2024; 24:1. [PMID: 38172860 PMCID: PMC10763195 DOI: 10.1186/s12909-023-04974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no "gold standard" for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still "foreign" is challenging and necessitates supportive leadership at all institutional levels.
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Affiliation(s)
- Gertrude N Kiwanuka
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Francis Bajunirwe
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Oloro
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Arnold Mindra
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Marshall
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sana Loue
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Izudi J, Bajunirwe F. Case fatality rate for Ebola disease, 1976-2022: A meta-analysis of global data. J Infect Public Health 2024; 17:25-34. [PMID: 37992431 DOI: 10.1016/j.jiph.2023.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023] Open
Abstract
An up-to-date pooled case fatality rate (CFR) for Ebola disease (EBOD) at the global level is lacking. We abstracted EBOD data from 1976 to 2022 for 16 countries and 42 outbreaks to conduct a meta-analysis. The pooled CFR was 60.6% (95% confidence interval (CI) 51.6-69.4; 95% prediction interval 12.9-99.1). Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). The CFR in sub-Saharan Africa was 61.3% (95% CI 52.8-69.6) and for the rest of the world was 24.5% (95% CI 0.0-67.9%). CFR declined over time but stabilized at 61.0% (95% CI, 52.0-69.0) between 2014 and 2022. Overall, the EBOD CFR is still high and heterogeneous. Accordingly, early diagnosis, early treatment if available, and supportive care are important to prevent significant morbidity and mortality.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Bajunirwe F, Nantongo H. Effectiveness and durability of insecticide mixtures for pyrethroid resistance in sub-Saharan Africa. Lancet Infect Dis 2024; 24:11-12. [PMID: 37776875 DOI: 10.1016/s1473-3099(23)00437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Hanifah Nantongo
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Izudi J, Komakech A, Morukileng J, Bajunirwe F. Ebola incidence and mortality before and during a lockdown: The 2022 epidemic in Uganda. PLOS Glob Public Health 2023; 3:e0002702. [PMID: 38133997 PMCID: PMC10745136 DOI: 10.1371/journal.pgph.0002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
On September 20, 2022, an Ebola Disease (EBOD) outbreak was declared in Mubende district, Central Uganda. Following a rapid surge in the number of cases and mortality, the Government of Uganda imposed a lockdown in the two most affected districts, Mubende and Kassanda. We describe the trends in EBOD incidence and mortality nationally and in the two districts before and during the lockdown and the lessons learned during the epidemic response. We retrieved data from the Ministry of Health situation reports from September 20, 2022, when the EBOD outbreak was declared until November 26, 2022, when the lockdown ended. We graphed trends in EBOD morbidity and mortality during a 3-week and 6-week lockdown, computed the EBOD case fatality rate, and summarized the major lessons learned during the epidemic response. We found case fatality rate during the pre-lockdown, 3-week lockdown, and 6-week lockdown period was 37.9% (22/58), 39.3% (53/135), and 38.7% (55/142), respectively. In the early weeks of the lockdown, EBOD incidence and mortality increased nationally and in Kassanda district while Mubende district registered a decline in incidence and stagnation in mortality. With the extension of the lockdown to six weeks, the EBOD incidence and mortality during the 4-6-week lockdown declined compared to the pre-lockdown period. In conclusion, the EBOD incidence and mortality remained higher in the early weeks of the lockdown than during the pre-lockdown period nationally and in one of the two districts. With extended lockdown, incidence and mortality dropped in the 4-6-week period than the pre-lockdown period. Therefore, reliance on known public health measures to control an EBOD outbreak is important.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Allan Komakech
- Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Job Morukileng
- Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Ericson JE, Burgoine K, Kumbakumba E, Ochora M, Hehnly C, Bajunirwe F, Bazira J, Fronterre C, Hagmann C, Kulkarni AV, Kumar MS, Magombe J, Mbabazi-Kabachelor E, Morton SU, Movassagh M, Mugamba J, Mulondo R, Natukwatsa D, Kaaya BN, Olupot-Olupot P, Onen J, Sheldon K, Smith J, Ssentongo P, Ssenyonga P, Warf B, Wegoye E, Zhang L, Kiwanuka J, Paulson JN, Broach JR, Schiff SJ. Neonatal Paenibacilliosis: Paenibacillus Infection as a Novel Cause of Sepsis in Term Neonates With High Risk of Sequelae in Uganda. Clin Infect Dis 2023; 77:768-775. [PMID: 37279589 PMCID: PMC10495130 DOI: 10.1093/cid/ciad337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Paenibacillus thiaminolyticus may be an underdiagnosed cause of neonatal sepsis. METHODS We prospectively enrolled a cohort of 800 full-term neonates presenting with a clinical diagnosis of sepsis at 2 Ugandan hospitals. Quantitative polymerase chain reaction specific to P. thiaminolyticus and to the Paenibacillus genus were performed on the blood and cerebrospinal fluid (CSF) of 631 neonates who had both specimen types available. Neonates with Paenibacillus genus or species detected in either specimen type were considered to potentially have paenibacilliosis, (37/631, 6%). We described antenatal, perinatal, and neonatal characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacilliosis versus clinical sepsis due to other causes. RESULTS Median age at presentation was 3 days (interquartile range 1, 7). Fever (92%), irritability (84%), and clinical signs of seizures (51%) were common. Eleven (30%) had an adverse outcome: 5 (14%) neonates died during the first year of life; 5 of 32 (16%) survivors developed postinfectious hydrocephalus (PIH) and 1 (3%) additional survivor had neurodevelopmental impairment without hydrocephalus. CONCLUSIONS Paenibacillus species was identified in 6% of neonates with signs of sepsis who presented to 2 Ugandan referral hospitals; 70% were P. thiaminolyticus. Improved diagnostics for neonatal sepsis are urgently needed. Optimal antibiotic treatment for this infection is unknown but ampicillin and vancomycin will be ineffective in many cases. These results highlight the need to consider local pathogen prevalence and the possibility of unusual pathogens when determining antibiotic choice for neonatal sepsis.
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Affiliation(s)
- Jessica E Ericson
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathy Burgoine
- Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Elias Kumbakumba
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ochora
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine Hehnly
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Francis Bajunirwe
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Claudio Fronterre
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Cornelia Hagmann
- Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Abhaya V Kulkarni
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Senthil Kumar
- Harvard T.H. Chan School of Public Health, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Sarah U Morton
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mercedeh Movassagh
- Harvard T.H. Chan School of Public Health, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Mugamba
- CURE Children's Hospital of Uganda, Mbale, Uganda
| | | | | | | | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda
- Department of Public Health, Busitema University, Busitema, Uganda
| | - Justin Onen
- CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Kathryn Sheldon
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jasmine Smith
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Benjamin Warf
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Lijun Zhang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Julius Kiwanuka
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - James R Broach
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Morton SU, Hehnly C, Burgoine K, Ssentongo P, Ericson JE, Kumar MS, Hagmann C, Fronterre C, Smith J, Movassagh M, Streck N, Bebell LM, Bazira J, Kumbakumba E, Bajunirwe F, Mulondo R, Mbabazi-Kabachelor E, Nsubuga BK, Natukwatsa D, Nalule E, Magombe J, Erickson T, Ngonzi J, Ochora M, Olupot-Olupot P, Onen J, Ssenyonga P, Mugamba J, Warf BC, Kulkarni AV, Lane J, Whalen AJ, Zhang L, Sheldon K, Meier FA, Kiwanuka J, Broach JR, Paulson JN, Schiff SJ. Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda: an observational case-control study. Lancet Microbe 2023; 4:e601-e611. [PMID: 37348522 PMCID: PMC10529524 DOI: 10.1016/s2666-5247(23)00106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Paenibacillus thiaminolyticus is a cause of postinfectious hydrocephalus among Ugandan infants. To determine whether Paenibacillus spp is a pathogen in neonatal sepsis, meningitis, and postinfectious hydrocephalus, we aimed to complete three separate studies of Ugandan infants. The first study was on peripartum prevalence of Paenibacillus in mother-newborn pairs. The second study assessed Paenibacillus in blood and cerebrospinal fluid (CSF) from neonates with sepsis. The third study assessed Paenibacillus in CSF from infants with hydrocephalus. METHODS In this observational study, we recruited mother-newborn pairs with and without maternal fever (mother-newborn cohort), neonates (aged ≤28 days) with sepsis (sepsis cohort), and infants (aged ≤90 days) with hydrocephalus with and without a history of neonatal sepsis and meningitis (hydrocephalus cohort) from three hospitals in Uganda between Jan 13, 2016 and Oct 2, 2019. We collected maternal blood, vaginal swabs, and placental samples and the cord from the mother-newborn pairs, and blood and CSF from neonates and infants. Bacterial content of infant CSF was characterised by 16S rDNA sequencing. We analysed all samples using quantitative PCR (qPCR) targeting either the Paenibacillus genus or Paenibacillus thiaminolyticus spp. We collected cranial ultrasound and computed tomography images in the subset of participants represented in more than one cohort. FINDINGS No Paenibacillus spp were detected in vaginal, maternal blood, placental, or cord blood specimens from the mother-newborn cohort by qPCR. Paenibacillus spp was detected in 6% (37 of 631 neonates) in the sepsis cohort and, of these, 14% (5 of 37 neonates) developed postinfectious hydrocephalus. Paenibacillus was the most enriched bacterial genera in postinfectious hydrocephalus CSF (91 [44%] of 209 patients) from the hydrocephalus cohort, with 16S showing 94% accuracy when validated by qPCR. Imaging showed progression from Paenibacillus spp-related meningitis to postinfectious hydrocephalus over 1-3 months. Patients with postinfectious hydrocephalus with Paenibacillus spp infections were geographically clustered. INTERPRETATION Paenibacillus spp causes neonatal sepsis and meningitis in Uganda and is the dominant cause of subsequent postinfectious hydrocephalus. There was no evidence of transplacental transmission, and geographical evidence was consistent with an environmental source of neonatal infection. Further work is needed to identify routes of infection and optimise treatment of neonatal Paenibacillus spp infection to lessen the burden of morbidity and mortality. FUNDING National Institutes of Health and Boston Children's Hospital Office of Faculty Development.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Christine Hehnly
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathy Burgoine
- Neonatal Unit, Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda; Busitema University, Busitema, Uganda
| | - Paddy Ssentongo
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jessica E Ericson
- Division of Pediatric Infectious Disease, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - M Senthil Kumar
- Department of Biostatistics, Harvard T H Chan School of Public Health and Department of Data Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Cornelia Hagmann
- Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, UK
| | - Jasmine Smith
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Mercedeh Movassagh
- Department of Biostatistics, Harvard T H Chan School of Public Health and Department of Data Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Nicholas Streck
- Department of Pathology and Laboratory Medicine Division of Clinical Pathology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lisa M Bebell
- Division of Infectious Diseases, Department of Medicine, Center for Global Health, and Medical Practice Evaluation Center and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Elias Kumbakumba
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Epidemiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | | | | | | | - Tim Erickson
- CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Ochora
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Olupot-Olupot
- Neonatal Unit, Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda; Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda; Busitema University, Busitema, Uganda
| | - Justin Onen
- CURE Children's Hospital of Uganda, Mbale, Uganda; Mulago National Referral Hospital, Makerere University, Kampala, Uganda
| | - Peter Ssenyonga
- CURE Children's Hospital of Uganda, Mbale, Uganda; Mulago National Referral Hospital, Makerere University, Kampala, Uganda
| | - John Mugamba
- CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA, USA
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, ON, Canada
| | - Jessica Lane
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Andrew J Whalen
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lijun Zhang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Kathryn Sheldon
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Frederick A Meier
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julius Kiwanuka
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - James R Broach
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joseph N Paulson
- Department of Data Sciences, N-Power Medicine, Redwood City, CA, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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Izudi J, Okello G, Bajunirwe F. Low treatment success rate among previously treated persons with drug-susceptible pulmonary tuberculosis in Kampala, Uganda. J Clin Tuberc Other Mycobact Dis 2023; 32:100375. [PMID: 37214160 PMCID: PMC10199253 DOI: 10.1016/j.jctube.2023.100375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Rationale In 2017, the treatment regimen for previously treated persons with tuberculosis (TB) changed to a shorter regimen that lasts six months and consists of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol. Few studies have examined treatment success rate (TSR) among previously treated persons with TB including the associated factors. Objective To determine TSR and the associated factors among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen in Kampala, Uganda. Methods We retrieved data (January 2012 and December 2021) across six TB clinics in the Kampala Metropolitan area for all previously treated persons with bacteriologically confirmed pulmonary TB. TSR was defined as cure or treatment completion. Frequencies and percentages for categorical data, and the mean and standard deviation for numerical data were computed. Multivariable modified Poisson regression analysis was performed to identify factors associated with TSR, reported as adjusted risk ratio (aRR) with a 95% confidence interval (CI). Measurements and main results We enrolled 230 participants with a mean age of 34.8±10.6 years. TSR was 52.2% and was associated with Mycobacterium tuberculosis (MTB) sputum smear load of ≥2+ (1-10 or >10 Acid Fast Bacilli (AFB)/Field) (aRR = 0.51; 95% CI, 0.38-0.68), TB/human immunodeficiency virus (HIV) (aRR = 0.67; 95% CI, 0.51-0.88) or unknown HIV serostatus (aRR = 0.42; 95% CI, 0.26-0.68), and digital community-based directly observed therapy short-course (DOTS) (aRR = 0.42; 95% CI, 0.20-0.88). Conclusions The TSR among previously treated persons with bacteriologically confirmed pulmonary TB on a six-month treatment regimen is suboptimal. TSR is less likely for people with TB/HIV co-infection or unknown HIV serostatus, high MTB sputum smear load, and on digital community-based DOTs. We recommend strengthening of TB/HIV collaborative activities and people with TB with high MTB sputum smear load should receive targeted treatment support, and the contextual barriers to digital community DOTS should be addressed.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Gerald Okello
- Makerere University College of Health Sciences, School of Public Health
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda
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Kangwagye P, Bright LW, Atukunda G, Basaza R, Bajunirwe F. Utilization of health insurance by patients with diabetes or hypertension in urban hospitals in Mbarara, Uganda. PLOS Glob Public Health 2023; 3:e0000501. [PMID: 37315042 DOI: 10.1371/journal.pgph.0000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Diabetes and hypertension are among the leading contributors to global mortality and require life-long medical care. However, many patients cannot access quality healthcare due to high out-of-pocket expenditures, thus health insurance would help provide relief. This paper examines factors associated with utilization of health insurance by patients with diabetes or hypertension at two urban hospitals in Mbarara, southwestern Uganda. METHODS We used a cross-sectional survey design to collect data from patients with diabetes or hypertension attending two hospitals located in Mbarara. Logistic regression models were used to examine associations between demographic factors, socio-economic factors and awareness of scheme existence and health insurance utilization. RESULTS We enrolled 370 participants, 235 (63.5%) females and 135 (36.5%) males, with diabetes or hypertension. Patients who were not members of a microfinance scheme were 76% less likely to enrol in a health insurance scheme (OR = 0.34, 95% CI: 0.15-0.78, p = 0.011). Patients diagnosed with diabetes/hypertension 5-9 years ago were more likely to enrol in a health insurance scheme (OR = 2.99, 95% CI: 1.14-7.87, p = 0.026) compared to those diagnosed 0-4 years ago. Patients who were not aware of the existing schemes in their areas were 99% less likely to take up health insurance (OR = 0.01, 95% CI: 0.0-0.02, p < 0.001) compared to those who knew about health insurance schemes operating in the study area. Majority of respondents expressed willingness to join the proposed national health insurance scheme although concerns were raised about high premiums and misuse of funds which may negatively impact decisions to enrol. CONCLUSION Belonging to a microfinance scheme positively influences enrolment by patients with diabetes or hypertension in a health insurance program. Although a small proportion is currently enrolled in health insurance, the vast majority expressed willingness to enrol in the proposed national health insurance scheme. Microfinance schemes could be used as an entry point for health insurance programs for patients in these settings.
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Affiliation(s)
- Peter Kangwagye
- Department of Public Health, Bishop Stuart University, Mbarara, Uganda
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gershom Atukunda
- Department of Public Health, Bishop Stuart University, Mbarara, Uganda
| | - Robert Basaza
- Department of Public Health, Leadership Program, Uganda Christian University, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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12
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Anyanwu MU, Demetrovics Z, Griffiths MD, Horváth Z, Czakó A, Bajunirwe F, Tamwesigire I. Problem Gambling Among Adolescents in Uganda: A Cross-sectional Survey Study. J Gambl Stud 2023; 39:971-985. [PMID: 37029857 PMCID: PMC10175322 DOI: 10.1007/s10899-023-10205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Abstract
In recent years, gambling has evolved and grown substantially with new gambling activities and facilities being introduced, making gambling products and opportunities more available than ever before in Uganda. While the growth of gambling industry is considered to have a beneficial impact on the economy, it is increasingly becoming a social and public health issue especially among a minority of young people who experience problem gambling, which can damage personal, family, vocational, and academic pursuits. The present study estimated the prevalence of problem gambling and identified the socio-demographic, school, environmental and health risks of problem gambling among secondary school students in Mbarara Municipality, Uganda. A cross-sectional study was conducted among secondary school students in Mbarara Municipality. A total of 921 students from 12 schools were recruited using cluster sampling. An ordinal logistic regression model was used to explore the relationship between problem gambling and the socio-demographic, academic, environmental and health variables. Of 905 participants, 362 reported having ever gambled (40%), and 160 were classified as problem gamblers (17.7%; 44.2% among those who had ever gambled). Problem gambling was significantly associated with being male, being non-religious, other religion (African traditional religion), having employment (outside of school), distance to nearest gambling venue, parental gambling, peer gambling, substance use, risky sexual behavior, and psychological distress. The present study found a very high prevalence of problem gambling among Ugandan secondary school students. Therefore, there is need to institute public health measures towards raising awareness, prevention and treatment of problem gambling among Ugandan adolescents.
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Affiliation(s)
- Michael U Anyanwu
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Mark D Griffiths
- International Gaming Research Unit Psychology Department, Nottingham Trent University, Nottingham, UK.
| | - Zsolt Horváth
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Andrea Czakó
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Imelda Tamwesigire
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Izudi J, Bajunirwe F, Cattamanchi A. Increase in rifampicin resistance among people previously treated for TB. Public Health Action 2023; 13:4-6. [PMID: 37152209 PMCID: PMC10162363 DOI: 10.5588/pha.22.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/02/2022] [Indexed: 05/09/2023] Open
Abstract
People previously treated for TB are at a higher risk of rifampicin-resistant or multidrug-resistant TB (RR/MDR-TB). Uganda's recent RR-TB estimates were not updated, including during the COVID-19 pandemic. Using programmatic data (2012-2021), we report on the distribution and trends in RR-TB among people previously treated for bacteriologically confirmed pulmonary TB (BC-PTB) across six TB clinics in Kampala, Uganda. The RR-TB prevalence between 2012 and 2015 was 0% (95% CI 0-2.3). The prevalence rose significantly in recent years to 7.0% (95% CI 4.4-10.8) between 2016 and 2021 (P < 0.001). RR-TB is increasing among people previously treated for BC-PTB in Kampala; surveillance for RR-TB should be enhanced.
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Affiliation(s)
- J Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - F Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - A Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
- Center for Tuberculosis, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
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Adrawa N, Izudi J, Nyeko K, Welikhe E, Kizito BJ, Bajunirwe F. High prevalence of risky sexual behaviour among key populations receiving antiretroviral therapy at a large HIV clinic in northern Uganda. Afr Health Sci 2023; 23:362-372. [PMID: 37545940 PMCID: PMC10398433 DOI: 10.4314/ahs.v23i1.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Risky sexual behaviour (RSB) among key populations pose a significant risk of human immunodeficiency virus (HIV) infection but remains understudied. Objectives We assessed the prevalence and factors associated with RSB among key populations living with HIV (KPLHIV) in the post-conflict region of northern Uganda. Methods We designed a cross-sectional study using secondary data, with the outcome as RSB defined as having multiple sexual partners, or condomless sex in the past 3 months, or sexual intercourse with a commercial sex worker in the past 3 months, or sexual intercourse under the influence of substance use in the past 3 months. We used modified Poisson regression to determine factors associated with RSB, reported as adjusted risk ratio (aRR) with 95% confidence interval (CI). Results We studied 165 participants and 122 (73.9%) reported RSB and this was more likely among heterosexual females (aRR, 2.39; 95% CI, 1.54-3.71), the married (aRR, 1.92; 95% CI, 1.42-2.49) or separated participants (aRR, 1.47; 95% CI, 1.21-1.79), and transgender persons (aRR, 3.71; 95% CI, 2.05-6.71). Conclusions RSB is highly prevalent among KPLHIV in northern Uganda so they should be targeted with HIV prevention and behavioural interventions to prevent potential HIV transmission to the general population.
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Affiliation(s)
- Norbert Adrawa
- The AIDS Support Organization (TASO), Gulu Centre of Clinical Excellence, P. O. BOX 347, Gulu City
| | - Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), P.O.BOX, 1410, Mbarara City
| | - Kenneth Nyeko
- The AIDS Support Organization (TASO), Gulu Centre of Clinical Excellence, P. O. BOX 347, Gulu City
| | - Emma Welikhe
- The AIDS Support Organization (TASO), Gulu Centre of Clinical Excellence, P. O. BOX 347, Gulu City
| | - Bennet Joseph Kizito
- The AIDS Support Organization (TASO), Gulu Centre of Clinical Excellence, P. O. BOX 347, Gulu City
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), P.O.BOX, 1410, Mbarara City
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Muhumuza A, Najjuma JN, MacIntosh H, Sharma N, Singhal N, Hollaar GL, Wishart I, Bajunirwe F, Santorino D. Understanding the barriers and enablers for postgraduate medical trainees becoming simulation educators: a qualitative study. BMC Med Educ 2023; 23:28. [PMID: 36641526 PMCID: PMC9840242 DOI: 10.1186/s12909-022-03995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED INTRODUCTION : There is increasing evidence that Simulation-based learning (SBL) is an effective teaching method for healthcare professionals. However, SBL requires a large number of faculty to facilitate small group sessions. Like many other African contexts, Mbarara University of Science and Technology (MUST) in Uganda has large numbers of medical students, but limited resources, including limited simulation trained teaching faculty. Postgraduate medical trainees (PGs) are often involved in clinical teaching of undergraduates. To establish sustainable SBL in undergraduate medical education (UME), the support of PGs is crucial, making it critical to understand the enablers and barriers of PGs to become simulation educators. METHODS We used purposive sampling and conducted in-depth interviews (IDIs) with the PGs, key informant interviews (KIIs) with university staff, and focus group discussions (FGDs) with the PGs in groups of 5-10 participants. Data collection tools were developed using the Consolidated framework for implementation research (CFIR) tool. Data were analyzed using the rigorous and accelerated data reduction (RADaR) technique. RESULTS We conducted seven IDIs, seven KIIs and four focus group discussions. The barriers identified included: competing time demands, negative attitude towards transferability of simulation learning, inadequacy of medical simulation equipment, and that medical simulation facilitation is not integrated in the PGs curriculum. The enablers included: perceived benefits of medical simulation to medical students plus PGs and in-practice health personnel, favorable departmental attitude, enthusiasm of PGs to be simulation educators, and improved awareness of the duties of a simulation educator. Participants recommended sensitization of key stakeholders to simulation, training and motivation of PG educators, and evaluation of the impact of a medical simulation program that involves PGs as educators. CONCLUSION In the context of a low resource setting with large undergraduate classes and limited faculty members, SBL can assist in clinical skill acquisition. Training of PGs as simulation educators should address perceived barriers and integration of SBL into UME. Involvement of departmental leadership and obtaining their approval is critical in the involvement of PGs as simulation educators.
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Affiliation(s)
- Albert Muhumuza
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Heather MacIntosh
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nishan Sharma
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nalini Singhal
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Ian Wishart
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francis Bajunirwe
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Data Santorino
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Ohurira T, Iyer HS, Wagman JA, Hahn JA, Bajunirwe F. Proximity to Alcohol Sellers and Dose Response Relationship Between Alcohol Consumption With Intimate Partner Violence in Rural Southwestern Uganda. J Interpers Violence 2023; 38:NP1040-NP1059. [PMID: 35438584 DOI: 10.1177/08862605221086648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Intimate partner violence (IPV) is associated with several adverse public health outcomes and alcohol use is one of its risk factors. Proximity to alcohol selling points could be linked with problem drinking and IPV. We aimed to determine whether proximal location to alcohol and intensity of alcohol consumption are associated with IPV in rural southwest Uganda.Methods: We conducted a cross-sectional study in rural southwest Uganda with structured interviews at household level. We used the alcohol use disorders identification test (AUDIT) and the Conflict Tactics Scale to measure past year alcohol consumption and IPV (perpetration and victimization). We estimated Euclidean distances between participants' households and nearest alcohol outlets using geographic information systems. We used generalized estimating equation models to calculate adjusted odds ratios (aOR) for the factors associated with IPV.Results: We enrolled 742 participants and median age was 41 years (inter-quartile range or IQR 32-53) and 52.2% of respondents were male. The overall prevalence of IPV in the past year was 52.2%. In a multivariable regression model, women (aOR = 2.24, 95%CI 1.28, 3.91) compared to men, those living proximal to an alcohol selling point (OR = 1.77, 95% CI 1.38, 2.27) were more likely to experience IPV. There was a dose-response relationship between alcohol consumption and IPV. With non-drinkers as the reference category, the aORs were 4.54 (95% CI 2.04, 10.08) for casual drinkers, 10.53 (95% CI 4.15, 26.77) for hazardous drinkers and 15.31 (95% CI 4.73, 49.54) for alcohol dependent drinkers.Conclusion: IPV is very common and has a dose-response relationship with alcohol consumption and drinking outlet proximity. There is an urgent need for IPV and alcohol interventions programs in these rural communities. Policy to restrict proximity of alcohol outlets to residential locations should be examined as an intervention for alcohol consumption and IPV perpetration.
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Affiliation(s)
- Tushaba Ohurira
- Community Health Department, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hari S Iyer
- 1855Dana-Farber Cancer Institute, Boston, USA
| | - Jennifer A Wagman
- Fielding School of Public Health,25808University of California Los Angeles, Los Angeles CA, USA
| | - Judith A Hahn
- Department of Medicine,12224University of California, San Francisco, CA, USA
| | - Francis Bajunirwe
- Community Health Department, 108123Mbarara University of Science and Technology, Mbarara, Uganda
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Ericson JE, Burgoine K, Hehnly C, Kumbakumba E, Ochora M, Bajunirwe F, Bazira J, Fronterre C, Hagmann C, Kulkarni A, Senthil Kumar M, Magombe J, Mbabazi-Kabachelor E, Morton S, Movassagh M, Mugamba J, Mulondo R, Muwanguzi A, Natukwatsa D, Kaaya BN, Olupot-Olupot P, Onen J, Sheldon K, Smith J, Ssentongo P, Ssenyonga P, Warf B, Wegoye E, Zhang L, Broach J, Kiwanuka J, Paulson J, Schiff S. 1328. Paenibacillosis: An Emerging Cause of Neonatal Sepsis and Postinfectious Hydrocephalus. Open Forum Infect Dis 2022. [PMCID: PMC9752957 DOI: 10.1093/ofid/ofac492.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The etiology of neonatal sepsis is often not identified. Molecular methods can identify pathogens that culture-based methods miss. Most cases of neonatal sepsis globally are treated empirically per WHO guidelines with intravenous ampicillin and gentamicin, which may not be the best regimen for all pathogens. Methods We prospectively enrolled 800 neonates presenting with signs of sepsis to two Ugandan hospitals. Blood and cerebrospinal fluid were subjected to 16S rRNA sequencing, which identified Paenibacillus thiaminolyticus in 33/800 (4%) neonates. We confirmed the presence of P. thiaminolyticus by quantitative polymerase chain reaction (PCR). We describe neonatal and birth characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacillosis. We performed antibiotic susceptibility testing and genomic analyses on three clinical isolates successfully grown in the laboratory. Results Neonates presented at a median age of 3 (1, 7) days. Fever (86%), irritability (78%) and seizures (52%) were common presenting signs (Figure). Most neonates were born vaginally (73%) at a medical facility (79%). Twelve (36%) had an adverse outcome: 5 (15%) neonates died; 4 (14%) survivors developed postinfectious hydrocephalus and three (9%) additional survivors had neurodevelopmental impairment. All three isolates were resistant to vancomycin, two were resistant to penicillin and ampicillin and one was unlikely to be sensitive to ceftriaxone; all were susceptible to gentamicin and meropenem. The genomes of all three strains contained multiple beta-lactamase genes and a cluster of genes that encodes a type IV pilus. Clinical signs at presentation for neonates with good and poor outcomes followng paenibacillosis
![]() Conclusion Molecular methods such as 16S rRNA sequencing and PCR can be used to improve the identification of pathogens causing neonatal sepsis. Paenibacillosis is an important emerging cause of neonatal sepsis in Uganda and is likely an underrecognized cause of postinfectious hydrocephalus in the region and possibly elsewhere. Antibiotics commonly used for neonatal sepsis may be inadequate for the treatment of paenibacillosis. Additional studies to understand the pathophysiology and optimal treatment of this novel infection are urgently needed to prevent neonatal mortality and morbidity including postinfectious hydrocephalus. Disclosures Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant Abhaya Kulkarni, MD, MSc, PhD, Medtronic: Advisor/Consultant.
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Affiliation(s)
| | - Kathy Burgoine
- Mbale Regional Referral Hospital, Mbale, Uganda, Mbale, Mbale, Uganda
| | | | - Elias Kumbakumba
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
| | - Moses Ochora
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
| | - Francis Bajunirwe
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
| | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
| | | | | | | | - M Senthil Kumar
- Harvard T.H. Chan School of Public Health and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Joshua Magombe
- CURE Children's Hospital of Uganda, Mbale, Mbale, Uganda
| | | | | | - Mercedeh Movassagh
- Harvard T.H. Chan School of Public Health and Dana Farber Cancer Institute, Boston, Massachusetts
| | - John Mugamba
- CURE Children's Hospital of Uganda, Mbale, Mbale, Uganda
| | - Ronald Mulondo
- CURE Children's Hospital of Uganda, Mbale, Mbale, Uganda
| | | | | | | | | | - Justin Onen
- CURE Children's Hospital of Uganda, Mbale, Mbale, Uganda
| | | | - Jasmine Smith
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | | | | | - Lijun Zhang
- Penn State College of Medicine, Hershey, Pennsylvania
| | - James Broach
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Julius Kiwanuka
- Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
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Izudi J, Sheira LA, Bajunirwe F, McCoy SI, Cattamanchi A. Effect of 6-month vs. 8-month regimen on retreatment success for pulmonary TB. Int J Tuberc Lung Dis 2022; 26:1188-1190. [PMID: 36447325 PMCID: PMC9728952 DOI: 10.5588/ijtld.22.0357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- J. Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
,African Population and Health Research Center, Nairobi, Kenya
| | - L. A. Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - F. Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - S. I. McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - A. Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, CA, USA
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Bajunirwe F, Semakula D, Izudi J. Career aspirations of specialty among medical students in sub-Saharan Africa: a systematic review and meta-analysis of data from two decades, 2000-2021. BMJ Open 2022; 12:e057020. [PMID: 36028276 PMCID: PMC9422889 DOI: 10.1136/bmjopen-2021-057020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To determine the distribution of career aspirations for the discipline of specialty among undergraduate medical students in sub-Saharan Africa (SSA). DESIGN We searched PubMed/MEDLINE, EMBASE Google Scholar and Google for studies published between 1 January 2000 and 31 June 2021. Two reviewers extracted data from eligible studies, with disagreements resolved through consensus with a third reviewer. The random effects model was used to pool proportions, presented with the corresponding 95% CI. Heterogeneity was assessed using Cochrane's (Q) test but quantified with I2 values. Sources of heterogeneity were checked using meta-regression analysis while publication bias was assessed using funnel plot and Egger's test. SETTING SSA. PARTICIPANTS Undergraduate medical students. OUTCOMES Primary outcome was pooled proportion of career aspirations for the discipline of medical specialty and the secondary outcome was reasons for the specialty selection. RESULTS We identified 789 citations but meta-analysed 32 studies, with an overall sample size of 8231 participants. The most popular career aspiration for the discipline of specialty was surgery (29.5%; 95% CI 25.0% to 34.2%), followed by internal medicine (17.3%, 95% CI 11.7% to 23.7%), and then obstetrics and gynaecology (15.0%, 95% CI 12.3% to 17.9%), and paediatrics (11.3%; 95% CI 9.6% to 13.2%). The less popular medical disciplines of specialty included public health, orthopaedics, ophthalmology, family medicine, pathology, anaesthesiology, dermatology, otolaryngology, psychiatry and emergency medicine. The reasons for the selection of a medical discipline for specialty related to mentor and peer influences, prospect for economic gains, personal factors, long-term career interests and goals and discipline-specific factors. CONCLUSION Surgery is the most preferred career aspiration for medical students in SSA, followed by internal medicine. The choices do not necessarily match the disease burden on the continent and medical schools should consider strengthening career counselling and mentoring in their curriculum. PROSPERO REGISTRATION NUMBER CRD42021260501.
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Affiliation(s)
- Francis Bajunirwe
- Community Health, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Daniel Semakula
- Africa Center for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jonathan Izudi
- Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Nuwagira E, Baluku JB, Meya DB, Philpotts LL, Siedner MJ, Bajunirwe F, Mpagama SG, Lai PS. Burden, clinical features and outcomes of post-tuberculosis lung disease in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e062260. [PMID: 36008068 PMCID: PMC9422857 DOI: 10.1136/bmjopen-2022-062260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) is significantly associated with multiple postinfectious, non-communicable diseases after microbiological cure. For example, those with a history of TB disease have a higher risk of developing chronic lung diseases at a younger age. However, the extent and nature of post-TB complications are not well described. Here, we present a protocol for a systematic review and meta-analysis, which aims to synthesise literature on the burden of post-TB lung disease (PTLD) in sub-Saharan Africa, describe phenotypes, long-term outcomes and the health-related quality of life of people with PTLD. METHODS AND ANALYSIS A systematic search will be conducted using PubMed, EMBASE, Web of Science, African Journals Online and the Cochrane Library of Systematic Reviews. Papers published in English and French languages that report the prevalence, clinical features, quality of life and long-term outcomes of people with PTLD in sub-Saharan Africa will be considered. We will assess and critically appraise the methodological quality of all studies using the modified covidence. Qualitative and quantitative (network and meta-analysis) synthesis will be performed and STATA V.16 will be used to estimate the burden of PTLD. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review and meta-analysis. Our results will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021274018.
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Affiliation(s)
- Edwin Nuwagira
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David B Meya
- Department of Medicine, Makerere University Kampala, Kampala, Uganda
| | - Lisa Liang Philpotts
- Treadwell Virtual Library, Massachusetts General Hospital, Boston, Massachusetts, UK
| | - Mark J Siedner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stella G Mpagama
- Infectious Diseases Unit, Tuberculosis Treatment Center Kibong'oto, Kilimanjaro, Tanzania
| | - Peggy S Lai
- Division of Pulmonology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Izudi J, Okello G, Semakula D, Bajunirwe F. Low condom use at the last sexual intercourse among university students in sub-Saharan Africa: Evidence from a systematic review and meta-analysis. PLoS One 2022; 17:e0272692. [PMID: 35947583 PMCID: PMC9365151 DOI: 10.1371/journal.pone.0272692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background There is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA. Methods In this systematic review and meta-analysis, two reviewers independently searched electronic databases and grey literature for eligible studies published until July 30, 2020, extracted data, and assessed the risk of bias in the included studies. We used the Dersimonian-Liard random-effects model to pool the proportion of condom use at the LSI and the association between condom use at the LSI with sex, age, and condom negotiation efficacy, reported using risk ratio (RR). We assessed publication bias using funnel plot and Egger’s test, and explored sources of heterogeneity using sub-group and meta-regression analyses. Results We meta-analyzed 44 studies with a combined sample size of 27,948 participants.Of 14,778 sexually active participants, 8,744 (pooled proportion, 52.9%; 95% CI, 45.0–60.7; 95% prediction interval, 2.8–98.9; I-squared = 99.0%, p< 0.0001) reported condom use at the LSI and the proportion of condom use at the LSI remained stagnant between 2000 and 2019 (p = 0.512). Condom use at the LSI was not associated with being a female compared to a male (pooled RR, 1.08; 95% CI, 0.68–1.71), being of a younger age (≤24 years old) compared to older age (25 years and more) (pooled RR, 1.16; 95% CI, 0-85-1.57), and having a higher condom negotiation efficacy compared to a lower condom negotiation efficacy (pooled RR, 1.54; 95% CI, 0-81-2.94). Conclusions We found a low and heterogenous use of a condom at the LSI among university students in SSA which was not associated with sex, age, or condom negotiation efficacy. Accordingly, context-relevant interventions are needed to improve condom use at the LSI among university students in SSA.
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Affiliation(s)
- Jonathan Izudi
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| | - Gerald Okello
- Department of Reproductive Health, Ministry of Health, Kampala, Uganda
| | - Daniel Semakula
- African Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Francis Bajunirwe
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
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Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Izudi J, Tamwesigire IK, Bajunirwe F. Diagnostic accuracy of paper-based reporting of tuberculosis treatment outcomes in rural eastern Uganda. IJID Regions 2022; 2:107-109. [PMID: 35757076 PMCID: PMC9216645 DOI: 10.1016/j.ijregi.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/21/2021] [Accepted: 01/02/2022] [Indexed: 12/02/2022]
Abstract
Accurate tuberculosis (TB) data is imperative for performance monitoring and strategic decision-making. Data inaccuracies between TB control programmes are largely understudied. A paper-based system for treatment outcome compilation is inaccurate. A computer-generated TB treatment outcome is needed to ensure data accuracy.
Inaccurate reporting of tuberculosis (TB) data to the district and national TB control programmes undermines effective TB control, yet this remains understudied. This study assessed the accuracy of the paper-based approach compared with the World Health Organization (WHO) standard TB treatment outcome as the gold standard for the determination of TB treatment outcome. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the paper-based approach, as well as the percentage agreement between the paper-based approach and the WHO standard TB treatment outcome, are reported. Data from 987 participants were used. Ninety-three participants were misclassified as cured and 195 were misclassified as not cured by the paper-based approach, giving 62.7% sensitivity, 80.0% specificity, 77.9% PPV, 65.5% NPV and percentage agreement of 70.8%. Treatment failure had 64.7% sensitivity, 99.9% specificity, 52.4% PPV, 99.4% NPV, and percentage agreement of 98.4%. Treatment success had 98.8% sensitivity, 96.8% specificity, 99.2% PPV and 94.8% NPV. The paper-based approach was found to report treatment success accurately, but did not report cure and treatment failure accurately. Interventions are thus required to improve the accuracy of the paper-based approach.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Corresponding author. Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda. Tel.: +256 782097744.
| | - Imelda K. Tamwesigire
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Lukabwe H, Kajabwangu R, Mugisha D, Mayengo H, Munyanderu B, Baluku A, Manyang A, Lapat JJ, Banya F, Kayondo M, Mayanja R, Muhumuza J, Bajunirwe F, Ngonzi J. Effectiveness of preoperative bath using chloroxylenol antiseptic soap on the incidence of post emergency cesarean section surgical site infection at Mbarara Regional Referral hospital, Uganda: a randomized controlled trial. Pan Afr Med J 2022; 41:92. [PMID: 35465375 PMCID: PMC8994462 DOI: 10.11604/pamj.2022.41.92.23687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 01/05/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Surgical Site Infections (SSIs) constitute 15%-45% of hospital acquired infections in sub-Saharan Africa. Cesarean section (CS) increases the risk of developing sepsis by 5-20 times and is highest when the operation is emergency. Therefore, the purpose of this study was to measure the effect of chloroxylenol in reducing the incidence of post cesarean SSIs at Mbarara Regional Referral Hospital (MRRH). Methods a randomized controlled trial was conducted at MRRH maternity ward and mothers were randomized into either control or intervention arms. The intervention was a complete body bath with chloroxylenol antiseptic soap before the operation, while the control arm participants received a standard ward pre-operative preparation procedures. All participants were followed up for 30 days and assessed using an SSI screening tool. Results ninety-six women were randomized, and 48 were assigned to each arm. The overall incidence of SSI was 30.21%. The incidence of SSI was significantly lower in the intervention compared to the control arm (6.25% in the intervention arm versus 54.17% in the control arm) (p-value <0.001). Chloroxylenol bath was protective of SSI with a 90% risk reduction for SSI (95% confidence interval of 67%–97%). Conclusion a preoperative bath with chloroxylenol for pregnant mothers is associated with a significantly lower risk of post cesarean section surgical site infections. Health facilities with a high burden of post SSI should consider adding this simple and effective intervention to the existing infection prevention measures. Clinical Trials.gov registration (NCT03544710).
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Affiliation(s)
- Henry Lukabwe
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Rodgers Kajabwangu
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Dale Mugisha
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Horace Mayengo
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Baraka Munyanderu
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Asanairi Baluku
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Anthony Manyang
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Jolly Joe Lapat
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | | | - Musa Kayondo
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Ronald Mayanja
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Joy Muhumuza
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
| | - Francis Bajunirwe
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda
- Corresponding author: Joseph Ngonzi, Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda.
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Izudi J, Kiragga AN, Okoboi S, Bajunirwe F, Castelnuovo B. Adaptations to HIV services delivery amidst the COVID-19 pandemic restrictions in Kampala, Uganda: A qualitative study. PLOS Glob Public Health 2022; 2:e0000908. [PMID: 36962823 PMCID: PMC10022311 DOI: 10.1371/journal.pgph.0000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
The enforcement of the coronavirus disease (COVID-19) pandemic restrictions disrupted health services delivery and currently, there is a limited understanding regarding measures employed by health facilities to ensure delivery of human immunodeficiency virus (HIV) services amidst the interruptions. We, therefore, designed a qualitative study to explore the measures for continuity of HIV services during the COVID-19 pandemic restrictions in Kampala, Uganda. This study was conducted at six large primary health care facilities in the Kampala Metropolitan area. Qualitative data were collected from anti-retroviral therapy (ART) focal persons and lay health workers namely linkage facilitators and peer mothers through key informant interviews (KIIs). Overall, 14 KIIs were performed, 10 with lay health workers and 4 with ART focal persons. Data were audio-recorded, transcribed verbatim, and analyzed using the content approach, and the results were presented as themes along with participant quotations. Five themes emerged to describe measures for continuity of HIV services. The measures included: 1) leveraging the use of mobile phone technology to support ART adherence counseling, psychosocial care, and reminders concerning clinic appointments and referrals; 2) adoption of novel differentiated service delivery models for ART like the use of motorcycle taxis and introduction of an individualized ART delivery model for patients with non-disclosed HIV status; 3) scale-up of existing differentiated service delivery models for ART, namely multi-month dispensing of antiretroviral drugs (ARVs), fast-track ARV refill, home-based ARV refill, peer ART delivery, use of community pharmacy model, and community client-led ART delivery model; and, 4) reorientation of health facility functioning to the COVID-19 pandemic restrictions characterized by the use of nearby health facilities for ARV refill and viral load monitoring, transportation of healthcare providers and flexible work schedules and reliance on shift work. We found several measures were adopted to deliver HIV care, treatment, and support services during the COVID-19 pandemic restrictions in Kampala, Uganda. We recommend the scale-up of the new measures for service continuity in the post-COVID-19 period.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Agnes N Kiragga
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Stephen Okoboi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
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Bunori H, Izudi J, Alege JB, Bajunirwe F. Willingness of caregivers to donate a kidney to a patient with end-stage renal disease: Findings from four dialysis providing health facilities in Uganda. PLOS Glob Public Health 2022; 2:e0000287. [PMID: 36962211 PMCID: PMC10021730 DOI: 10.1371/journal.pgph.0000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
Most patients with end-stage renal disease (ESRD) benefit from a kidney transplant but there is limited information from developing countries like Uganda about the willingness of caregivers for patients with end-stage kidney disease to donate a kidney. In this cross-sectional study, we examined the magnitude and factors associated with the willingness of caregivers to donate a kidney to their patient with ESRD in Kampala, Uganda. The study was conducted at four health facilities that provide kidney dialysis in Kampala, Uganda. We used a structured questionnaire to interview caregivers for patients with ESRD. Caregivers who reported they would consider donating a kidney to a patient with ESRD were considered willing and the rest as unwilling. We summarized data using descriptive statistics and used an adjusted prevalence risk ratio (aPRR) from a generalized linear model to establish factors independently associated with willingness to donate.We enrolled 125 participants with a mean age of 32.3±9.8 years and found 68 (54.4%) participants were willing to donate a kidney for transplant. Willingness to donate a kidney was more likely among older caregivers namely those aged 25-34 years (aPRR, 1.15; 95% CI, 1.01-1.31) and ≥35 years (aPRR 1.16; 95% CI, 1.05-1.29) compared to those aged 18-24 years, females compared to males (aPRR, 1.30; 95% CI, 1.19-1.42), those with a positive attitude towards organ donation (aPRR, 1.24; 95% CI, 1.13-1.36), and when organ kidney donation was permissible by the participant's religious faith (aPRR, 1.11; 95% CI, 1.01-1.22). Conversely, willingness to donate a kidney was less likely when the family did not approve of kidney donation (aPRR, 0.80; 95% CI, 0.71-0.90). We concluded that more than half of caregivers to patients with ESRD are willing to donate a kidney for transplant. To improve the willingness of caregivers to patients with ESRD in donating a kidney, the social, religious, and personal barriers to kidney donation may need to be addressed.
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Affiliation(s)
- Hope Bunori
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Jonathan Izudi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Alege
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Data S, Dubé MM, Bajunirwe F, Kyakwera C, Robinson T, Najjuma JN, Cherop M, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, MacIntosh H, Cheng A. Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda: A Cohort Study. Simul Healthc 2021; 16:e100-e108. [PMID: 33337727 DOI: 10.1097/sih.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students. METHODS We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores. RESULTS One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months. CONCLUSIONS An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.
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Affiliation(s)
- Santorino Data
- From the Mbarara University of Science and Technology (S.D., F.B., C.K., N.N.J., C.M., L.A., T.N., M.T.), Mbarara, Uganda; KidSIM Simulation Program (M.D., T.R., I.W., A.C.), Alberta Children's Hospital; and Department of Pediatrics (J.L.B., N.S., I.W., A.C.), and Global Health and International Partnerships (H.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Izudi J, Okoboi S, Lwevola P, Kadengye D, Bajunirwe F. Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda: A propensity-score matched analysis. PLoS One 2021; 16:e0258745. [PMID: 34665842 PMCID: PMC8525739 DOI: 10.1371/journal.pone.0258745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. METHODS In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). RESULTS Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13-2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32-0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). CONCLUSIONS Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Okoboi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Lwevola
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Damazo Kadengye
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Abstract
Background Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive complication of pregnancy and increases the risk of cardiovascular disease in later life. Pregnancy-related hypertension complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older, senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older and senior women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. Methods We conducted a qualitative study in rural Southwestern Uganda. The key informants were senior, older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants and data were collected till we reached saturation point. We analyzed data using an inductive thematic approach to identify themes. Results We interviewed 20 key informants with four themes identified. The 'causes' theme emerged from the subthemes of confusion with other conditions, spiritual beliefs and high blood pressure. The 'risk factors' theme emerged from the subthemes of oedema-related illnesses, poverty-induced malnutrition, and strained relationships. The 'remedies' theme emerged from the consistent mention of traditional herbal treatment, seek medical help, spiritual healing, emotional healing and corrective nutrition as potential solutions. The theme 'effects of preeclampsia/eclampsia' emerged from the mention of pregnancy complications like premature delivery, child loss, operative delivery like caesarian section delivery as well as death. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, ghost attacks and stress from strained relationships including marital tension. Women were generally aware of the outcomes of eclampsia, mainly that it kills. Conclusions Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel these myths and misconceptions, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.
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Affiliation(s)
- Harriet Nabulo
- Department of Nursing, Mbarara University of Science and Technology, Department of Nursing, Mbarara, Uganda
| | - Gad Ruzaaza
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Mugabi
- Department of Community Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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30
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Abstract
Considered attention is needed to the interplay between evangelical and charismatic religions and legislation in Uganda and their implications for public health, bioethics, and medical education. This manuscript examines the growth of the evangelical and charismatic movements in Uganda during the past several decades, concurrent trends in the formulation and implementation of law and public policy, and implications for the prevention and treatment of sexually transmitted infections, family violence, physician-patient communication, and medical and health education. The article concludes with suggested strategies to address the adverse consequences stemming from the interjection of religious perspectives into the domains of public health, clinical care, and health education.
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Affiliation(s)
- Sana Loue
- Case Western Reserve University School of Medicine, Cleveland, Ohio USA
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31
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Paulson JN, Williams BL, Hehnly C, Mishra N, Sinnar SA, Zhang L, Ssentongo P, Mbabazi-Kabachelor E, Wijetunge DSS, von Bredow B, Mulondo R, Kiwanuka J, Bajunirwe F, Bazira J, Bebell LM, Burgoine K, Couto-Rodriguez M, Ericson JE, Erickson T, Ferrari M, Gladstone M, Guo C, Haran M, Hornig M, Isaacs AM, Kaaya BN, Kangere SM, Kulkarni AV, Kumbakumba E, Li X, Limbrick DD, Magombe J, Morton SU, Mugamba J, Ng J, Olupot-Olupot P, Onen J, Peterson MR, Roy F, Sheldon K, Townsend R, Weeks AD, Whalen AJ, Quackenbush J, Ssenyonga P, Galperin MY, Almeida M, Atkins H, Warf BC, Lipkin WI, Broach JR, Schiff SJ. Paenibacillus infection with frequent viral coinfection contributes to postinfectious hydrocephalus in Ugandan infants. Sci Transl Med 2021; 12:12/563/eaba0565. [PMID: 32998967 DOI: 10.1126/scitranslmed.aba0565] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/06/2020] [Indexed: 12/14/2022]
Abstract
Postinfectious hydrocephalus (PIH), which often follows neonatal sepsis, is the most common cause of pediatric hydrocephalus worldwide, yet the microbial pathogens underlying this disease remain to be elucidated. Characterization of the microbial agents causing PIH would enable a shift from surgical palliation of cerebrospinal fluid (CSF) accumulation to prevention of the disease. Here, we examined blood and CSF samples collected from 100 consecutive infant cases of PIH and control cases comprising infants with non-postinfectious hydrocephalus in Uganda. Genomic sequencing of samples was undertaken to test for bacterial, fungal, and parasitic DNA; DNA and RNA sequencing was used to identify viruses; and bacterial culture recovery was used to identify potential causative organisms. We found that infection with the bacterium Paenibacillus, together with frequent cytomegalovirus (CMV) coinfection, was associated with PIH in our infant cohort. Assembly of the genome of a facultative anaerobic bacterial isolate recovered from cultures of CSF samples from PIH cases identified a strain of Paenibacillus thiaminolyticus This strain, designated Mbale, was lethal when injected into mice in contrast to the benign reference Paenibacillus strain. These findings show that an unbiased pan-microbial approach enabled characterization of Paenibacillus in CSF samples from PIH cases, and point toward a pathway of more optimal treatment and prevention for PIH and other proximate neonatal infections.
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Affiliation(s)
- Joseph N Paulson
- Department of Biostatistics, Product Development, Genentech Inc., South San Francisco, CA 94080, USA
| | - Brent L Williams
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Christine Hehnly
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Nischay Mishra
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Shamim A Sinnar
- Center for Neural Engineering, Pennsylvania State University, University Park, PA 16802, USA.,Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Lijun Zhang
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Paddy Ssentongo
- Center for Neural Engineering, Pennsylvania State University, University Park, PA 16802, USA.,Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | | | - Dona S S Wijetunge
- Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Benjamin von Bredow
- Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Ronnie Mulondo
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Julius Kiwanuka
- Department of Pediatrics, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Epidemiology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda
| | - Lisa M Bebell
- Division of Infectious Disease, Massachusetts Genereal Hospital, Harvard Medical School, 55 Fruit St, GRJ-504, Boston, MA 02114, USA
| | - Kathy Burgoine
- Neonatal Unit, Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, Plot 29-33 Pallisa Road, P.O. Box 1966, Mbale, Uganda.,Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Plot 29-33 Pallisa Road, P.O. Box 1966 Mbale, Uganda.,University of Liverpool, Liverpool, L69 3BX, UK
| | - Mara Couto-Rodriguez
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.,Biotia, 100 6th avenue, New York, NY 10013, USA
| | - Jessica E Ericson
- Division of Pediatric Infectious Disease, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Tim Erickson
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Matthew Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802, USA.,Department of Biology, Pennsylvania State University, University Park, PA 16802, USA.,Department of Statistics, Pennsylvania State University, University Park, PA 16802, USA
| | - Melissa Gladstone
- Institute for Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK
| | - Cheng Guo
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Murali Haran
- Department of Statistics, Pennsylvania State University, University Park, PA 16802, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Brian Nsubuga Kaaya
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Sheila M Kangere
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Elias Kumbakumba
- Department of Pediatrics, Mbarara University of Science and Technology, P.O. Box 1410 Mbarara, Uganda
| | - Xiaoxiao Li
- Institute for Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Joshua Magombe
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston MA 02115, USA
| | - John Mugamba
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - James Ng
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Plot 29-33 Pallisa Road, P.O. Box 1966 Mbale, Uganda.,Busitema University, Mbale Campus, Plot 29-33 Pallisa Road, P.O. Box 1966, Mbale, Uganda
| | - Justin Onen
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Mallory R Peterson
- Center for Neural Engineering, Pennsylvania State University, University Park, PA 16802, USA.,Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA
| | - Farrah Roy
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Kathryn Sheldon
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Reid Townsend
- Department of Medicine, Washington University School of Medicine , St. Louis, MO 63130, USA
| | - Andrew D Weeks
- Sanyu Research Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool L8 7SS, UK
| | - Andrew J Whalen
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802, USA
| | - John Quackenbush
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Peter Ssenyonga
- CURE Children's Hospital of Uganda, Plot 97-105, Bugwere Road, P.O. Box 903 Mbale, Uganda
| | - Michael Y Galperin
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Mathieu Almeida
- Université Paris-Saclay, INRAE, MGP, Jouy-en-Josas, 78350, France
| | - Hannah Atkins
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - James R Broach
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Steven J Schiff
- Center for Neural Engineering, Pennsylvania State University, University Park, PA 16802, USA. .,Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA.,Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802, USA.,Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.,Department of Physics, Pennsylvania State University, University Park, PA 16802, USA
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32
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Seguya A, Bajunirwe F, Kakande E, Nakku D. Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda. PLoS One 2021; 16:e0253305. [PMID: 34138954 PMCID: PMC8211292 DOI: 10.1371/journal.pone.0253305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Despite the high burden of hearing loss (HL) globaly, most countries in resource limited settings lack infant hearing screening programs(IHS) for early HL detection. We examined the feasibility of establishing an IHS program in this setting, and in this pilot program measured the prevalence of infant hearing loss (IHL) and described the characteristics of the infants with HL. Methods We assessed feasibility of establishing an IHS program at a regional referral hospital in south-western Uganda. We recruited infants aged 1 day to 3 months and performed a three-staged screening. At stage 1, we used Transient Evoked Oto-acoustic Emissions (TEOAEs), at stage 2 we repeated TEOAEs for infants who failed TEOAEs at stage 1 and at stage 3, we conducted Automated brainstem responses(ABRs) for those who failed stage 2. IHL was present if they failed an ABR at 35dBHL. Results We screened 401 infants, mean age was 7.2 days (SD = 7.1). 74.6% (299 of 401) passed stage 1, the rest (25.4% or 102 of 401) were referred for stage 2. Of those referred (n = 102), only 34.3% (35 of 102) returned for stage 2 screening. About 14.3% (5/35) failed the repeat TEOAEs in at least one ear. At stage 3, 80% (4 of 5) failed the ABR screening in at least one ear, while 25% (n = 1) failed the test bilaterally. Among the 334 infants that completed the staged screening, the prevalence of IHL was 4/334 or 12 per 1000. Risk factors to IHL were Newborn Special Care Unit (NSCU) admission, gentamycin or oxygen therapy and prematurity. Conclusions IHS program establishment in a resource limited setting is feasible. Preliminary data indicate a high prevalence of IHL. Targeted screening of infants at high risk may be a more realistic and sustainable initial step towards establishing IHS program s in a developing country like Uganda.
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Affiliation(s)
- Amina Seguya
- Department of Ear, Nose and Throat Surgery, Mulago National Referral Hospital, Kampala, Uganda
- * E-mail:
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Doreen Nakku
- Department of Ear, Nose and Throat Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
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Seguya A, Bajunirwe F, Kakande E, Nakku D. Maternal knowledge on infant hearing loss and acceptability of hearing aids as an intervention at a Referral Hospital in southwestern Uganda. Int J Pediatr Otorhinolaryngol 2021; 145:110722. [PMID: 33933987 DOI: 10.1016/j.ijporl.2021.110722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Infant hearing screening enables early detection and management of hearing loss (HL) so that speech and language development delays are minimized. Parents play a critical role in successful screening and management of Infant Hearing loss (IHL) but there is limited data from resource limited settings on parental knowledge about HL and acceptability of IHL interventions. This study was aimed at exploring the maternal knowledge on the various causes of IHL and their acceptability of hearing aids as an intervention for IHL. METHODS A cross-sectional study was conducted at a referral hospital in southwestern Uganda. A semi-structured questionnaire was used to interview postpartum mothers to assess their knowledge on causes of IHL and acceptability of a hearing aid if prescribed. Logistic regression was used to calculate odds ratio (OR) for the factors associated with hearing aid refusal. RESULTS 401 mothers with a mean age of 25 years (Standard Deviation = 5.6 years) were recruited. Half of the mothers correctly identified at least five causes of IHL. The most well-known causes were measles (63.3%) and a positive family history of HL (61.6%). 60% of mothers held at least one superstitious belief as a cause of IHL. Majority of mothers (86%) would accept a hearing aid as an IHL intervention. Mothers with a positive family history of HL (OR = 0.42, p = 0.04), in middle or higher socioeconomic class (OR = 0.45, p = 0.01) and those with more than 3 antenatal visits in their recent pregnancy (OR = 0.44, p = 0.01) were less likely to refuse a hearing aid while mothers that were either widowed or separated from their spouses (OR = 15.64, p = 0.01) were more likely to refuse a hearing aid. CONCLUSION Although mothers had limited knowledge on some causes of IHL, there was a high acceptability of hearing aids as an intervention for IHL. Marital status, family history of hearing loss, socioeconomic status and antenatal care attendance are factors that could be used to identify mothers that might accept or refuse a hearing aid for their infant. There is need to increase awareness about causes of hearing loss to improve knowledge as well as dispel any non-biological beliefs held by communities.
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Affiliation(s)
- Amina Seguya
- Department of ENT Surgery, Mulago National Referral Hospital, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Uganda
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Doreen Nakku
- Department of ENT Surgery, Mbarara University of Science and Technology, Uganda
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Iyer HS, James P, Valeri L, Bajunirwe F, Nankya-Mutyoba J, Njelekela M, Chiwanga F, Sewram V, Ajayi I, Adebamowo C, Dalal S, Reid TG, Rebbeck TR, Adami HO, Holmes MD. Neighborhood greenness and burden of non-communicable diseases in Sub-Saharan Africa: A multi-country cross-sectional study. Environ Res 2021; 196:110397. [PMID: 33130166 PMCID: PMC8085185 DOI: 10.1016/j.envres.2020.110397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 05/04/2023]
Abstract
Population growth, demographic transitions and urbanization in sub-Saharan Africa (SSA) will increase non-communicable disease (NCD) burden. We studied the association between neighborhood greenness and NCDs in a multi-country cross-sectional study. Among 1178 participants, in adjusted models, a 0.11 unit NDVI increase was associated with lower BMI (β: -1.01, 95% CI: -1.35, -0.67), and lower odds of overweight/obesity (aOR: 0.73, 95% CI: 0.62, 0.85), diabetes (aOR: 0.77, 95% CI: 0.62, 0.96), and having ≥3 allostatic load components compared to none (aOR: 0.66, 95% CI: 0.52, 0.85). Except for diabetes, these remained statistically significant after Bonferroni correction. We observed no association between NDVI and hypertension or cholesterol. Our findings are consistent with health benefits of neighborhood greenness reported in other countries, suggesting greening strategies could be considered as part of broader public health interventions for NCDs.
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Affiliation(s)
- Hari S Iyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joan Nankya-Mutyoba
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania; Deloitte Consulting Limited, Dar Es Salaam, Tanzania
| | - Faraja Chiwanga
- Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Vikash Sewram
- African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - IkeOluwapo Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Clement Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Greenebaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Shona Dalal
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Todd G Reid
- Media Lab and Connection Science, Massachusetts Institute of Technology, Boston, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Michelle D Holmes
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
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35
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Ashaba S, Cooper-Vince C, Maling S, Satinsky EN, Baguma C, Akena D, Nansera D, Bajunirwe F, Tsai AC. Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda. J Affect Disord Rep 2021; 4:100094. [PMID: 34841384 PMCID: PMC8623847 DOI: 10.1016/j.jadr.2021.100094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors. METHODS We enrolled 224 ALHIV aged 13-17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support. RESULTS Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31-5.04; P=0.006) and physical abuse (ARR 2.16; 95% CI 1.19-3.89; P=0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64-11.25; P=0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57-2.98; P=0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05-3.920; P=0.03) and physical abuse (ARR 3.17; 95% CI 1.60-6.25.; P=0.001), but no differences by social support were noted. LIMITATIONS Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse. CONCLUSIONS Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | | | - Samuel Maling
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Emily N. Satinsky
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Baguma
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences, Makerere, Uganda
| | - Denis Nansera
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Nabifo SC, Tsai AC, Bajunirwe F. HIV-related stigma and its association with HIV transmission risk behaviors among boda boda motorcyclists in Mbarara Municipality, southwestern Uganda. Int J STD AIDS 2021; 32:791-798. [PMID: 33769905 DOI: 10.1177/0956462420987760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among boda boda (motorcycle taxi) riders, a key population in Uganda. Methods: We conducted a cross-sectional study among boda boda motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. Results: We enrolled 401 boda boda motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. Conclusions: HIV transmission risk behavior is common among boda boda motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.
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Affiliation(s)
- Stella C Nabifo
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Francis Bajunirwe
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
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Olupot B, Adrawa N, Bajunirwe F, Izudi J. HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda. J Clin Tuberc Other Mycobact Dis 2021; 23:100226. [PMID: 33732899 PMCID: PMC7944029 DOI: 10.1016/j.jctube.2021.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Distance from residence to a health facility presents a physical barrier. Our data show that long-distance is associated with a lower treatment success rate. Also, we found long-distance is insignificantly associated with high mortality. HIV modifies the effect of long-distance on mortality. People with tuberculosis who travel long distances need improved access to treatment.
Rationale Distance from residence to a health facility especially in rural areas presents a physical barrier and may influence tuberculosis (TB) treatment outcomes. Objectives We examined the association between distance from residence to a health facility and TB treatment outcomes namely treatment success rate (TSR) and mortality, and whether HIV influences this relationship among people with TB in Kumi district in rural eastern Uganda. Methods In this cross-sectional design, we abstracted data from TB unit registers across four large health facilities. Travel of ≥5 km to a health facility was considered a long distance. The primary outcome was TSR and the secondary was mortality. We performed a generalized linear model with Poisson distribution with a log-link and robust standard errors to determine the association between distance and the study outcomes adjusting for potential confounders. We report the adjusted risk ratio (aRR) and 95% confidence interval (CI). Measurement and results Of 611 participants studied, 484 (79.2%) were successfully treated, 18 (2.9%) died, and 359 (58.7%) travelled a long distance to access TB treatment. Long-distance was significantly associated with lower TSR (aRR, 0.93; 95% CI, 0.89–0.96). Further analysis showed that longer distance was associated with lower TSR among HIV positive persons with TB (aRR, 0.83; 95% CI, 0.72–0.96), but not among HIV negative persons with TB (aRR, 0.94; 95% CI, 0.85–1.03). Although it was not significant, longer distance showed a tendency towards worse mortality among HIV positive people with TB (aRR, 2.78; 95% CI, 0.80–9.66), but not among HIV negative people with HIV (aRR, 0.21; 0.03–1.74). Conclusions A majority of people with TB travel long distances to access treatment. Long distances are associated with lower TSR and higher mortality and affect people with TB who are HIV positive but not HIV negative. Interventions should focus on improving access to treatment for people with TB who travel long distances.
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Affiliation(s)
- Ben Olupot
- Institute of Public Health and Management (IPHM), Clarke International University (CIU), P.O. Box 7782, Kampala, Uganda
| | - Norbert Adrawa
- The AIDS Support Organization (TASO), Center of Clinical Excellence, P.O. Box 347, Gulu, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), P.O. Box 1410, Mbarara, Uganda
| | - Jonathan Izudi
- Institute of Public Health and Management (IPHM), Clarke International University (CIU), P.O. Box 7782, Kampala, Uganda.,Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), P.O. Box 1410, Mbarara, Uganda
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Nabifo SC, Izudi J, Bajunirwe F. Alcohol consumption and sports-betting among young male motorcycle taxi boda boda riders in urban southwestern Uganda. BMC Public Health 2021; 21:363. [PMID: 33593353 PMCID: PMC7885426 DOI: 10.1186/s12889-021-10406-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background The popularity of sports-betting is growing globally and may be associated with alcohol consumption among young adults. In this study, we examine the relationship between alcohol consumption plus other substances with sports-betting in a group of young adult males in Uganda. Methods We conducted a cross-sectional study and interviewed male motorcycle taxi boda boda riders in the southwestern Uganda town of Mbarara. We asked questions about alcohol consumption, smoking plus history and frequency of sports-betting. Results We enrolled 401 riders. The median age was 29.0 years, interquartile range 25–32 years. Seventy four (18.5%) had engaged in sports-betting in the past 30 days. Among those that reported sports-betting, 16(21.6%) engaged daily or almost daily. Alcohol use was significantly associated with sports-betting with an adjusted risk ratio (aRR) of 2.08(95% CI 1.36, 3.18) among moderate drinkers but not among heavy drinkers in comparison to low or non-drinkers. Cigarette smoking was significantly associated with sports-betting with an aRR 1.85(95% CI 1.13, 3.01). Conclusion Sports-betting is common among these young male motorcycle riders, and is associated with both alcohol consumption and cigarette smoking. Interventions to regulate sports-betting may be co-packaged with those to reduce alcohol consumption and cigarette smoking among young adult males. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10406-7.
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Affiliation(s)
- Stella Cheryl Nabifo
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.
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Magambo NK, Bajunirwe F, Bagenda F. Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment. BMC Public Health 2020; 20:1764. [PMID: 33228669 PMCID: PMC7686762 DOI: 10.1186/s12889-020-09859-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09859-z.
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Affiliation(s)
- Nicholas Kwikiriza Magambo
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda. .,Directorate of Health services, Hoima District, P.O.BOX 2, Hoima, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Fred Bagenda
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
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Kajabwangu R, Bajunirwe F, Lukabwe H, Atukunda E, Mugisha D, Lugobe HM, Nakalinzi J, Mugyenyi GR. Factors associated with delayed onset of active labor following vaginal misoprostol administration among women at Mbarara Regional Referral Hospital, Uganda. Int J Gynaecol Obstet 2020; 153:268-272. [PMID: 33010030 DOI: 10.1002/ijgo.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the factors associated with delayed onset of active labor following labor induction with vaginal misoprostol. METHODS We conducted a prospective cohort study over 6 months at a tertiary hospital in Uganda. We enrolled mothers with pregnancies of at least 28 weeks, who were undergoing labor induction with 50 µg of vaginal misoprostol, administered every 6 hours with a maximum of four doses, and followed them up until onset of active labor. Labor onset was considered delayed if it occurred later than 12 hours after the first dose. Bivariate and multivariate analysis was performed to determine factors associated with delayed onset of active labor. RESULTS Of the 88 mothers enrolled, 22.7% (n=20) had delayed onset of active labor. Nulliparity (adjusted relative risk [aRR] 2.34, 95% confidence interval [CI] 1.17-4.68) and gestational age less than 37 weeks (aRR 3.79, 95% CI 1.40-10.23) were associated with delayed onset of active labor following vaginal misoprostol administration whereas higher body mass index (aRR 0.38, 95% CI 0.18-0.79) decreased the risk. CONCLUSION Delayed onset of active labor following labor induction remains an important obstetric care challenge. Mothers undergoing labor induction should have their body mass index documented, and nulliparous women and mothers at less than 37 weeks of gestation should have their labor monitored for a longer duration following labor induction.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry Lukabwe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dale Mugisha
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry M Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joanita Nakalinzi
- Department of Pharmacy, Kampala International University Teaching Hospital, Ishaka, Uganda
| | - Godfrey R Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
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Najjuma JN, Bajunirwe F, Twine M, Namata T, Kyakwera CK, Cherop M, Santorino D. Stakeholder perceptions about the establishment of medical simulation-based learning at a university in a low resource setting: a qualitative study in Uganda. BMC Med Educ 2020; 20:379. [PMID: 33092603 PMCID: PMC7579972 DOI: 10.1186/s12909-020-02301-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/09/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Simulation based learning (SBL) is a technique where teachers recreate "real life" clinical experiences for health care teams for purposes of gaining clinical skills in a safe environment. There is evidence that SBL is superior to the traditional clinical teaching methods for acquisition of clinical skills. Although it is well established in resource rich settings, there is limited experience in resource limited settings and there is uncertainty regarding how SBL will be perceived among the stakeholders in medical education. As part of the steps leading to implementation of a SBL program at a university in Uganda, we sought to describe the perceptions of various stakeholders regarding the introduction of SBL methodology into learning at a medical school in Uganda. METHODS We conducted a formative qualitative assessment using key informant interviews (KIIs) among faculty members and university administrators and focus group discussions (FGDs) among medical and nursing students at Mbarara University of Science and Technology. Data were collected till saturation point and were transcribed and analyzed manually using open and axial coding approaches to develop themes. RESULTS We conducted seven KIIs and three FGDs. Overall, findings were categorized into five broad themes: 1. Motivation to adopt simulation-based learning 2. Prior experience and understanding of simulation-based education 3. Outcomes arising from introduction of medical simulation 4. Drawbacks to establishment of medical simulation; and 5. Potential remedies to the drawbacks. Overall, our data show there was significant buy-in from the institution for SBL, stakeholders were optimistic about the prospects of having a new method of teaching, which they perceived as modern to complement the traditional methods. There was significant knowledge but very limited prior experience of medical simulation. Also, there was some concern regarding how students and faculty would embrace training on lifeless objects, the human resources needed and sustainability of simulation-based learning in the absence of external funding. CONCLUSION Stakeholders perceive SBL positively and are likely to embrace the learning methods. Concerns about human resource needs and sustainability need to be addressed to ensure acceptability.
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Affiliation(s)
- Josephine Nambi Najjuma
- Department of Nursing, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.
- Simulation Center, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Margaret Twine
- Simulation Center, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P. O Box 1410, Mbarara, Uganda
| | - Tamara Namata
- Simulation Center, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | | | - Moses Cherop
- Simulation Center, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Data Santorino
- Simulation Center, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P. O Box 1410, Mbarara, Uganda
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Izudi J, Tamwesigire IK, Bajunirwe F. Association between GeneXpert Diagnosis and Same-Day Initiation of Tuberculosis Treatment in Rural Eastern Uganda. Am J Trop Med Hyg 2020; 103:1447-1454. [DOI: 10.4269/ajtmh.19-0900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Imelda K. Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Robinson T, Santorino D, Dube M, Twine M, Najjuma JN, Cherop M, Kyakwera C, Brenner J, Singhal N, Bajunirwe F, Wishart I, Lin Y, Lorentzen H, Lutnæs DE, Cheng A. Sim for Life: Foundations-A Simulation Educator Training Course to Improve Debriefing Quality in a Low Resource Setting: A Pilot Study. Simul Healthc 2020; 15:326-334. [PMID: 33003188 DOI: 10.1097/sih.0000000000000445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite the importance of debriefing, little is known about the effectiveness of training programs designed to teach debriefing skills. In this study, we evaluated the effectiveness of a faculty development program for new simulation educators at Mbarara University of Science and Technology in Uganda, Africa. METHODS Healthcare professionals were recruited to attend a 2-day simulation educator faculty development course (Sim for Life: Foundations), covering principles of scenario design, scenario execution, prebriefing, and debriefing. Debriefing strategies were contextualized to local culture and focused on debriefing structure, conversational strategies, and learner centeredness. A debriefing worksheet was used to support debriefing practice. Trained simulation educators taught simulation sessions for 12 months. Debriefings were videotaped before and after initial training and before and after 1-day refresher training at 12 months. The quality of debriefing was measured at each time point using the Objective Structured Assessment of Debriefing (OSAD) tool by trained, calibrated, and blinded raters. RESULTS A total of 13 participants were recruited to the study. The mean (95% confidence interval) OSAD scores pretraining, posttraining, and at 12 months before and after refresher were 18.2 (14.3-22.1), 26.7 (22.8-30.6), 25.5 (21.2-29.9), and 27.0 (22.4-31.6), respectively. There was a significant improvement from pretraining to posttraining (P < 0.001), with no significant decay from posttraining to 12 months (P = 0.54). There was no significant difference in OSAD scores pre- versus post-refresher training at 12 months (P = 0.49). CONCLUSIONS The Sim for Life Foundations program significantly improves debriefing skills with retention of debriefing skills at 12 months.
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Affiliation(s)
- Traci Robinson
- From the Department of Pediatrics (J.B., N.S., A.C.), Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada, Global Health Unit (T.R.), University of Calgary, Calgary, Alberta, Canada; Mbarara University of Science and Technology (D.S., M.T., J.N.N., M.C., C.K., F.B.), Mbarara, Uganda; eSIM Provincial Program (M.D.), Alberta Health Services; Department of Emergency Medicine (I.W.), University of Calgary; KidSIM Simulation Program (Y.L.), Alberta Children's Hospital, Calgary, Alberta, Canada; Operations Training, Oceaneering (H.L.), Sandnes; Formerly of: SAFER (D.E.L.); and The Norwegian Healthcare Investigation Board (D.E.L.), Stavanger, Norway
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Data S, Mukama M, McMillan D, Singhal N, Bajunirwe F. First-step validation of a text message-based application for newborn clinical management among pediatricians. BMC Pediatr 2020; 20:406. [PMID: 32854664 PMCID: PMC7450570 DOI: 10.1186/s12887-020-02307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/20/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neonatal mortality is high in developing countries. Lack of adequate training and insufficient management skills for sick newborn care contribute to these deaths. We developed a phone application dubbed Protecting Infants Remotely by Short Message Service (PRISMS). The PRISMS application uses routine clinical assessments with algorithms to provide newborn clinical management suggestions. We measured the feasibility, acceptability and efficacy of PRISMS by comparing its clinical case management suggestions with those of experienced pediatricians as the gold standard. METHODS Twelve different newborn case scenarios developed by pediatrics residents, based on real cases they had seen, were managed by pediatricians and PRISMS®. Each pediatrician was randomly assigned six of twelve cases. Pediatricians developed clinical case management plans for all assigned cases and then obtained PRISMS suggested clinical case managements. We calculated percent agreement and kappa (k) statistics to test the null hypothesis that pediatrician and PRISMS management plans were independent. RESULTS We found high level of agreement between pediatricians and PRISMS for components of newborn care including: 10% dextrose (Agreement = 73.8%), normal saline (Agreement = 73.8%), anticonvulsants (Agreement = 100%), blood transfusion (Agreement =81%), phototherapy (Agreement = 90.5%), and supplemental oxygen (agreement = 69.1%). However, we found poor agreement with potential investigations such as complete blood count, blood culture and lumbar puncture. PRISMS had a user satisfaction score of 3.8 out of 5 (range 1 = strongly disagree, 5 = strongly agree) and an average PRISMS user experience score of 4.1 out of 5 (range 1 = very bad, 5 = very good). CONCLUSION Management plans for newborn care from PRISMS showed good agreement with management plans from experienced Pediatricians. We acknowledge that the level of agreement was low in some aspects of newborn care.
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Affiliation(s)
- Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.
- Consortium for Affordable Medical Technologies in Uganda, Mbarara, Uganda.
| | - Martin Mukama
- Consortium for Affordable Medical Technologies in Uganda, Mbarara, Uganda
| | - Douglas McMillan
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Bajunirwe F, Izudi J, Asiimwe S. Long-distance truck drivers and the increasing risk of COVID-19 spread in Uganda. Int J Infect Dis 2020; 98:191-193. [PMID: 32615323 PMCID: PMC7323644 DOI: 10.1016/j.ijid.2020.06.085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022] Open
Abstract
COVID-19 was first detected in Uganda in the third week of March 2020. Although the number of COVID-19 cases has grown steadily, data have not been analyzed to determine whether a pattern in the nature of cases has emerged. The first cases were detected among international arrivals and after that among their local contacts. However, in mid-April, a number of cases were detected among long-distance truck drivers arriving from the neighboring countries. Among the 442 cases that have tested positive, a majority, 317 (71.8%) were truck drivers, 75 (16.9%) were community cases, and 50 (11.3%) were international arrivals. A majority of the community cases have been linked to contact with long-distance truck drivers; interventions are urgently needed to protect long-distance truck drivers.
Objective To examine the patterns of COVID-19 transmission in Uganda. Methods We reviewed ten weeks of press releases from the Uganda Ministry of Health from the day when the first case was announced, March 22, through May 29, 2020. We obtained the press releases from the MoH website and the Twitter handle (@MinofHealthUG). Data include the number of persons tested and the categories were classified as international arrivals, community members, and long-distance truck drivers. Results The first cases were international arrivals from Asia and Europe, and after that, community cases emerged. However, in the middle of April 2020, COVID-19 cases were detected among long-distance truck drivers. By May 29, 2020, 89, 224 persons had been tested; overall, 442 tested positive. Of those that tested positive, the majority, or 317 (71.8%) were truck drivers, 75 (16.9%) were community cases, and 50 (11.3%) were international arrivals. The majority of community cases have been linked to contact with truck drivers. Conclusions Truck drivers were the most frequently diagnosed category, and have become a core group for COVID-19 in Uganda. They have generated significant local transmission, which now threatens a full-blown epidemic unless strict controls are put in place.
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Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology (MUST), Uganda.
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology (MUST), Uganda.
| | - Stephen Asiimwe
- Department of Community Health, Mbarara University of Science and Technology (MUST), Uganda; Global Health Collaborative (GHC) at MUST, Uganda.
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Izudi J, Tamwesigire IK, Bajunirwe F. Sputum smear non-conversion among adult persons with bacteriologically confirmed pulmonary tuberculosis in rural eastern Uganda. J Clin Tuberc Other Mycobact Dis 2020; 20:100168. [PMID: 32529053 PMCID: PMC7283142 DOI: 10.1016/j.jctube.2020.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale Failure to convert sputum at two months of treatment among persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) indicates poor response to treatment but data are limited on its assessment. Objective We determined the frequency and factors associated with sputum smear non-conversion at two months among persons with BC-PTB in eastern Uganda. Methods We abstracted data of adult persons with BC-PTB, from routinely available records from TB registers at 10 clinics in eastern Uganda. We determined factors that are independently associated with sputum smear non-conversion using logistic regression analysis. We expressed the results as odds ratio (OR) with 95% confidence interval (CI). Measurements and main results Of 516 persons with BC-PTB, 81 (15.7%) did not achieve sputum smear conversion at two months of TB treatment. Higher Mycobacteria tuberculosis (MTB) load and treatment at a private-not-for-profit (PNFP) facility compared to government health facility were significantly associated with sputum smear non-conversion. A one unit (+1) increase in MTB load based on ZN stain counts was associated with a 48% increase in the odds of sputum smear non-conversion with adjusted odds ratio (AOR), 1.48 (95% CI, 1.02-2.18). TB treatment at private-not-for-profit health facility was associated with a two-fold increase in the odds of sputum smear non-conversion (AOR, 2.03; 95% CI, 1.01-3.92). Conclusions Our study shows that sputum smear non-conversion is common at two months of treatment in this population. It is more likely among patients with higher baseline MTB load and those treated at PNFP facilities. Strategies targeting patients with these risk factors are needed to enhance sputum smear conversion.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Bajunirwe F. Pyrethroid resistance in sub-Saharan Africa. Lancet 2020; 395:1236-1237. [PMID: 32305084 DOI: 10.1016/s0140-6736(20)30632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
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Izudi J, Tamwesigire IK, Bajunirwe F. Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study. BMC Public Health 2020; 20:501. [PMID: 32295549 PMCID: PMC7161267 DOI: 10.1186/s12889-020-08646-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates. Results We retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50). Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
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Bajunirwe F, Ayebazibwe N, Mulogo E, Eng M, McGrath J, Kaawa-Mafigiri D, Mugyenyi P, Sethi AK. Effectiveness of a mobile antiretroviral pharmacy and HIV care intervention on the continuum of HIV care in rural Uganda. AIDS Care 2020; 32:1111-1115. [PMID: 32279527 DOI: 10.1080/09540121.2020.1753006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conducted at two district hospitals, among patients who lived >5 km from the hospital. For each hospital, we identified 4 health centers in the catchment area to serve as site for the mobile pharmacy. Each site was visited once a month to provide ART refills and adherence counseling. We measured patient waiting time, adherence and viral load suppression before and after the intervention. The proportion of patients who missed an ART dose in the last 30 days dropped from 20% to 8.5% at 12 months post-intervention (p = 0.009) and those with detectable viral load dropped from 19.9% to 7.4% (p = 0.001), however, mean waiting time increased from 4.48 to 4.76 h (p = 0.13). Mobile pharmacy intervention in rural Uganda is feasible and resulted in improvement in adherence and viral load suppression. Although it did not reduce patient waiting time at the clinic, we recommend scale-up in rural areas where patients face transportation challenges.
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Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Ayebazibwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maria Eng
- Applied Science for Health, LLC, Baltimore, MD, USA
| | - Janet McGrath
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, USA
| | - David Kaawa-Mafigiri
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Ajay K Sethi
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Izudi J, Tamwesigire IK, Bajunirwe F. Surveillance for multi-drug and rifampicin resistant tuberculosis and treatment outcomes among previously treated persons with tuberculosis in the era of GeneXpert in rural eastern Uganda. J Clin Tuberc Other Mycobact Dis 2020; 19:100153. [PMID: 32123755 PMCID: PMC7038458 DOI: 10.1016/j.jctube.2020.100153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Rationale Previously treated persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) have increased risk of developing multi-drug resistant or rifampicin resistant tuberculosis (MDR/RR-TB). Surveillance for resistance is critical to identify and treat MDR/RR-TB to ensure cure and prevent transmission. There are limited studies conducted on this subject. Objectives We examined the frequency and factors associated with MDR/RR-TB surveillance among previously treated persons with BC-PTB, and described their treatment outcomes in rural eastern Uganda. Methods We reviewed treatment records for BC-PTB between January 2015 and June 2018 at 10 clinics in eastern Uganda. We collected data on demographics, surveillance for MDR/RR, use of GeneXpert and treatment outcomes. We performed bivariate and multivariate analyses. For multivariate analysis, we used the modified Poisson regression analysis with robust standard errors and stated the results as adjusted risk ratio (aRR) with 95% confidence intervals (CI). All analyses were conducted in R version 3.5.2. Measurements and main results We obtained records for 135 previously treated persons with BC-PTB and of these, 41 (30.4%) had undergone surveillance for MDR/RR-TB. Treatment failures were less likely to have surveillance compared to relapses (aRR, 0.28; 95% CI, 0.08-0.95), and there was an increasing trend in the likelihood for surveillance between 2015 and 2018 (aRR, 1.77; 95% CI, 1.39-2.25). There was no difference in MDR/RR-TB surveillance rate between health facilities with and without GeneXpert on-site (aRR, 1.52; 95% CI, 0.81-2.86) and between male and female patients (aRR, 0.54; 95% CI, 0.21-1.37). Overall, 92 (68.1%) previously treated persons with BC-PTB were successfully treated for tuberculosis. Conclusions MDR/RR-TB surveillance and treatment success rates among previously treated persons with BC-PTB in rural eastern Uganda are low. Tuberculosis programs should strengthen MDR/RR-TB surveillance and especially target those with treatment failure.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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