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Tannor EK, Davidson B, Nlandu Y, Bagasha P, Bilchut WH, Davids MR, Diongole HM, Ekrikpo UE, Hafiz EO, Ibrahim KS, Kalyesubula R, Nalado AM, Olanrewaju TO, Onu UC, Pereira-Kamath N, Sakajiki AM, Salah M, Vincent L, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Ashuntantang GE, Arogundade FA. Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:12-28. [PMID: 38618494 PMCID: PMC11010621 DOI: 10.1016/j.kisu.2024.01.002] [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: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bianca Davidson
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Directorate of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | - M. Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Hassane M. Diongole
- Division of Nephrology, Department of Medicine, National Hospital Zinder, Zinder, Niger
- Faculty of Health Sciences, University of Zinder, Zinder, Niger
| | - Udeme E. Ekrikpo
- Department of Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ehab O.A. Hafiz
- Electron Microscopy Department, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Kwaifa Salihu Ibrahim
- Nephrology Unit, Department of Medicine, Wuse District Hospital, Abuja, Nigeria
- Department of Internal Medicine, College of Health Sciences, Nile University, Federal Capital Territory, Abuja, Nigeria
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aisha M. Nalado
- Department of Medicine, Bayero University Kano, Kano, Nigeria
| | - Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ugochi Chika Onu
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, ItukuOzalla, Enugu State, Nigeria
| | | | - Aminu Muhammad Sakajiki
- Department of Medicine, Usmanu Danfodiyo University and Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohamed Salah
- National Institute of Urology & Nephrology, Cairo, Egypt
| | | | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gloria Enow Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Fatiu Abiola Arogundade
- Renal Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Currin S, George JA, Hansen CH, Naicker S, Tomlinson L, Crampin A, Kalyesubula R, Newton R, Nakanga WP, Nitsch D, Fabian J. Single-sample measured glomerular filtration rate in Malawi, South Africa, and Uganda. Kidney Int 2024; 105:882-885. [PMID: 38307202 DOI: 10.1016/j.kint.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Sean Currin
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, South Africa.
| | - Jaya A George
- National Health Laboratory Service, South Africa; Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christian Holm Hansen
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Kalyesubula
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Wisdom P Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [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] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
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Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
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Tusubira AK, Ssinabulya I, Kalyesubula R, Nalwadda CK, Akiteng AR, Ngaruiya C, Rabin TL, Katahoire A, Armstrong-Hough M, Hsieh E, Hawley NL, Schwartz JI. Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda. PLOS Glob Public Health 2023; 3:e0001777. [PMID: 38079386 PMCID: PMC10712841 DOI: 10.1371/journal.pgph.0001777] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. METHODS Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants' healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient's conditions. RESULTS Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P<0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s). CONCLUSION Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, California, United States of America
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, United States of America
- Department of Epidemiology, School of Global Public Health, New York University, New York, United States of America
| | - Evelyn Hsieh
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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5
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Schwab J, Wachinger J, Munana R, Nabiryo M, Sekitoleko I, Cazier J, Ingenhoff R, Favaretti C, Subramonia Pillai V, Weswa I, Wafula J, Emmrich JV, Bärnighausen T, Knauf F, Knauss S, Nalwadda CK, Sudharsanan N, Kalyesubula R, McMahon SA. Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46614. [PMID: 38032702 PMCID: PMC10722357 DOI: 10.2196/46614] [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: 03/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. OBJECTIVE This study aims to design and pilot-test a mobile money-based intervention to increase the availability of antihypertensive medication and lower clients' out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. METHODS We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. RESULTS As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. CONCLUSIONS Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. TRIAL REGISTRATION German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46614.
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Affiliation(s)
- Josephine Schwab
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Maxencia Nabiryo
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | | | - Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Caterina Favaretti
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vasanthi Subramonia Pillai
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - John Wafula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Julius Valentin Emmrich
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Samuel Knauss
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christine K Nalwadda
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
- Department of Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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6
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Ingenhoff R, Robertson N, Munana R, Bodnar BE, Weswa I, Sekitoleko I, Gaal J, Kirenga BJ, Kalyesubula R, Knauf F, Siddharthan T. Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening and Referral in Rural Uganda: A Qualitative Study using the Implementation Outcomes Framework. Int J Chron Obstruct Pulmon Dis 2023; 18:2769-2783. [PMID: 38046984 PMCID: PMC10693197 DOI: 10.2147/copd.s420137] [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] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda. Methods This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis. Results Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs. Conclusion CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Richard Munana
- School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USA
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Kalyesubula R. The realities of diagnosing and managing glomerular disease in low-income countries. Nat Rev Nephrol 2023; 19:687. [PMID: 37596389 DOI: 10.1038/s41581-023-00761-6] [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] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Affiliation(s)
- Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda.
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
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Kazibwe A, Oryokot B, Kyazze AP, Ssekamatte P, Akabwai GP, Seremba E, Mukunya D, Kagimu M, Andia-Biraro I, Kalyesubula R. The Effect of COVID-19 Restrictions on General and HIV Positive Inpatient Admissions and Treatment Outcomes: An Uncontrolled Before-and-after Study at a Ugandan Tertiary Hospital. AIDS Behav 2023; 27:3745-3754. [PMID: 37231190 PMCID: PMC10211272 DOI: 10.1007/s10461-023-04092-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan - Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31-40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85-2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.
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Affiliation(s)
- Andrew Kazibwe
- College of Health Sciences, School of Medicine, Department of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda
- The AIDS Support Organisation (TASO), Programs Directorate, P. O. Box 10443, Kampala, Uganda
| | - Bonniface Oryokot
- The AIDS Support Organisation (TASO), Programs Directorate, P. O. Box 10443, Kampala, Uganda
- University of Suffolk, Ipswich, UK
| | - Andrew Peter Kyazze
- Tuberculosis and Comorbidities (TAC) Research Group, P. O. Box 7072, Kampala, Uganda
| | - Philip Ssekamatte
- Tuberculosis and Comorbidities (TAC) Research Group, P. O. Box 7072, Kampala, Uganda
- College of Health Sciences, School of Biomedical Sciences, Department of Immunology and Molecular Biology, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - George Patrick Akabwai
- Center of Excellence, Baylor College of Medicine, P. O. Box 72025, Kampala, Uganda
- Kiruddu National Referral Hospital, P. O. Box 6558, Kampala, Uganda
| | - Emmanuel Seremba
- Kiruddu National Referral Hospital, P. O. Box 6558, Kampala, Uganda
| | - David Mukunya
- Faculty of Health Sciences, Department of Public Health, Busitema University, P. O. Box 236, Tororo, Uganda
| | - Magid Kagimu
- College of Health Sciences, School of Medicine, Department of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Irene Andia-Biraro
- College of Health Sciences, School of Medicine, Department of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda
- Tuberculosis and Comorbidities (TAC) Research Group, P. O. Box 7072, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- College of Health Sciences, School of Biomedical Sciences, Department of Physiology, Makerere University, P. O. Box 7072, Kampala, Uganda
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Sembajwe FL, Namaganda A, Nfambi J, Muwonge H, Katamba G, Nakato R, Nabachenje P, Kawala Kagoya E, Namubamba A, Kiggundu D, Bitek B, Kalyesubula R, Iputo J. Dietary intake, body composition and micronutrient profile of patients on maintenance hemodialysis attending Kiruddu National Referral Hospital, Uganda: A cross sectional study. PLoS One 2023; 18:e0291813. [PMID: 37856499 PMCID: PMC10586598 DOI: 10.1371/journal.pone.0291813] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
Patients on maintenance hemodialysis are at a great risk for altered nutritional status, characterized by protein energy wasting and micronutrient deficiency due to medication interactions and dietary restrictions. This study determined the dietary intake, micronutrient profile and body composition of patients on maintenance hemodialysis at Kiruddu National referral hospital (KNRH), Uganda. A cross sectional study was done among adult CKD patients on maintenance hemodialysis therapy at KNRH. Data concerning patients' demographics, clinical history and dietary intake was obtained using interactive and quantitative food frequency questionnaires. Body composition was obtained using the TANITA BC-351, Japan weighing Bathroom scale and anthropometric measurements using standard methods and procedures. Serum micronutrient profile assessment was done using the COBAS Auto analyzer. Data analysis was done using the SPSS software version 20. T-test was used to make comparisons and logistic regression analysis was done to check for any correlations. A P-value of < 0.05 was considered statistically significant. Among the 63 hemodialysis patients, 38% were female, with a median duration of hemodialysis of 12 months and the overall age range of patients was 31-40 years. Majority (92.1%) of the patients had hypertension. Carbohydrates like maize flour were highly consumed, in addition to eggs among the proteins on the daily basis. Fruits and vegetables were not highly consumed. Regarding body composition; 75% of the study participants had normal Body mass Index (BMI), the mean muscle mass was 51.94±8.68, body fat was 15.25±7.35, bone mass was 2.77±0.46 and body water was 62.04±9.06. Patients had deranged micronutrient levels especially for Vitamin D, Potassium and phosphorus. In conclusion, hemodialysis patients at KNRH, have altered nutritional status as evidenced by altered body weight for some patients and deranged micronutrient levels. We recommend that hemodialysis patients should be regularly assessed for nutritional status, appropriately treated and educated about their nutritional status.
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Affiliation(s)
- Fred Lawrence Sembajwe
- Department of Medical Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Medical Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joshua Nfambi
- Department of Medical Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Godfrey Katamba
- Department of Physiology, College of Health, Medicine and Life Sciences, King Ceasor University, Kampala, Uganda
| | - Ritah Nakato
- Department of Pharmacology, College of Medicine, Lira University, Lira, Uganda
| | - Prossy Nabachenje
- Department of Pediatrics, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Enid Kawala Kagoya
- Department of Community Health and Behavioural Sciences, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Annet Namubamba
- Department of Public Health, School of public Health Kololo Annex, Makerere University, Kampala, Uganda
| | - Daniel Kiggundu
- Department of Medicine, Dialysis Unit, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Brian Bitek
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Robert Kalyesubula
- Department of Medical Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Jehu Iputo
- Department of Medical Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
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Kalyesubula R, Anandh U. Introduction: Infections and the Kidney: An Area of Resurgent Concern. Semin Nephrol 2023; 43:151463. [PMID: 38172032 DOI: 10.1016/j.semnephrol.2023.151463] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Robert Kalyesubula
- Department of Physiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad, Delhi NCR, India
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Karam S, Abdul Hafidz MI, Calice-Silva V, Chen T, Dupuis S, Ekrikpo UE, Francis A, Jha V, Kalyesubula R, Kumar V, Nakhoul G, Pereira-Kamath N, Tannor EK, Tran A, Wijewickrama E, Wong MM, Chanchlani R. Nurturing Global Leadership, Advocacy, Research, and Collegiality: The Unique Experience of The International Society of Nephrology Emerging Leaders Program. Kidney Int Rep 2023; 8:1703-1707. [PMID: 37705897 PMCID: PMC10496062 DOI: 10.1016/j.ekir.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, USA
| | | | - Viviane Calice-Silva
- Pro-Rim Foundation, Joinville, Santa Catarina, Brazil and Department of Clinical Medicine, Faculty of Medicine, University of the Region of Joinville (UNIVILLE), Joinville, Santa Catarina, Brazil
| | - Titi Chen
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sophie Dupuis
- International Society of Nephrology, Brussels, Belgium
| | | | - Anna Francis
- Department of Clinical Medicine, School of Medicine, University of Queensland, Brisbane, Australia
| | - Vivekanand Jha
- International Society of Nephrology, Brussels, Belgium
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Georges Nakhoul
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Elliot K. Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anh Tran
- International Society of Nephrology, Brussels, Belgium
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Michelle M.Y. Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, Hamilton, Ontario, Canada
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12
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Mayanja R, Machipisa T, Soremekun O, Kamiza AB, Kintu C, Kalungi A, Kalyesubula R, Sande OJ, Jjingo D, Fabian J, Robinson-Cohen C, Franceschini N, Nitsch D, Nyirenda M, Zeggini E, Morris AP, Chikowore T, Fatumo S. Genome-wide association analysis of cystatin-C kidney function in continental Africa. EBioMedicine 2023; 95:104775. [PMID: 37639939 PMCID: PMC10474146 DOI: 10.1016/j.ebiom.2023.104775] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Chronic kidney disease is becoming more prevalent in Africa, and its genetic determinants are poorly understood. Creatinine-based estimated glomerular filtration rate (eGFR) is commonly used to estimate kidney function, modelling the excretion of the endogenous biomarker (creatinine). However, eGFR based on creatinine has been shown to inadequately detect individuals with low kidney function in Sub-Saharan Africa, with eGFR based on cystatin-C (eGFRcys) exhibiting significantly superior performance. Therefore, we opted to conduct a GWAS for eGFRcys. METHODS Using the Uganda Genomic Resource, we performed a genome-wide association study (GWAS) of eGFRcys in 5877 Ugandans and evaluated replication in independent studies. Subsequently, putative causal variants were screened through Bayesian fine-mapping. Functional annotation of the GWAS loci was performed using Functional Mapping and Annotation (FUMA). FINDINGS Three independent lead single nucleotide polymorphisms (SNPs) (P-value <5 × 10-8 (based on likelihood ratio test (LRT))) were identified; rs59288815 (ANK3), rs4277141 (OR51B5) and rs911119 (CST3). From fine-mapping, rs59288815 and rs911119 each had a posterior probability of causality of >99%. The rs911119 SNP maps to the cystatin C gene and has been previously associated with eGFRcys among Europeans. With gene-set enrichment analyses of the olfactory receptor family 51 overlapping genes, we identified an association with the G-alpha-S signalling events. INTERPRETATION Our study found two previously unreported associated SNPs for eGFRcys in continental Africans (rs59288815 and rs4277141) and validated a previously well-established SNP (rs911119) for eGFRcys. The identified gene-set enrichment for the G-protein signalling pathways relates to the capacity of the kidney to readily adapt to an ever-changing environment. Additional GWASs are required to represent the diverse regions in Africa. FUNDING Wellcome (220740/Z/20/Z).
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Affiliation(s)
- Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Tafadzwa Machipisa
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa; Clinical Research Laboratory-Genetic and Molecular Epidemiology Laboratory (CRLB-GMEL), Population Health Research Institute (PHRI) & McMaster University, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Abram B Kamiza
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allan Kalungi
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- Medical Research Council/ Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Obondo J Sande
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics (ACE-B), Makerere University, Kampala, Uganda
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nora Franceschini
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Moffat Nyirenda
- Clinical Research Laboratory-Genetic and Molecular Epidemiology Laboratory (CRLB-GMEL), Population Health Research Institute (PHRI) & McMaster University, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada; London School of Hygiene and Tropical Medicine London, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; TUM School of Medicine, Translational Genomics, Technical University of Munich and Klinikum Rechts der Isar, Munich, Germany
| | - Andrew P Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Tinashe Chikowore
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Medical Research Council/ Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine London, UK; Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
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13
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Kalyesubula R, Wearne N, Kubo M, Hussey N, Naicker S. HIV and Associated TB: A Lethal Association for Kidney Health? Semin Nephrol 2023; 43:151470. [PMID: 38245391 DOI: 10.1016/j.semnephrol.2023.151470] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.
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Affiliation(s)
- Robert Kalyesubula
- Department of Physiology and Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mary Kubo
- Department of Clinical Medicine and Therapeutics, East African Kidney Institute, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Nadia Hussey
- Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Kintu C, Soremekun O, Machipisa T, Mayanja R, Kalyesubula R, Bagaya BS, Jjingo D, Chikowore T, Fatumo S. Meta-analysis of African ancestry genome-wide association studies identified novel locus and validates multiple loci associated with kidney function. BMC Genomics 2023; 24:496. [PMID: 37644460 PMCID: PMC10464349 DOI: 10.1186/s12864-023-09601-0] [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] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
Despite recent efforts to increase diversity in genome-wide association studies (GWASs), most loci currently associated with kidney function are still limited to European ancestry due to the underlying sample selection bias in available GWASs. We set out to identify susceptibility loci associated with estimated glomerular filtration rate (eGFRcrea) in 80027 individuals of African-ancestry from the UK Biobank (UKBB), Million Veteran Program (MVP), and Chronic Kidney Disease genetics (CKDGen) consortia.We identified 8 lead SNPs, 7 of which were previously associated with eGFR in other populations. We identified one novel variant, rs77408001 which is an intronic variant mapped to the ELN gene. We validated three previously reported loci at GATM-SPATA5L1, SLC15A5 and AGPAT3. Fine-mapping analysis identified variants rs77121243 and rs201602445 as having a 99.9% posterior probability of being causal. Our results warrant designing bigger studies within individuals of African ancestry to gain new insights into the pathogenesis of Chronic Kidney Disease (CKD), and identify genomic variants unique to this ancestry that may influence renal function and disease.
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Affiliation(s)
- Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Tafadzwa Machipisa
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Bernard S Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics (ACE-B), Makerere University, Kampala, 10101, Uganda
- Department of Computer Science, College of Computing, Makerere University, Kampala, Uganda
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Edward A, Kalyesubula R, Pariyo G, Kyazze AP, Hu X, Appel LJ, Matsushita K. Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study. PLOS Glob Public Health 2023; 3:e0001609. [PMID: 37459296 PMCID: PMC10351720 DOI: 10.1371/journal.pgph.0001609] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert Kalyesubula
- Departments of Medicine and Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Peter Kyazze
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Xiao Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence J. Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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El-Khoury JM, Karger AB, Cavalier E, Kalyesubula R, Teo BW, Costa E Silva VT, Inker LA. International Perspectives on GFR Estimation and Race-Based Adjustments. Clin Chem 2023:hvad095. [PMID: 37453046 DOI: 10.1093/clinchem/hvad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Joe M El-Khoury
- Associate Professor, Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Amy B Karger
- Associate Professor, Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Etienne Cavalier
- Professor of Clinical Chemistry, Center for Interdisciplinary Research on Medicines (CIRM), University of Liege, Liège, Belgium
- Head of the Department of Clinical Chemistry, University Hospital of Liege, Liège, Belgium
- Chairman of the European Federation of Laboratory Medicine (EFLM) Task Group on Chronic Kidney Disease (TG-CKD), Milano, Italy
| | - Robert Kalyesubula
- Chair, Physiology Department and Senior Lecturer of Nephrology at Makerere University College of Health Sciences, Kampala, Uganda
| | - Boon Wee Teo
- Associate Professor, Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Verônica T Costa E Silva
- Assistant Professor, Serviço de Nefrologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Investigação Médica (LIM) 16, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lesley A Inker
- Professor of Medicine, Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
- Director, Kidney and Blood Pressure Center, Division of Nephrology, Tufts Medical Center, Boston, MA, United States
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17
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Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Kalyesubula R, Nakimuli A, Naome M, Patel KP, Masenga SK, Kirabo A. Glycocalyx-Sodium Interaction in Vascular Endothelium. Nutrients 2023; 15:2873. [PMID: 37447199 DOI: 10.3390/nu15132873] [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: 05/20/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
The glycocalyx generally covers almost all cellular surfaces, where it participates in mediating cell-surface interactions with the extracellular matrix as well as with intracellular signaling molecules. The endothelial glycocalyx that covers the luminal surface mediates the interactions of endothelial cells with materials flowing in the circulating blood, including blood cells. Cardiovascular diseases (CVD) remain a major cause of morbidity and mortality around the world. The cardiovascular risk factors start by causing endothelial cell dysfunction associated with destruction or irregular maintenance of the glycocalyx, which may culminate into a full-blown cardiovascular disease. The endothelial glycocalyx plays a crucial role in shielding the cell from excessive exposure and absorption of excessive salt, which can potentially cause damage to the endothelial cells and underlying tissues of the blood vessels. So, in this mini review/commentary, we delineate and provide a concise summary of the various components of the glycocalyx, their interaction with salt, and subsequent involvement in the cardiovascular disease process. We also highlight the major components of the glycocalyx that could be used as disease biomarkers or as drug targets in the management of cardiovascular diseases.
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Affiliation(s)
- Lawrence Fred Sembajwe
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Robert Kalyesubula
- Department of Medical Physiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - Mwesigwa Naome
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sepiso K Masenga
- Department of Physiological Sciences, School of Medicine and Health Sciences, Mulungushi University, Kabwe P.O. Box 80415, Zambia
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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18
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Batte C, Semulimi AW, Mutebi RK, Twinamasiko N, Muyama SR, Mukisa J, Atukunda I, Mukunya D, Kalyesubula R, Trishul S, Kirenga B. Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda. PLOS Glob Public Health 2023; 3:e0002013. [PMID: 37276227 DOI: 10.1371/journal.pgph.0002013] [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: 01/31/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Measuring quality of life is a key component in the management of Chronic Obstructive Pulmonary Disease (COPD). The COPD assessment test (CAT), an easy to administer and shorter instrument than the standard Saint George's respiratory questionnaire (SGRQ), could be an alternative tool for measuring the quality of life of COPD patients in rural Uganda. A cross-sectional study was conducted between June and August 2022, consecutively recruiting 113 COPD patients aged > 40 years from the Low-Dose Theophylline for the management of Biomass-associated COPD (LODOT-BCOPD) study. Upon obtaining consent, participants answered an interviewer administered social demographic, CAT and SGRQ questionnaire. Internal consistency for both SGRQ and CAT was determined using Cronbach's alpha coefficient and values > 0.7 were considered acceptable while correlations were determined using Spearman's rank correlation. Limits of Agreement were visualised using Bland Altman and pair plots. Of the 113 participants, 51 (45.1%) were female. The mean age was 64 ± 12 years, 19 (16.8%) had history of smoking while majority (112 (99.1%)) reported use of firewood for cooking. There was a strong correlation of 0.791 (p < 0.001) between the CAT and SGRQ total scores with a high internal consistency of CAT, Cronbach's alpha coefficient of 0.924 (0.901-0.946). The agreement between the absolute CAT scores and the SGRQ scores was good with a mean difference of -0.932 (95% Confidence Interval: -33.49-31.62). In summary, CAT has an acceptable validity and can be used as an alternative to the SGRQ to assess the quality of life of COPD patients in rural Uganda.
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Affiliation(s)
- Charles Batte
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Climate Change and Health Unit, Tree Adoption Uganda, Kampala, Uganda
| | - Andrew Weil Semulimi
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Kasoma Mutebi
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Ugand
- Department of Medicine, Mengo Hospital, Kampala, Uganda
| | - Nelson Twinamasiko
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Ugand
| | - Sarah Racheal Muyama
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Kampala, Uganda
| | - Immaculate Atukunda
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Mukunya
- Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Robert Kalyesubula
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Centre for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Siddharthan Trishul
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Bruce Kirenga
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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19
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Ingenhoff R, Munana R, Weswa I, Gaal J, Sekitoleko I, Mutabazi H, Bodnar BE, Rabin TL, Siddharthan T, Kalyesubula R, Knauf F, Nalwadda CK. Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda. BMC Public Health 2023; 23:881. [PMID: 37173687 PMCID: PMC10176286 DOI: 10.1186/s12889-023-15704-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Richard Munana
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hillary Mutabazi
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christine K Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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20
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Kintu C, Soremekun O, Kamiza AB, Kalungi A, Mayanja R, Kalyesubula R, Bagaya S B, Jjingo D, Fabian J, Gill D, Nyirenda M, Nitsch D, Chikowore T, Fatumo S. The causal effects of lipid traits on kidney function in Africans: bidirectional and multivariable Mendelian-randomization study. EBioMedicine 2023; 90:104537. [PMID: 37001235 PMCID: PMC10070509 DOI: 10.1016/j.ebiom.2023.104537] [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] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Observational studies have investigated the effect of serum lipids on kidney function, but these findings are limited by confounding, reverse causation and have reported conflicting results. Mendelian randomization (MR) studies address this confounding problem. However, they have been conducted mostly in European ancestry individuals. We, therefore, set out to investigate the effect of lipid traits on the estimated glomerular filtration rate (eGFR) based on serum creatinine in individuals of African ancestry. METHODS We used the two-sample and multivariable Mendelian randomization (MVMR) approaches; in which instrument variables (IV's) for the predictor (lipid traits) were derived from summary-level data of a meta-analyzed African lipid GWAS (MALG, n = 24,215) from the African Partnership for Chronic Disease Research (APCDR) (n = 13,612) & the Africa Wits-IN-DEPTH partnership for Genomics studies (AWI-Gen) dataset (n = 10,603). The outcome IV's were computed from the eGFR summary-level data of African-ancestry individuals within the Million Veteran Program (n = 57,336). A random-effects inverse variance method was used in our primary analysis, and pleiotropy was adjusted for using robust and penalized sensitivity testing. The lipid predictors for the MVMR were high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG). FINDINGS We found a significant causal association between genetically predicted low-density lipoprotein (LDL) cholesterol and eGFR in African ancestry individuals β = 1.1 (95% CI [0.411-1.788]; p = 0.002). Similarly, total cholesterol (TC) showed a significant causal effect on eGFR β = 1.619 (95% CI [0.412-2.826]; p = 0.009). However, the IVW estimate showed that genetically predicted HDL-C β = -0.164, (95% CI = [-1.329 to 1.00]; p = 0.782), and TG β = -0.934 (CI = [-2.815 to 0.947]; p = 0.33) were not significantly causally associated with the risk of eGFR. In the multivariable analysis inverse-variance weighted (MVIVW) method, there was evidence for a causal association between LDL and eGFR β = 1.228 (CI = [0.477-1.979]; p = 0.001). A significant causal effect of Triglycerides (TG) on eGFR in the MVIVW analysis β = -1.3 ([-2.533 to -0.067]; p = 0.039) was observed as well. All the causal estimates reported reflect a unit change in the outcome per a 1 SD increase in the exposure. HDL showed no evidence of a significant causal association with eGFR in the MVIVW method (β = -0.117 (95% CI [-1.252 to 0.018]; p = 0.840)). We found no evidence of a reverse causal impact of eGFR on serum lipids. All our sensitivity analyses indicated no strong evidence of pleiotropy or heterogeneity between our instrumental variables for both the forward and reverse MR analysis. INTERPRETATION In this African ancestry population, genetically predicted higher LDL-C and TC are causally associated with higher eGFR levels, which may suggest that the relationship between LDL, TC and kidney function may be U-shaped. And as such, lowering LDL_C does not necessarily improve risk of kidney disease. This may also imply the reason why LDL_C is seen to be a poorer predictor of kidney function compared to HDL. In addition, this further supports that more work is warranted to confirm the potential association between lipid traits and risk of kidney disease in individuals of African Ancestry. FUNDING Wellcome (220740/Z/20/Z).
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Affiliation(s)
- Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Opeyemi Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Abram B Kamiza
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Allan Kalungi
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Robert Kalyesubula
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Bernard Bagaya S
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics (ACE-B), Makerere University, Kampala 10101, Uganda
| | - June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Chief Scientific Advisor Office, Research and Early Development, Novo Nordisk, Copenhagen, Denmark
| | - Moffat Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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21
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Fabian J, Kalyesubula R, Mkandawire J, Nakanga W, Prynn J, Snyman T, Ssebunnya B, Musenge E, Dreyer G, George J, Hansen C, Newton R, Crampin A, Nitsch D, Tomlinson L. WCN23-0503 Measurement of kidney function in Malawi, South Africa, and Uganda - a multi-centre population cohort study. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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22
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Batte A, Gyagenda JO, Otwombe K, Muhindo R, Bagasha P, Kiggundu D, Aujo JC, Atuhe DM, Kansiime G, Hussein R, Namuyimbwa L, Mukasa SL, Kabuye A, Mukasa J, Sekasanvu E, Kalyesubula R. Prevalence and predictors of hypertension among adults in Mbarara City, Western Uganda. Chronic Illn 2023; 19:132-145. [PMID: 34786975 DOI: 10.1177/17423953211058408] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study aim was to evaluate the prevalence and predictors of hypertension among an urban adult population in Mbarara city, Western Uganda. METHODS We evaluated blood pressure measurements, social demographic and clinical parameters of adults living in Mbarara city, Uganda. These parameters were extracted from medical records of adults who participated in the Uganda World Kidney Day 2020 health screening activities. A total of 302 adults were evaluated for hypertension using the American College of Cardiology/American Heart Association 2017 (blood pressure threshold 130/80 mmHg) and International Society of Hypertension 2020 guidelines (threshold 140/90 mmHg). RESULTS The mean age of the participants was 42.5 years (standard deviation: 15.1) and majority were male 195/302 (64.6%). Using American College of Cardiology/American Heart Association 2017 guidelines, 156/302 (51.7%) adults were newly diagnosed with hypertension compared to 68/302 (22.5%) newly diagnosed with hypertension using International Society of Hypertension 2020 guidelines. Only 23/302 (7.6%) were on treatment. Based on American College of Cardiology/American Heart Association 2017 guidelines, age ≥40 years and overweight/obesity were statistically significant predictors of hypertension (p < 0.05 for all) at multivariate analysis. Using the International Society of Hypertension 2020 guidelines, age ≥40 years predicted hypertension. DISCUSSION The prevalence of hypertension is high among this urban adult population irrespective of the guidelines used, highlighting the need for hypertension prevention interventions.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joseph Ogavu Gyagenda
- Nephrology Unit, Department of Medicine, 281437St Francis Hospital Nsambya Kampala, Kampala, Uganda.,Uganda Martyrs University School of Medicine, Kampala, Uganda
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, 37708University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, 37708University of the Witwatersrand, South Africa
| | - Rose Muhindo
- Department of Internal Medicine, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peace Bagasha
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - Daniel Kiggundu
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - Judith Caroline Aujo
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | - David Martin Atuhe
- Nephrology Unit, Department of Medicine, 281437St Francis Hospital Nsambya Kampala, Kampala, Uganda
| | - Grace Kansiime
- Department of Nephrology, 249321Mulago National Referral Hospital, Kampala, Uganda
| | | | - Lydia Namuyimbwa
- Department of Physiology, 323124Kabale University, Kabale, Uganda
| | | | | | - Joseph Mukasa
- 585446Health Life promotion Africa, Limited, Kampala, Uganda
| | | | - Robert Kalyesubula
- Department of Physiology, 58589Makerere University College of Health Sciences, Kampala, Uganda
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23
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Wong M, Nakhoul G, Calice-Silva V, Tannor E, Kumar V, Abdul Hafidz M, Chanchlani R, Chen T, Ekrikpo U, Francis A, Kalyesubula R, Karam S, Pereira-Kamath N, Wijewickrama E, Jha V. WCN23-0776 BARRIERS TO ACCESSING ESSENTIAL MEDICINES IN NEPHROLOGY AND RELATED NON-COMMUNICABLE DISEASES: A SCOPING REVIEW. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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24
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Kayongo A, Bartolomaeus TUP, Birkner T, Markó L, Löber U, Kigozi E, Atugonza C, Munana R, Mawanda D, Sekibira R, Uwimaana E, Alupo P, Kalyesubula R, Knauf F, Siddharthan T, Bagaya BS, Kateete DP, Joloba ML, Sewankambo NK, Jjingo D, Kirenga B, Checkley W, Forslund SK. Sputum Microbiome and Chronic Obstructive Pulmonary Disease in a Rural Ugandan Cohort of Well-Controlled HIV Infection. Microbiol Spectr 2023; 11:e0213921. [PMID: 36790203 PMCID: PMC10100697 DOI: 10.1128/spectrum.02139-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 11/03/2021] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Sub-Saharan Africa has increased morbidity and mortality related to chronic obstructive pulmonary disease (COPD). COPD among people living with HIV (PLWH) has not been well studied in this region, where HIV/AIDS is endemic. Increasing evidence suggests that respiratory microbial composition plays a role in COPD severity. Therefore, we aimed to investigate microbiome patterns and associations among PLWH with COPD in Sub-Saharan Africa. We conducted a cross-sectional study of 200 adults stratified by HIV and COPD in rural Uganda. Induced sputum samples were collected as an easy-to-obtain proxy for the lower respiratory tract microbiota. We performed 16S rRNA gene sequencing and used PICRUSt2 (version 2.2.3) to infer the functional profiles of the microbial community. We used a statistical tool to detect changes in specific taxa that searches and adjusts for confounding factors such as antiretroviral therapy (ART), age, sex, and other participant characteristics. We could cluster the microbial community into three community types whose distribution was shown to be significantly impacted by HIV. Some genera, e.g., Veillonella, Actinomyces, Atopobium, and Filifactor, were significantly enriched in HIV-infected individuals, while the COPD status was significantly associated with Gammaproteobacteria and Selenomonas abundance. Furthermore, reduced bacterial richness and significant enrichment in Campylobacter were associated with HIV-COPD comorbidity. Functional prediction using PICRUSt2 revealed a significant depletion in glutamate degradation capacity pathways in HIV-positive patients. A comparison of our findings with an HIV cohort from the United Kingdom revealed significant differences in the sputum microbiome composition, irrespective of viral suppression. IMPORTANCE Even with ART available, HIV-infected individuals are at high risk of suffering comorbidities, as shown by the high prevalence of noninfectious lung diseases in the HIV population. Recent studies have suggested a role for the respiratory microbiota in driving chronic lung inflammation. The respiratory microbiota was significantly altered among PLWH, with disease persisting up to 3 years post-ART initiation and HIV suppression. The community structure and diversity of the sputum microbiota in COPD are associated with disease severity and clinical outcomes, both in stable COPD and during exacerbations. Therefore, a better understanding of the sputum microbiome among PLWH could improve COPD prognostic and risk stratification strategies. In this study, we observed that in a virologically suppressed HIV cohort in rural Uganda, we could show differences in sputum microbiota stratified by HIV and COPD, reduced bacterial richness, and significant enrichment in Campylobacter associated with HIV-COPD comorbidity.
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Affiliation(s)
- Alex Kayongo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Theda Ulrike Patricia Bartolomaeus
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Till Birkner
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Lajos Markó
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Ulrike Löber
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Edgar Kigozi
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Carolyne Atugonza
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Richard Munana
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Mawanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rogers Sekibira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Esther Uwimaana
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Patricia Alupo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- African Community Center for Social Sustainability (ACCESS), Department of Research, Nakaseke, Uganda
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Trishul Siddharthan
- University of Miami, School of Medicine, Division of pulmonary and critical care medicine, Miami, Florida, USA
| | - Bernard S. Bagaya
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - David P. Kateete
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Moses L. Joloba
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Nelson K. Sewankambo
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - Daudi Jjingo
- Makerere University, College of Computing and Information Sciences, Department of Computer Science, Kampala, Uganda
- African Center of Excellence in Bioinformatics and Data Science, Infectious Diseases Institute, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sofia K. Forslund
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany
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Kasoma Mutebi R, Weil Semulimi A, Mukisa J, Namusobya M, Namirembe JC, Nalugga EA, Batte C, Mukunya D, Kirenga B, Kalyesubula R, Byakika-Kibwika P. Prevalence of and Factors Associated with Hypertension Among Adults on Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross Sectional Study. Integr Blood Press Control 2023; 16:11-21. [PMID: 37102123 PMCID: PMC10123006 DOI: 10.2147/ibpc.s403023] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens. Methods We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents. Results The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2-31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m3 (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122-1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206-8.108, P < 0.001] and 35-44 years [aPR: 2.455, 95% CI: 1.216-4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m3 [aPR: 1.489, 95% CI: 1.072-2.067, P = 0.017] as compared with BMI < 25 kg/m3, duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001-1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064-1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205-2.484, P = 0.003] were associated with hypertension. Conclusion One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.
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Affiliation(s)
- Ronald Kasoma Mutebi
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Mengo Hospital, Kampala, Uganda
- Correspondence: Ronald Kasoma Mutebi, Department of Medicine, Mengo Hospital, PO BOX 7161, Kampala, Uganda, Email
| | - Andrew Weil Semulimi
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Kampala, Uganda
| | - Martha Namusobya
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Esther Alice Nalugga
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Batte
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Bruce Kirenga
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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26
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Ssekitooleko B, Ssuna B, Nimanya SA, Kiwewa R, Ssewanyana Y, Nkonge E, Bua E, Wandabwa J, Ocen W, Nassanga R, Asiimwe F, Kalyesubula R. High incidence of acute kidney injury among patients with major trauma at Mulago National Referral Hospital, Uganda: risk factors and overall survival. Afr Health Sci 2022; 22:191-198. [PMID: 37092070 PMCID: PMC10117470 DOI: 10.4314/ahs.v22i4.23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Introduction: Acute kidney injury (AKI) is a common and life-threatening complication of major trauma. Recognition is often delayed and management is frequently sub-optimal. We determined the incidence, risk factors and immediate outcomes of AKI in patients with major trauma at Mulago National Referral Hospital.Methods: This was a prospective study. We recruited adult patients with ISS of > 16. The KDIGO criteria was used to stage AKI. Serum creatinine was measured at baseline, 24, 48, 72 hours and on discharge from the study. Participants were followed up for seven days if not yet discharged. Bivariate and multivariate analysis was done using modified Poisson regression with robust standard errors.Results: 224 patients were recruited. The incidence was 67/1000 persons per day. The risk factors were male sex, delayed presentation, hypoglycemia at admission, RR=1.62 (95%CI 1.24-2.12) and non-operative management RR=1.39 (95%CI 1.02-1.89). Out of the 62 patients that died, 34 (54.8%) had AKI. The overall mortality rate was 39.5 patients per thousand per day.Conclusion: There was a high incidence of AKI among patients with major trauma. Efforts to reduce morbidity and mortality should be prioritized.Keywords: AKI=Acute kidney injury; major trauma; ISS = injury severity score.
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Affiliation(s)
- Badru Ssekitooleko
- Makerere University College of Health Sciences, School of Medicine
- Islamic University in Uganda
| | - Bashir Ssuna
- Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University
- Uganda TB Implementation Research Consortium
| | | | | | | | | | - Emmanuel Bua
- Makerere University College of Health Sciences, School of Medicine
| | - Joel Wandabwa
- Department of Surgery, Mulago National Referral Hospital
| | - William Ocen
- Department of Surgery, Mulago National Referral Hospital
| | | | - Frank Asiimwe
- Department of Surgery, Mulago National Referral Hospital
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27
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Fatumo S, Mugisha J, Soremekun OS, Kalungi A, Mayanja R, Kintu C, Makanga R, Kakande A, Abaasa A, Asiki G, Kalyesubula R, Newton R, Nyirenda M, Sandhu MS, Kaleebu P. Uganda Genome Resource: A rich research database for genomic studies of communicable and non-communicable diseases in Africa. Cell Genom 2022; 2:None. [PMID: 36388767 PMCID: PMC9646479 DOI: 10.1016/j.xgen.2022.100209] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Uganda Genome Resource (UGR) is a well-characterized genomic database with a range of phenotypic communicable and non-communicable diseases and risk factors generated from the Uganda General Population Cohort (GPC), a population-based open cohort established in 1989. The UGR comprises genotype data on ∼5,000 and whole-genome sequence data on ∼2,000 Ugandan GPC individuals from 10 ethno-linguistic groups. Leveraging other platforms at MRC/UVRI and LSHTM Uganda Research Unit, there is opportunity for additional sample collection to expand the UGR to advance scientific discoveries. Here, we describe UGR and highlight how it is providing opportunities for discovery of novel disease susceptibility genetic loci, refining association signals at new and existing loci, developing and testing polygenic scores to determine disease risk, assessing causal relations in diseases, and developing capacity for genomics research in Africa. The UGR has the potential to develop to a comparable level of European and Asian large-scale genomic initiatives.
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Affiliation(s)
- Segun Fatumo
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- The Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Opeyemi S. Soremekun
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Allan Kalungi
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Richard Mayanja
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher Kintu
- The African Computational Genomics (TACG) Research Group, MRC/UVRI and LSHTM, Entebbe, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Makanga
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Andrew Abaasa
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- Health and Systems for Health Research Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Robert Kalyesubula
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Newton
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Moffat Nyirenda
- The Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Manj S. Sandhu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Pontiano Kaleebu
- Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda
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28
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Francis A, Abdul Hafidz MI, Ekrikpo UE, Chen T, Wijewickrama E, Tannor EK, Nakhoul G, Wong MMY, Pereira-Kamath N, Chanchlani R, Kalyesubula R, Karam S, Kumar V, Calice-Silva V, Jha V. Barriers to accessing essential medicines for kidney disease in low- and lower middle-income countries|. Kidney Int 2022; 102:969-973. [PMID: 36044940 DOI: 10.1016/j.kint.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Francis
- Department of Clinical Medicine, School of Medicine, University of Queensland, Brisbane, Australia.
| | | | | | - Titi Chen
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Georges Nakhoul
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle M Y Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Viviane Calice-Silva
- Pro-Rim Foundation, Joinville, Santa Catarina, Brazil; Department of Clinical Medicine, Faculty of Medicine, University of the Region of Joinville (UNIVILLE), Joinville, Santa Catarina, Brazil
| | - Vivekanand Jha
- International Society of Nephrology, Brussels, Belgium; George Institute for Global Health, UNSW, New Delhi, India; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; School of Public Health, Imperial College, London, UK
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29
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Kalyesubula R, Conroy AL, Calice-Silva V, Kumar V, Onu U, Batte A, Kaze FF, Fabian J, Ulasi I. Screening for Kidney Disease in Low- and Middle-Income Countries. Semin Nephrol 2022; 42:151315. [DOI: 10.1016/j.semnephrol.2023.151315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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30
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Kazibwe A, Bisaso KR, Kyazze AP, Ninsiima S, Ssekamatte P, Bongomin F, Baluku JB, Kibirige D, Akabwai GP, Kamya MR, Mayanja-Kizza H, Byakika-Kibwika P, Kagimu M, Kalyesubula R, Andia-Biraro I. HIV, tuberculosis, diabetes mellitus and hypertension admissions and premature mortality among adults in Uganda from 2011 to 2019: is the tide turning? Trop Med Health 2022; 50:54. [PMID: 35948991 PMCID: PMC9458845 DOI: 10.1186/s41182-022-00447-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The growing burden of diabetes mellitus (DM) and hypertension (HTN) on the background of endemic Human Immuno-deficiency Virus (HIV) and tuberculosis (TB) is a concern in low- and middle-income countries. We aimed to describe annual trends in admissions, mortality rates and premature mortality (years of potential life lost-YPLLs) due to HIV, tuberculosis (TB), diabetes mellitus (DM) and hypertension (HTN) in Uganda. METHODS We conducted a retrospective cohort study, retrieving electronic records of adults admitted to Mulago and Kiruddu national referral hospitals medical wards between 1st January 2011 and 31st December 2019. We used STATA BE 17.0 and GraphPad Prism 8.0.2 to compute total admissions, inpatient crude mortality rates, and YPLLs; and demonstrate trends using Mann-Kendall test. RESULTS Of 108,357 admissions, 55,620 (51.3%) were female, 15,300 (14.1%) were recorded in 2012, and 22,997 (21.2%) were aged 21-30 years. HIV, TB, DM and HTN accounted for 26,021 (24.0%); 9537 (8.8%); 13,708 (12.7) and 13,252 (12.2%) of all admissions, respectively. Overall inpatient mortality was 16.7% (18,099/108,357), 53.5% (9674/18,099) were male, 21.5% (3898) were aged 31-40 years and 2597 (14.4%) were registered in 2013. HIV, TB, DM and HTN accounted for 35.6% (6444), 14.6% (2646), 9.1% (1648) and 11.8% (2142) of all deaths, respectively. Total admissions (Kendall's tau-B = - 0.833, p < 0.001) and deaths declined (Kendall's tau-B = - 0.611, p = 0.029). A total of 355,514 (mean = 20.8 years, SD 30.0) YPLLs were recorded, of which 54.6% (191,869) were in males; 36.2% (128,755) were among those aged 21-30 years and were recorded in 2012 (54,717; 15.4%). HIV, TB, DM and HTN accounted for 46.5% (165,352); 19.5% (69,347); 4.8% (16,991) and 4.5% (16,167) of YPLLs, respectively. Proportionate contribution of HIV to deaths and YPLLs declined, remained stagnant for TB; and increased for both DM and HTN. CONCLUSION TB and HIV account for higher though declining, while DM and HTN account for lower albeit rising morbidity and premature mortality among adult medical patients in Uganda. TB prevention and treatment; and DM/HTN service integration in HIV care should be optimized and scaled up.
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Affiliation(s)
- Andrew Kazibwe
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda ,Directorate of Programs, The AIDS Support Organisation, P. O. Box 10443, Kampala, Uganda
| | | | - Andrew Peter Kyazze
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda
| | - Sandra Ninsiima
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda
| | - Phillip Ssekamatte
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P. O. Box 166, Gulu, Uganda
| | - Joseph Baruch Baluku
- grid.513250.0Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Davis Kibirige
- Uganda Martyrs Hospital, Lubaga, P. O. Box 14130, Kampala, Uganda
| | - George Patrick Akabwai
- grid.423308.e0000 0004 0397 2008Baylor College of Medicine, Children’s Foundation, Kampala, Uganda
| | - Moses R. Kamya
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Magid Kagimu
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Robert Kalyesubula
- grid.11194.3c0000 0004 0620 0548Department of Physiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda ,grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Fabian J, Kalyesubula R, Mkandawire J, Hansen CH, Nitsch D, Musenge E, Nakanga WP, Prynn JE, Dreyer G, Snyman T, Ssebunnya B, Ramsay M, Smeeth L, Tollman S, Naicker S, Crampin A, Newton R, George JA, Tomlinson L. Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study. Lancet Glob Health 2022; 10:e1159-e1169. [PMID: 35839814 DOI: 10.1016/s2214-109x(22)00239-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations. METHODS We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa. FINDINGS Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 m2 either directly measured or estimated by cystatin C was more than double that estimated from creatinine. A new creatinine-based equation did not outperform existing equations, and no equation, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 race-neutral equation, estimated GFR within plus or minus 30% of mGFR for 75% or more of the participants. Using a model to impute kidney function based on mGFR, the estimated prevalence of impaired kidney function was more than two-times higher than creatinine-based estimates in populations across six countries in Africa. INTERPRETATION Estimating GFR using serum creatinine substantially underestimates the individual and population-level burden of impaired kidney function in Africa with implications for understanding disease progression and complications, clinical care, and service provision. Scalable and affordable ways to accurately identify impaired kidney function in Africa are urgently needed. FUNDING The GSK Africa Non-Communicable Disease Open Lab. TRANSLATIONS For the Luganda, Chichewa and Xitsonga translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- June Fabian
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Robert Kalyesubula
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Mkandawire
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Surgery, Pan-African Academy of Christian Surgeons, Malamulo, Thyolo, Malawi; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wisdom P Nakanga
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Institute of Cardiovascular Science, University College London, London, UK
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Billy Ssebunnya
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and their Health Network, Accra, Ghana
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- MRC/UVRI & London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Kazibwe A, Okiror NE, Bongomin F, Namiiro AM, Baluku JB, Kalyesubula R, Kagimu M, Andia-Biraro I. Tetanus in Uganda: clinical outcomes of adult patients hospitalized at a tertiary health facility between 2011 and 2020. Open Forum Infect Dis 2022; 9:ofac373. [PMID: 35983266 PMCID: PMC9379815 DOI: 10.1093/ofid/ofac373] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 01/18/2023] Open
Abstract
Background Tetanus is a vaccine-preventable infectious disease associated with high mortality rates. Increased vaccination coverage globally and locally has resulted in substantial declines in the number of individuals diagnosed with tetanus. We report annual trends in tetanus admissions and deaths over a decade at a national referral hospital in Uganda. Methods This was a retrospective cohort study, using data from an electronic database of patients admitted to medical wards at a national referral hospital between 2011 and 2020. Data were abstracted on demographic characteristics, that is, length of hospital stay and mortality outcome. Admission and mortality rate trends were analyzed using the Mann-Kendall’s trend test, whereas Kaplan-Meier survival curves were used to compare gender survival rates. Results During the study period, 459 individuals were admitted with tetanus. Of these, 85.8% (394 of 459) were males, and 26.1% (120 of 459) were aged 20 years or less. Overall, 48.8% (224 of 459) participants died, 85.3% (191 of 224) of whom were males (85.3%, n = 191), although females had a higher mortality rate (50.8%, 33 of 65 vs 48.5%, 191 of 394). Those aged 31–40 years accounted for 23.7% (53 of 224) of the deaths; and 88.7% (197 of 224) of the deaths occurred within the first 7 days of admission. The total number of tetanus admissions declined (TauA = −.6444, P = .0116). However, mortality rates remained stable (TauA = .0222, P > .999). The average length of hospital stay was 8.1 days (standard deviation, 7.5; range, 1–46). Conclusions Although tetanus admissions declined, mortality rate remained high. Males were disproportionately affected. We recommend quality-of-care audits for inpatient care improvement and more research on the determinants of infection and mortality to inform vaccination for at-risk men.
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Affiliation(s)
- Andrew Kazibwe
- Correspondence: Andrew Kazibwe, MBChB, MMS, School of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda ()
| | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Gulu, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Magid Kagimu
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Moor SE, Tusubira AK, Wood D, Akiteng AR, Galusha D, Tessier-Sherman B, Donroe EH, Ngaruiya C, Rabin TL, Hawley NL, Armstrong-Hough M, Nakirya BD, Nugent R, Kalyesubula R, Nalwadda C, Ssinabulya I, Schwartz JI. Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment. BMJ Open 2022; 12:e059949. [PMID: 35863829 PMCID: PMC9310153 DOI: 10.1136/bmjopen-2021-059949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/29/2022] Open
Abstract
OBJECTIVE To explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions. SETTING Three health facilities in Nakaseke District, Uganda. DESIGN Discrete choice experiment (DCE). PARTICIPANTS 496 adults with HTN and/or DM. MAIN OUTCOME MEASURES Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility. RESULTS Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal. CONCLUSIONS Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.
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Affiliation(s)
- Sarah Eg Moor
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Dallas Wood
- Center for Applied Economics and Strategy, RTI International, Research Triangle Park, North Carolina, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Evelyn Hsieh Donroe
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mari Armstrong-Hough
- Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | | | - Rachel Nugent
- Global Non-Communicable Diseases, RTI International, Seattle, Washington, USA
| | - Robert Kalyesubula
- African Community for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Christine Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
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Okpechi I, Niang A, Hafez M, Ashuntantang G, Zaidi D, Ye F, Abdu A, Asinobi A, Balogun R, Chukwuonye I, Diongole H, Effa E, Ekrikpo U, Gouda Z, Hussaini J, Kaze F, Kilonzo K, Kalyesubula R, Kununa A, Makusidi M, Mbah I, McCullough M, Mengistu Y, Moloi M, Moturi G, Ndlovu K, Ngigi J, Nklandu Y, Ntarindwa J, Okel J, Olanrewaju T, Osafo C, Samuel-Okpechi U, Shigidi M, Sumaili E, Ulasi I, Umeizudike T, Wearne N, Jha V, Levin A, Johnson D, Bello A. A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities. ajn 2022. [DOI: 10.21804/25-1-5100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care.
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Batte A, Menon S, Ssenkusu JM, Kiguli S, Kalyesubula R, Lubega J, Berrens Z, Mutebi EI, Ogwang R, Opoka RO, John CC, Conroy AL. Neutrophil gelatinase-associated lipocalin is elevated in children with acute kidney injury and sickle cell anemia, and predicts mortality. Kidney Int 2022; 102:885-893. [PMID: 35718113 PMCID: PMC7613606 DOI: 10.1016/j.kint.2022.05.020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/10/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
Urine neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury that has been adapted to a urine dipstick test. However, there is limited data on its use in low-and-middle-income countries where diagnosis of acute kidney injury remains a challenge. To study this, we prospectively enrolled 250 children with sickle cell anemia aged two to 18 years encompassing 185 children hospitalized with a vaso-occlusive pain crisis and a reference group of 65 children attending the sickle cell clinic for routine care follow up. Kidney injury was defined using serial creatinine measures and a modified-Kidney Disease Improving Global Outcome definition for sickle cell anemia. Urine NGAL was measured using the NGAL dipstick and a laboratory reference. The mean age of children enrolled was 8.9 years and 42.8% were female. Among hospitalized children, 36.2% had kidney injury and 3.2% died. Measured urine NGAL levels by the dipstick were strongly correlated with the standard enzyme-linked immunosorbent assay for urine NGAL (hospitalized children, 0.71; routine care reference, 0.88). NGAL levels were elevated in kidney injury and significantly increased across injury stages. Hospitalized children with a high-risk dipstick test (300ng/mL and more) had a 2.47-fold relative risk of kidney injury (95% confidence interval 1.68 to 3.61) and 7.28 increased risk of death (95% confidence interval 1.10 to 26.81) adjusting for age and sex. Thus, urine NGAL levels were found to be significantly elevated in children with sickle cell anemia and acute kidney injury and may predict mortality.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Sahit Menon
- San Diego School of Medicine, University of California.
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | | | - Joseph Lubega
- Pediatric Hematology and Oncology, Baylor College of Medicine, Texas, USA.
| | - Zachary Berrens
- Department of Pediatrics, Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Rodney Ogwang
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi, Kenya.
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana.
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Wandabwa J, Kalyesubula R, Najjingo I, Nalunjogi J, Ssekitooleko B, Mbiine R, Alenyo R. Incidence and risk factors of acute kidney injury in severely burned patients in Mulago Hospital, Uganda - a prospective cohort. Int J Burns Trauma 2022; 12:131-138. [PMID: 35891972 PMCID: PMC9301158] [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] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) is associated with increased mortality among severely burned patients. According to World Health Organization (WHO) 11 million people suffer from burns worldwide and burns contribute to 180,000 deaths yearly. Majority of these burns occur in the Low and Middle-Income Countries. Currently there is no published data on the incidence, risk factors and outcomes of AKI among patients with severe burns in Uganda. Early screening and treatment of patients at risk of developing AKI has been shown to improve survival. We therefore carried out a study to determine the incidence and risk factors of AKI in Uganda. METHODS This was a prospective cohort study that consecutively included patients with severe burns admitted in Mulago National Referral Hospital burns unit between February and May 2018. Patients were followed up for 14 days and AKI was assessed according to the KIDGO criteria. The incidence of AKI was expressed as a proportion. Kaplan Meier graph was used to estimate the median survival of patients with or without AKI. The risk factors for AKI were assessed using cox proportion hazard regression analysis. RESULTS Of the 147 patients screened, 92 met the inclusion criteria but 2 declined to participate in the study. Of the study participants, 48 (53.3%) were male, 47 (52.2%) were aged 3 years and below, the median TBSA was 17 (IQR; 13-23), 58 (69.9%) had low albumin levels and 16 (18.6%) had inhalation burns. The incidence of AKI was found to be 34.4% (95% CI; 25.9-45.9) with a mortality of 11.76% (95% CI; 6.37-20.73). Total burn surface area HR=3.10 (95% CI; 1.39 to 6.94 P=0.003) was the only independent risk factor for AKI. CONCLUSION The incidence and mortality rate of AKI in patients with severe burns was found to be high. Having burns greater than 18% TBSA was an independent risk factor for AKI. Therefore, patients with burns greater than 18% should be assessed regularly for AKI so that treatment is instituted early should it occur.
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Affiliation(s)
- Joel Wandabwa
- Department of Surgery, Makerere University, College of Health SciencesKampala, Uganda
| | - Robert Kalyesubula
- Department of Internal Medicine and Department of Physiology, Makerere University, College of Health SciencesKampala, Uganda
| | | | | | - Badru Ssekitooleko
- Department of Surgery, Makerere University, College of Health SciencesKampala, Uganda
| | - Ronald Mbiine
- Department of Surgery, Makerere University, College of Health SciencesKampala, Uganda
| | - Rose Alenyo
- Department of Surgery, Makerere University, College of Health SciencesKampala, Uganda
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Kalyesubula R, Brewster U, Kansiime G. Global Dialysis Perspective: Uganda. Kidney360 2022; 3:933-936. [PMID: 36128482 PMCID: PMC9438417 DOI: 10.34067/kid.0007002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/01/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Robert Kalyesubula
- Departments of Physiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Section of Nephrology, Yale School of Medicine, Connecticut
| | | | - Grace Kansiime
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Ingenhoff R, Nandawula J, Siddharthan T, Ssekitoleko I, Munana R, Bodnar BE, Weswa I, Kirenga BJ, Mutungi G, van der Giet M, Kalyesubula R, Knauf F. Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial. Trials 2022; 23:440. [PMID: 35610712 PMCID: PMC9128241 DOI: 10.1186/s13063-022-06403-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension. METHODS We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. CONCLUSION The results of this study will inform community delivered HTN management across a range of LMIC settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05068505 . Registered on October 6, 2021.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Juliet Nandawula
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Isaac Ssekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | | | - Markus van der Giet
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Uganda Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Mulindwa F, Andia I, McLaughlin K, Kabata P, Baluku J, Kalyesubula R, Kagimu M, Ocama P. A quality improvement project assessing a new mode of lecture delivery to improve postgraduate clinical exposure time in the Department of Internal Medicine, Makerere University, Uganda. BMJ Open Qual 2022; 11:bmjoq-2020-001101. [PMID: 35577398 PMCID: PMC9114931 DOI: 10.1136/bmjoq-2020-001101] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/22/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Masters in Internal Medicine at the Makerere University College of Health Sciences is based on a semester system with a blend of lectures and clinical work. The programme runs for 3 years with didactic lectures set mostly for mornings and clinical care thereafter. Anecdotal reports from attending physicians in the department highlighted clinical work time interruption by didactic lectures which was thought to limit postgraduate (PG) students' clinical work time. We set out to evaluate the clinical learning environment and explore avenues to optimise clinical exposure time. METHODS Baseline data in form of time logs documenting first-year PG activities was collected by intern doctors without the awareness of the PGs. In addition, a PG and attending physician survey on PG ward performance was carried out. These data informed a root cause analysis from which an intervention to change the mode of lecture delivery from daily lecturers across the semester to a set of block lectures was undertaken. Postimplementation time logs and survey data were compared with the pre-intervention data. RESULTS Post-intervention, during a period of 50 ward round observations, PGs missed 3/50 (6%) ward rounds as compared with 10/50 (20%) pre-intervention. PGs arrived on wards before attending physicians 18/24 (75%) times post-intervention and on average had 59 min to prepare for ward rounds as compared with 5/26 (19.2%) times and 30 min, respectively, pre-intervention. Both PGs and physicians believed PGs had enough time for patient care post-intervention (17/17 (100%) vs 4/17 (23.5%) and 7/8 (87.5%) vs 2/8 (25%)), respectively. CONCLUSION The baseline data collected confirmed the anecdotal reports and a change to a block week lecture system led to improvements in PGs' clinical work time and both resident and physician approvals of PG clinical work.
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Affiliation(s)
- Frank Mulindwa
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Immunomodulation and Vaccines, MRC/UVRI & LSHTM, Kampala, Uganda
| | | | - Pritch Kabata
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Baluku
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Majid Kagimu
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Sembajwe LF, Nfambi J, Lugaajju A, Kalyesubula R. Effect of soaking, boiling and frying on selenium content of major African fresh foods. JFSH 2022; 7:191-201. [PMID: 36016906 PMCID: PMC9400505 DOI: 10.18502/jfsh.v7i4.9283] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Selenium is an essential trace element that is crucial for normal functioning of human body systems and it is obtained from diet or dietary supplements. The concentration of selenium (Se) varies from soil-to-soil and therefore in various food types. We profiled the selenium concentration in the major African fresh foods and studied the effect of boiling, frying and overnight soaking on their selenium content. The foods were taken to the chemistry laboratory, processed for determining selenium concentration in the fresh foods and then subjected to the various treatments before determining their Se concentration using an atomic absorption spectrometer. Among the fresh foods studied, pumpkin seeds were found to have the highest Se concentration (109.25 ± 0.125 parts per billion (ppb)), while Irish potatoes had the lowest (16.25 ± 0.125 ppb). In most fresh foods studied, boiling and frying had the effect of reducing the Se concentration, except in yams that showed an increased concentration after frying. Overnight soaking of matooke (plantain bananas) and beans showed an effect of causing a considerable reduction in the Se concentration from 36.375 ± 0.281 ppb and 59.125 ± 0.031 ppb to 14.03 ± 0.441 ppb and 24.375 ± 0.281 ppb, respectively. Boiling and frying cause a significant reduction in Se concentration of most African fresh foods. Overnight soaking of matooke and beans caused further reduction in the selenium concentration of the fresh foods. This implies that people who pre-soak their food before cooking it are likely to lose more selenium than those who do not soak and may be more likely to suffer from Se deficiencies.
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Kalyesubula R, Sekitoleko I, Tomlin K, Hansen CH, Ssebunya B, Makanga R, Mbonye MK, Seeley J, Smeeth L, Newton R, Tomlinson LA. Association of impaired kidney function with mortality in rural Uganda: results of a general population cohort study. BMJ Open 2022; 12:e051267. [PMID: 35473721 PMCID: PMC9045120 DOI: 10.1136/bmjopen-2021-051267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 03/23/2021] [Accepted: 04/08/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine the association between baseline kidney function and subsequent all-cause mortality. DESIGN AND SETTING A general population-based cohort study from rural Uganda. PARTICIPANTS People aged 18 years and above with measured baseline estimated glomerular filtration rate (eGFR), recruited from survey rounds in 2011-2012 or 2014-2015 and followed up to March 2019. OUTCOME MEASURE The primary outcome was all-cause mortality, identified through reports from community health workers and verified by verbal autopsy. The association between baseline eGFR category and mortality was determined using multivariable Cox regression. RESULTS Of 5812 participants in both rounds, we included 5678 (97.7%) participants with kidney function and mortality data; the median age was 36 years (IQR 24-50), 60.7% were female, 10.3% were hypertensive, 9.8% were HIV-positive and 1.5% were diabetic. During a median follow-up of 5.0 years (IQR 3.7-6.0) there were 140 deaths. In age-adjusted and sex-adjusted analyses, eGFR <45 mL/min/1.73 m2 at baseline was associated with a 5.97 (95% CI 2.55 to 13.98) increased risk of mortality compared with those with baseline eGFR >90 mL/min/1.73 m2. After inclusion of additional confounders (HIV, body mass index, diabetes, hypertension, alcohol and smoking status) into the model, eGFR <45 mL/min/1.73 m2 at baseline remained strongly associated with mortality (HR 6.12, 95% CI 2.27 to 16.45), although the sample size fell to 3102. Test for trend showed strong evidence (p<0.001) that the rate of mortality increased progressively as the category of baseline kidney function decreased. When very high eGFR was included as a separate category in age-adjusted and sex-adjusted analyses, baseline eGFR ≥120 mL/min/1.73 m2 was associated with increased risk of mortality (HR 2.68, 95% CI 1.47 to 4.87) compared with the reference category of 90-119 mL/min/1.73 m2. CONCLUSION In a prospective cohort in rural Uganda we found that impaired baseline kidney function was associated with subsequently increased total mortality. Improved understanding of the determinants of kidney disease and its progression is needed in order to inform interventions for prevention and treatment.
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Affiliation(s)
- Robert Kalyesubula
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Physiology and Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Isaac Sekitoleko
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Keith Tomlin
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christian Holm Hansen
- Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Billy Ssebunya
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Ronald Makanga
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Moses Kwizera Mbonye
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Newton
- Non-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| | - Laurie A Tomlinson
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Batte A, Menon S, Ssenkusu J, Kiguli S, Kalyesubula R, Lubega J, Mutebi EI, Opoka RO, John CC, Starr MC, Conroy AL. Acute kidney injury in hospitalized children with sickle cell anemia. BMC Nephrol 2022; 23:110. [PMID: 35303803 PMCID: PMC8933904 DOI: 10.1186/s12882-022-02731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/22/2021] [Accepted: 03/08/2022] [Indexed: 01/06/2023] Open
Abstract
Background Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifications to the Kidney Disease: Improving Global Outcomes (KDIGO) definition would influence clinical outcomes of AKI in children with SCA hospitalized with a VOC. Methods We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital in Uganda. Kidney function was assessed on admission, 24–48 h of hospitalization, and day 7 or discharge. Creatinine was measured enzymatically using an isotype-dilution mass spectrometry traceable method. AKI was defined using the original-KDIGO definition as ≥ 1.5-fold change in creatinine within seven days or an absolute change of ≥ 0.3 mg/dl within 48 h. The SCA modified-KDIGO (sKDIGO) definition excluded children with a 1.5-fold change in creatinine from 0.2 mg/dL to 0.3 mg/dL. Results Using KDIGO, 90/185 (48.7%) children had AKI with 61/185 (33.0%) AKI cases present on admission, and 29/124 (23.4%) cases of incident AKI. Overall, 23 children with AKI had a 1.5-fold increase in creatinine from 0.2 mg/dL to 0.3 m/dL. Using the sKDIGO-definition, 67/185 (36.2%) children had AKI with 43/185 (23.2%) cases on admission, and 24/142 (16.9%) cases of incident AKI. The sKDIGO definition, but not the original-KDIGO definition, was associated with increased mortality (0.9% vs. 7.5%, p = 0.024). Using logistic regression, AKI risk factors included age (aOR, 1.10, 95% CI 1.10, 1.20), hypovolemia (aOR, 2.98, 95% CI 1.08, 8.23), tender hepatomegaly (aOR, 2.46, 95% CI 1.05, 5.81), and infection (aOR, 2.63, 95% CI 1.19, 5.81) (p < 0.05). Conclusion These results demonstrate that AKI is a common complication in children with SCA admitted with VOC. The sKDIGO definition of AKI in children with SCA was a better predictor of clinical outcomes in children. There is need for promotion of targeted interventions to ensure early identification and treatment of AKI in children with SCA.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, P.O Box 6717, Kampala, Uganda.
| | - Sahit Menon
- San Diego School of Medicine, University of California, San Diego, USA
| | - John Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joseph Lubega
- Pediatric Hematology and Oncology, Baylor College of Medicine, Texas, USA
| | | | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle C Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Bagasha P, Kiggundu D, Naitala Andrew R, Katabira E, Kalyesubula R. POS-732 QUALITY OF LIFE AND ONE-YEAR SURVIVAL OF PATIENTS WITH KIDNEY FAILURE IN A RESOURCE LIMITED SETTING. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Batte A, Kasirye P, Baluku R, Kiguli S, Kalyesubula R, John CC, Schwaderer AL, Imel EA, Conroy AL. Mineral bone disorders and kidney disease in hospitalized children with sickle cell anemia. Front Pediatr 2022; 10:1078853. [PMID: 36819194 PMCID: PMC9932899 DOI: 10.3389/fped.2022.1078853] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mineral bone disorders (MBD) are common in sickle cell anemia (SCA). Frequent vaso-occlusive crises (VOC) further impact MBD in children with SCA. We evaluated the prevalence of markers of SCA-related MBD (sMBD) in hospitalized children and assessed the relationship between sMBD and individual mineral abnormalities with kidney disease. METHODS We prospectively recruited 185 children with SCA hospitalized with a VOC. Serum measures of mineral bone metabolism (calcium, phosphate, parathyroid hormone, 25-hydroxy vitamin D, FGF23, osteopontin) were measured at enrollment. The primary outcome was markers of sMBD defined as a composite of hypocalcemia, hyperphosphatemia, hyperparathyroidism, or deficiency in 25-OH vitamin D. Secondary outcomes included individual abnormalities in mineral metabolism. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were used to define SCA-associated acute kidney injury (AKI). AKI was further assessed using urine NGAL as a marker of tubular injury. Acute kidney disease (AKD) was defined as a composite of AKI, an eGFR < 90 ml/min per 1.73 m2 using the Cystatin C GFR equation, or evidence of structural injury (positive biomarker test or albuminuria). RESULTS The mean age of children was 8.9 years and 41.6% were female. The prevalence of sMBD was 47.6%, with hypocalcemia the most frequent abnormality (29.9%, 55/184) followed by hyperphosphatemia (20.7%, 38/184), hyperparathyroidism (8.7%, 16/185), and vitamin D deficiency (5.4%, 10/185). There was no association between sMBD and sKDIGO-defined AKI using serial changes in creatinine or when incorporating biomarkers to define AKI. However, the presence of AKD was associated with a 2.01-fold increased odds of sMBD (95% CI 1.05 to 3.83) and was driven by a decrease in eGFR (OR, 2.90 95% CI: 1.59 to 5.29). When evaluating individual mineral abnormalities, hypocalcemia was associated with AKD and low eGFR while hyperparathyroidism was associated with low eGFR, AKI and structural injury. Vitamin D deficiency was associated with structural kidney injury. Vitamin D deficiency, hyperparathryoidism, and increases in FGF23 and osteopontin predicted mortality (p < 0.05 for all). CONCLUSION MBD is common among children with SCA hospitalized with VOC. Biomarkers of kidney injury and bone health may help risk stratify children at risk of sMBD. Routine evaluation of sMBD in children with SCA may improve long-term bone health.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Philip Kasirye
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Reagan Baluku
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Erik A Imel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
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Siddharthan T, Robertson NM, Rykiel NA, Underhill LJ, Rahman N, Kafle S, Mohan S, Padalkar R, McKeown S, Flores-Flores O, Quaderi SA, Alupo P, Kalyesubula R, Kirenga B, Luo J, Cárdenas MK, Gianella G, Miranda JJ, Checkley W, Hurst JR, Pollard SL. Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings. PLOS Glob Public Health 2022; 2:e0001309. [PMID: 36962898 PMCID: PMC10021856 DOI: 10.1371/journal.pgph.0001309] [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: 06/01/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). METHODS All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD. RESULTS We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. CONCLUSION The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.
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Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, Miami, Florida, United States of America
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nicole M Robertson
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- University of Kentucky School of Medicine, Louisville, Kentucky, United States of America
| | - Natalie A Rykiel
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lindsay J Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nihaal Rahman
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sujan Kafle
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Roma Padalkar
- Rowan University School of Osteopathic Medicine, Glassboro, New Jersey, United States of America
| | - Sarah McKeown
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Oscar Flores-Flores
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
| | | | - Patricia Alupo
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Jing Luo
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gonzalo Gianella
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - John R Hurst
- Respiratory Medicine, University College London, London, United Kingdom
| | - Suzanne L Pollard
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Ingenhoff R, Brewster U, Rastegar A, Kalyesubula R, Knauf F. Global Health Education in Nephrology: The Time has Come. J Am Soc Nephrol 2021; 32:2990-2993. [PMID: 34645697 PMCID: PMC8638410 DOI: 10.1681/asn.2021060731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ursula Brewster
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Asghar Rastegar
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Robert Kalyesubula
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda,Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany,Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Siddharthan T, Kalyesubula R, Morgan B, Ermer T, Rabin TL, Kayongo A, Munana R, Anton N, Kast K, Schaeffner E, Kirenga B, Knauf F. The rural Uganda non-communicable disease (RUNCD) study: prevalence and risk factors of self-reported NCDs from a cross sectional survey. BMC Public Health 2021; 21:2036. [PMID: 34743687 PMCID: PMC8572568 DOI: 10.1186/s12889-021-12123-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are an increasing global concern, with morbidity and mortality largely occurring in low- and middle-income settings. We established the prospective Rural Uganda Non-Communicable Disease (RUNCD) cohort to longitudinally characterize the NCD prevalence, progression, and complications in rural Africa. Methods We conducted a population-based census for NCD research. We systematically enrolled adults in each household among three sub-counties of the larger Nakaseke Health district and collected baseline demographic, health status, and self-reported chronic disease information. We present our data on self-reported chronic disease, as stratified by age, sex, educational attainment, and sub-county. Results A total of 16,694 adults were surveyed with 10,563 (63%) respondents enrolled in the self-reported study. Average age was 37.8 years (SD = 16.5) and 45% (7481) were male. Among self-reported diseases, hypertension (HTN) was most prevalent (6.3%). 1.1% of participants reported a diagnosis of diabetes, 1.1% asthma, 0.7% COPD, and 0.4% kidney disease. 2.4% of the population described more than one NCD. Self-reported HTN was significantly higher in the peri-urban subcounty than in the other two rural sub-counties (p < 0.001); diagnoses for all other diseases did not differ significantly between sub-counties. Odds for self-reported HTN increased significantly with age (OR = 1.87 per 10 years of age, 95% CI 1.78–1.96). Male sex was associated with lower odds of reporting asthma (OR = 0.53, 95% CI 0.34–0.82) or HTN (OR = 0.31, 95% CI 0.26–0.40). Conclusions The RUNCD will establish one of the largest NCD patient cohorts in rural Africa. First analysis highlights the feasibility of systematically enrolling large numbers of adults living in a rural Ugandan district. In addition, our study demonstrates low levels of self-reported NCDs compared to the nation-wide established levels, emphasizing the need to better educate, characterize, and care for the majority of rural communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12123-7.
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Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, 1951 NW 7th Ave, Suite 2308, Miami, FL, 33136, USA. .,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Robert Kalyesubula
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Brooks Morgan
- Division of Pulmonary and Critical Care, School of Medicine, University of Miami, 1951 NW 7th Ave, Suite 2308, Miami, FL, 33136, USA.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Ermer
- Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tracy L Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Alex Kayongo
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Richard Munana
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Nora Anton
- World Health Summit c/o Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Kast
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bruce Kirenga
- Makerere College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Knauf
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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Affiliation(s)
- Rouvick M Gama
- King's Kidney Care, King's College Hospital NHS Trust, London, UK
| | - Robert Kalyesubula
- Makerere University College of Health Sciences, Kampala, Uganda
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Viyaasan Mahalingasivam
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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49
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Tusubira AK, Nalwadda CK, Akiteng AR, Hsieh E, Ngaruiya C, Rabin TL, Katahoire A, Hawley NL, Kalyesubula R, Ssinabulya I, Schwartz JI, Armstrong-Hough M. Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda. Ann Glob Health 2021; 87:86. [PMID: 34458110 PMCID: PMC8378074 DOI: 10.5334/aogh.3308] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. Objective We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Methods Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Results Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Conclusion Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY USA
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50
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Batte C, Mukisa J, Rykiel N, Mukunya D, Checkley W, Knauf F, Kalyesubula R, Siddharthan T. Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda. BMC Public Health 2021; 21:1343. [PMID: 34233648 PMCID: PMC8264981 DOI: 10.1186/s12889-021-11411-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. Methods We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions. Results Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting. Conclusions Hypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11411-6.
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Affiliation(s)
- Charles Batte
- School of Medicine, Lung Institute, Makerere University College of Health Sciences, Upper Hill Mulago Hill, Kampala, Uganda.
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Natalie Rykiel
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - David Mukunya
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Kalyesubula
- School of Medicine, Lung Institute, Makerere University College of Health Sciences, Upper Hill Mulago Hill, Kampala, Uganda
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
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