1
|
Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
Collapse
|
2
|
Benyumiza D, Kumakech E, Gutu J, Banihani J, Mandap J, Talib ZM, Wakida EK, Maling S, Obua C. Caregiver's perspectives on the Central Nervous System infection illness trajectory among older persons with dementia in Northern Uganda-a qualitative community-based study. BMC Geriatr 2022; 22:825. [PMID: 36303115 PMCID: PMC9609188 DOI: 10.1186/s12877-022-03499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have explored the Central Nervous System (CNS) infection illness trajectory among older persons with dementia in sub-Saharan African (SSA) settings. This study explored the Caregiver’s perspectives on the Central Nervous System infection illness trajectory among the older persons with dementia in Northern Uganda. Methods This was a qualitative study conducted in Lira District northern Uganda in March 2022 amongst purposively selected 20 caregivers of the older persons aged 50 + years with a positive history of CNS infection and later life dementia. Data were collected using an in-depth interview guide. Audio recordings and field notes of the interviews were undertaken. The interviews generated data on the CNS infection illness trajectory from onset to the current demented state of the older persons. The audio-recorded interviews were transcribed verbatim before manual reflective thematic analysis. Results Older persons with a positive history of CNS infection illness and later life dementia in rural northern Uganda presented with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also manifestations of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines was sought and utilized for the treatment and care of the CNS infection illness and dementia by the older persons amidst improper diagnosis and mismanagement. Conclusions and recommendations Older persons with early-life CNS infections illness and later-life dementia were reported to present with symptoms including neck pain, back pain, chronic headache, high blood pressure, and fatigue. The reported symptoms of CNS infection illness may be intertwined with co-morbidities particularly traumatic injury involving the head, neck, and spine, high blood pressure, and chronic headache. Healthcare professionals should integrate routine screening of older persons for the history of CNS infections, chronic headache, high blood pressure, trauma to the head, neck, and spine, and dementia and early treatment.
Collapse
Affiliation(s)
- Deo Benyumiza
- Department of Nursing and Midwifery, Faculty of Health Science, Lira University, P.O. Box 1035, Lira City, Uganda
| | - Edward Kumakech
- Department of Nursing and Midwifery, Faculty of Health Science, Lira University, P.O. Box 1035, Lira City, Uganda
| | - Jastine Gutu
- Office of the Health Professional Education Partnership Initiative – Transforming Ugandan Institution’s Training Against HIV/AIDS (HEPI-TUITAH) Program Administration, Faculty of Health Science, Lira University, Lira, Uganda
| | - Jude Banihani
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA
| | - Joshua Mandap
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA
| | - Zohray M. Talib
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA ,grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda
| | - Edith K. Wakida
- grid.514026.40000 0004 6484 7120Department of Medicine, California University of Science and Medicine, San Bernadinio, USA ,grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda
| | - Samuel Maling
- grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, P.O. BOX 1014, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
3
|
Nweke MC, Okemuo AJ, Uduonu EM, Ugwu PI, Nwachukwu C, Mshunqane N. Meta-analysis of factors affecting prevalence estimates of HIV-associated neurocognitive disorder in sub-Saharan Africa. S AFR J SCI 2021. [DOI: 10.17159/sajs.2021/8575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in sub- Saharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources.
Collapse
Affiliation(s)
- Martins C. Nweke
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa
| | - Adaora J. Okemuo
- Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria
| | - Ekezie M. Uduonu
- Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria
| | | | | | - Nombeko Mshunqane
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
4
|
Diaz MM, Zacarías MG, Sotolongo P, Sanes MF, Franklin DJ, Marquine MJ, Cherner M, Cárcamo C, Ellis RJ, Lanata S, García PJ. Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru. Front Neurol 2021; 12:629257. [PMID: 34220665 PMCID: PMC8248346 DOI: 10.3389/fneur.2021.629257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru. Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH. Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04-2.86) in unadjusted analyses, but not in adjusted analyses. Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.
Collapse
Affiliation(s)
- Monica M. Diaz
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
- University of California Global Health Institute, San Diego, CA, United States
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcela Gil Zacarías
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia Sotolongo
- Department of Psychology, Jackson Memorial Hospital, Miami, FL, United States
| | - María F. Sanes
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Donald J. Franklin
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - María J. Marquine
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mariana Cherner
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Cesar Cárcamo
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ronald J. Ellis
- Human Immunodeficiency Virus (HIV) Neurobehavioral Research Center, University of California, San Diego, San Diego, CA, United States
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Serggio Lanata
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Patricia J. García
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
5
|
Naidu T, Pillay SR, Ramlall S, Mthembu SS, Padayatchi N, Burns JK, Tomita A. Major Depression and Stigma among Individuals with Multidrug-Resistant Tuberculosis in South Africa. Am J Trop Med Hyg 2020; 103:1067-1071. [PMID: 32700662 DOI: 10.4269/ajtmh.19-0426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Stigma is an important social determinant of health-seeking behavior; however, the nature and extent of its association with depression among people living with multidrug-resistant tuberculosis (MDR-TB) are not well-understood. We enrolled 200 microbiologically confirmed MDR-TB inpatients at a TB specialist hospital in KwaZulu-Natal Province, an area considered the epicenter for MDR-TB coinfection in South Africa. Four aspects of stigma and their association with major depression were assessed through individual interviews: 1) community and 2) patient perspectives toward TB, and 3) community and 4) patient perspectives toward HIV. A major depressive episode (MDE), HIV coinfection, and low income were significantly associated with greater stigma subscales. Based on an adjusted regression model, the MDE was the only factor independently associated with (all aspects of) stigma. These results indicate the potential utility of addressing stigma associated with the MDE as an important step in improving health-seeking behavior to promote adherence and retention in care.
Collapse
Affiliation(s)
- Thirusha Naidu
- Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Suntosh R Pillay
- King DinuZulu Hospital, KwaZulu-Natal Department of Health, Durban, South Africa.,Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Suvira Ramlall
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | | | - Nesri Padayatchi
- MRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Jonathan K Burns
- Institute of Health Research, University of Exeter, Exeter, United Kingdom.,Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
6
|
Ramlall S, Lessells RJ, Naidu T, Sandra Mthembu S, Padayatchi N, Burns JK, Tomita A. Neurocognitive functioning in MDR-TB patients with and without HIV in KwaZulu-Natal, South Africa. Trop Med Int Health 2020; 25:919-927. [PMID: 32428324 DOI: 10.1111/tmi.13444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Optimising medication adherence is one of the essential factors in reversing the tide of a TB-HIV syndemic in sub-Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients' ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been examined in individuals with drug-resistant TB. We therefore investigated performance on several key neurocognitive domains in relationship to HIV status in a multidrug-resistant tuberculosis patients (MDR-TB) sample. METHODS We enrolled microbiologically confirmed MDR-TB inpatients at a TB-specialist referral hospital in KwaZulu-Natal province, South Africa. We collected cross-sectional data on sociodemographic, clinical and neurocognitive function (e.g. attention, memory, executive functioning, language fluency, visual-spatial, eye-hand coordination). For the primary analysis, we excluded participants with major depressive episode/substance use disorder (MDE/SUD). We fitted adjusted Poisson regression models to explore the association between HIV and neurocognitive function. RESULTS We enrolled 200 people with MDR-TB; 33 had MDE/SUD, and data of 167 were analysed (151 HIV+, 16 HIV-). The mean age of participants was 34.2 years; the majority were female (83%), and 53% had not completed secondary school. There was evidence of impaired neurocognitive functioning across all domains in both HIV+/- study participants. Based on the regression analyses, individuals with co-infection (MDR-TB/HIV+), as well as those who had longer duration of hospital stays experienced significantly lower cognitive performance in several domains. Poor cognitive performance was significantly related to older age and lower educational attainment. The presence of major depression or substance use disorders did not influence the significance of the findings. CONCLUSIONS Adults with MDR-TB have significant neurocognitive impairment, especially if HIV positive. An integrated approach is necessary in the management of MDR-TB as cognitive health influences the ability to adhere to chronic treatment, clinical outcomes and functionality.
Collapse
Affiliation(s)
- Suvira Ramlall
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Richard J Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Thirusha Naidu
- Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa.,Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|