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Baluku JB, Namanda B, Namiiro S, Rwabwera DK, Mwesigwa G, Namaara C, Twinomugisha B, Nyirazihawe I, Nuwagira E, Kansiime G, Kizito E, Nabukenya-Mudiope MG, Sekadde MP, Bongomin F, Senfuka J, Olum R, Byaruhanga A, Munabi I, Kiguli S. Death after cure: mortality among pulmonary tuberculosis survivors in rural Uganda. Int J Infect Dis 2024:107069. [PMID: 38649006 DOI: 10.1016/j.ijid.2024.107069] [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] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To determine the incidence of mortality and its predictors among pulmonary TB (PTB) survivors treated at a rural Ugandan tertiary hospital. METHODS We conducted a retrospective chart review of data between 2013 and 2023. We included all people that met the WHO's definition of tuberculosis cure and traced them or their next of kin to determine vital status (alive/deceased). We estimated the cumulative incidence of mortality per 1,000 population, crude all-cause mortality rate per 1,000 person-years, and median years of potential life lost (YPLL) for deceased individuals. Using Cox proportional hazard models, we investigated predictors of mortality. RESULTS Of 334 PTB survivors enrolled, 38 (11.4%) had died. The cumulative incidence of all-cause mortality was 113.7 per 1,000 population, and the crude all-cause mortality rate was 28.5 per 1,000 person-years. The median YPLL for deceased individuals was 23.8 years (IQR: 9.6-32.8). Hospitalization (aHR: 4.3, 95% CI: 1.1-16.6) and unemployment (aHR: 7.04, 95% CI: 1.5-31.6) at TB treatment initiation predicted mortality. CONCLUSION PTB survivors experience post high mortality rates after TB cure. Survivors who were hospitalized and unemployed at treatment initiation were more likely to die after cure. Social protection measures and long-term follow-up of previously hospitalized patients could improve the long-term survival of TB survivors.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, Kampala, Uganda; Kiruddu National Referral Hospital, Kampala, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | | | | | | | | | | | | | - Edwin Nuwagira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Kansiime
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Ronald Olum
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Ian Munabi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Makerere University College of Health Sciences, Kampala, Uganda
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Olum R, Ahaisibwe B, Atuhairwe I, Balizzakiwa T, Kizito P, Apiyo M, Kalanzi J, Nabawanuka A, Bahatungire R, Kerry V. Readiness To Manage Ebola Virus Disease Among Emergency Healthcare Workers in Uganda: A Nationwide Multicenter Survey. Res Sq 2024:rs.3.rs-4212996. [PMID: 38659914 PMCID: PMC11042437 DOI: 10.21203/rs.3.rs-4212996/v1] [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: 04/26/2024]
Abstract
Background Emerging infectious diseases like the Ebola Virus Disease (EVD) pose significant global public health threats. Uganda has experienced multiple EVD outbreaks, the latest occurring in 2022. Frontline healthcare workers (HCWs) are at increased risk, yet there isn't sufficient evidence of existing knowledge of EVD of these health workers. We aimed to assess the readiness of Uganda's emergency healthcare workers to manage Ebola virus disease (EVD) and identify their training needs to inform targeted capacity-building interventions for future outbreaks. Methods This multicentre nationwide cross-sectional study was conducted from July to August 2023 among 691 HCWs providing emergency care in 14 secondary and tertiary hospitals across Uganda. Participants were consecutively recruited using the probability-proportional-to-size sampling technique, and data was collected using a self-reported questionnaire. Factors associated with EVD knowledge were identified through a mixed-effect linear model. Results Data from 691 eligible HCWs with a median age of 32 (IQR: 28-38) was analyzed (response rate: 92%). Only one-third (34.4%, n = 238) had received EVD training in the past year. The median EVD knowledge score was 77.4% (IQR: 71.2% - 83.4%). EVD knowledge was associated with longer professional experience in years (β: 0.21, 95% CI: 0.03 to 0.39, p = 0.024) and higher level of education: diploma (β: 3.37, 95% CI: 1.49 to 5.25, p < 0.001), undergraduate degree (β: 6.45, 95% CI: 4.11 to 8.79) and postgraduate degree (β: 7.13, 95% CI: 4.01 to 10.25, p < 0.001). Being a doctor (β: 2.55, 95% CI: 0.35 to 4.74, p = 0.023), providing care in the obstetrics/gynecology department (β: -1.90, 95% CI: -3.47 to - 0.32, p = 0.018), previous EVD training (β: 2.27, 95% CI: 0.96 to 3.59, p = 0.001) and accessing EVD information through social media (β: 2.52, 95% CI: 1.17 to 3.88, p < 0.001) were also significantly associated with EVD knowledge. Conclusion Our study reveals that Ugandan HCWs' EVD response readiness varies by individual factors and information sources. We recommend targeted training and suggest future research on educational innovations and social media's potential to fill knowledge gaps.
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Kibirige D, Owarwo N, Kyazze AP, Morgan B, Olum R, Bongomin F, Andia-Biraro I. Prevalence, Clinical Features, and Predictors of Adrenal Insufficiency in Adults With Tuberculosis or HIV: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2024; 11:ofae098. [PMID: 38560601 PMCID: PMC10981394 DOI: 10.1093/ofid/ofae098] [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: 11/21/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Despite the high frequency of adrenal insufficiency (AI) in patients with tuberculosis or HIV, its diagnosis is often missed or delayed resulting in increased mortality. This systematic review and meta-analysis aimed to document the prevalence, significant clinical features, and predictors of AI in adult patients with tuberculosis or HIV. Methods We systematically searched databases (Medline, Embase, CINAHL, Cochrane Library, and Africa Journal Online) for published studies on AI in adult patients with tuberculosis or HIV. The pooled prevalence of AI was determined by a random-effect model meta-analysis. A narrative review was used to describe the significant clinical features and predictors of AI in adult patients with tuberculosis or HIV. Results A total of 46 studies involving 4044 adults were included: 1599 with tuberculosis and 2445 with HIV. The pooled prevalence of AI was 33% (95% CI, 22%-45%; I2 = 97.7%, P < .001) in participants with tuberculosis and 28% (95% CI, 18%-38%; I2 = 98.9%, P < .001) in those with HIV. Presentation with multidrug-resistant tuberculosis, abdominal pain, salt craving, myalgia, increased severity and duration of tuberculosis disease, and the absence of nausea predicted AI in participants with tuberculosis in 4 studies. Cytomegalovirus antigenemia positivity, rifampicin therapy, and eosinophilia >3% predicted AI in participants with HIV in 2 studies. Conclusions AI is relatively common in adults with tuberculosis or HIV. Its timely screening, diagnosis, and management in patients with these 2 conditions should be encouraged to avert mortality.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Noela Owarwo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Peter Kyazze
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bethan Morgan
- Education and Research Centre, Wythenshawe Hospital, Manchester, UK
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Baluku JB, Nalwanga R, Kazibwe A, Olum R, Nuwagira E, Mugenyi N, Mulindwa F, Bongomin F. Association between biomarkers of inflammation and dyslipidemia in drug resistant tuberculosis in Uganda. Lipids Health Dis 2024; 23:65. [PMID: 38429714 PMCID: PMC10905847 DOI: 10.1186/s12944-024-02063-7] [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] [Received: 12/23/2023] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Active tuberculosis (TB) significantly increases the risk of cardiovascular disease, but the underlying mechanisms remain unclear. This study aimed to investigate the association between inflammation biomarkers and dyslipidemia in patients with drug-resistant TB (DR-TB). METHODS This was a secondary analysis of data from a cross-sectional multi-center study in Uganda conducted 2021. Participants underwent anthropometric measurements and laboratory tests included a lipid profile, full haemogram and serology for HIV infection. Dyslipidemia was defined as total cholesterol > 5.0 mmol/l and/or low-density lipoprotein cholesterol > 4.14 mmol/l, and/or triglycerides (TG) ≥ 1.7 mmol/l, and/or high density lipoprotein cholesterol (HDL-c) < 1.03 mmol/l for men and < 1.29 mmol/l for women. Biomarkers of inflammation were leukocyte, neutrophil, lymphocyte, monocyte, and platelet counts, as well as neutrophil/lymphocyte (NLR), platelet/lymphocyte, and lymphocyte/monocyte (LMR) ratios, mean corpuscular volume (MCV), and the systemic immune inflammation index (SII) (neutrophil × platelet/lymphocyte). Modified Poisson Regression analysis was used for determining the association of the biomarkers and dyslipidemia. RESULTS Of 171 participants, 118 (69.0%) were co-infected with HIV. The prevalence of dyslipidemia was 70.2% (120/171) with low HDL-c (40.4%, 69/171) and hypertriglyceridemia (22.5%, 38/169) being the most common components. Patients with dyslipidemia had significantly higher lymphocyte (P = 0.008), monocyte (P < 0.001), and platelet counts (P = 0.014) in addition to a lower MCV (P < 0.001) than those without dyslipidemia. Further, patients with dyslipidemia had lower leucocyte (P < 0.001) and neutrophil (P = 0.001) counts, NLR (P = 0.008), LMR (P = 0.006), and SII (P = 0.049). The MCV was inversely associated with low HDL-C (adjusted prevalence ratio (aPR) = 0.97, 95% CI 0.94-0.99, P = 0.023) but was positively associated with hypertriglyceridemia (aPR = 1.04, 95% CI 1.00-1.08, P = 0.052). CONCLUSIONS Individuals with dyslipidemia exhibited elevated lymphocyte, monocyte, and platelet counts compared to those without. However, only MCV demonstrated an independent association with specific components of dyslipidemia. There is need for further scientific inquiry into the potential impact of dyslipidemia on red cell morphology and a pro-thrombotic state among patients with TB.
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Affiliation(s)
- Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | | | | | - Ronald Olum
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin Nuwagira
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [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: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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Sekandi JN, Quach T, Olum R, Nakkonde D, Farist L, Obiekwe R, Zalwango S, Buregyeya E. Stigma and Associated Sex Disparities Among Patients with Tuberculosis in Uganda: A Cross-Sectional Study. Res Sq 2024:rs.3.rs-3794900. [PMID: 38260614 PMCID: PMC10802719 DOI: 10.21203/rs.3.rs-3794900/v1] [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: 01/24/2024]
Abstract
Background Tuberculosis (TB) is one of the leading causes of death from a single infectious agent globally. Stigma associated with TB encompassing self-, anticipated-, and public-stigma has significant negative effects on treatment adherence. In Uganda, limited data exist on the prevalence of stigma and its relationship with sex among patients with TB. We evaluate prevalence of three types of stigma and their relationship with the sex of patients undergoing TB treatment. Methods This cross-sectional study was conducted between July 2020 to March 2021 at selected TB clinics in Kampala, Uganda. Eligible participants were aged 18-65 with confirmed TB and starting their prescribed treatment. We collected data on socio-demographics and used 13 items to capture the self-, anticipated-, and public-stigma from which we composed the dependent variables. The primary independent variable was sex. We employed multivariable logistic regression analysis to evaluate the association between sex and the three stigma types. Additionally, we considered potential confounders such as age, HIV, and employment status. Statistical significance was defined as p<0.05. Results In this study we enrolled 144 participants with a mean age of 35.8 years (standard deviation = 12). Half of the participants (50%, n=72) were female, 44% had a secondary education, 37.5% were unemployed, and 32.6% were co-infected with HIV. The prevalence of self-stigma was 71.1%, anticipated stigma was 75.7%, and public stigma was 41.7%. Significant factors were associated with self-stigma were female sex (adjusted odds ratio (AOR): 2.35 95% CI: 1.02-5.74) and unemployment (AOR: 2.95 95% CI: 1.16-8.58). HIV-positive status was significantly associated with anticipated stigma (AOR: 3.58 95% CI: 1.38-11.23). However, none of the variables we evaluated showed a significant association with public stigma. Conclusions Our study showed a high prevalence of self, anticipated and public stigma among TB patients. Notably, females and unemployed individuals were at a higher risk of self-stigma, while those with HIV/AIDS and TB were more likely to report anticipated stigma. To combat stigma effectively, interventions should be tailored to cater to sex-specific needs and persons living with HIV. Future research should delve further in determinants of TB-related stigma in high-burden settings.
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Affiliation(s)
- Juliet N Sekandi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Trang Quach
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Leila Farist
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Rochelle Obiekwe
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Sarah Zalwango
- Kampala Capital City Authority, Department of Public Health Service and Environment, Kampala, Uganda
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Kakinda M, Olum R, Baluku JB, Bongomin F. Diagnostic Accuracy of Clinical Diagnostic Scoring Systems for Childhood Tuberculosis: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2024; 11:ofad624. [PMID: 38221980 PMCID: PMC10787364 DOI: 10.1093/ofid/ofad624] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024] Open
Abstract
Background Diagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, point-based scoring systems and diagnostic algorithms have been developed to improve the diagnostic yields in this population. However, there are no updated systematic reviews of the existing childhood TB scoring systems and algorithms. Hence, we systematically reviewed the diagnostic accuracy of the childhood TB diagnostic scoring systems and algorithms. Methods We systematically searched PubMed, CINAHL, Embase, Scopus, and Google Scholar databases for relevant articles published until 30 March 2023. QUADAS-2 was used to assess their study quality. Diagnostic accuracy measures (ie, sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) were pooled using a random-effects model. Results We included 15 eligible studies, with a total of 7327 study participants aged <15 years, with 10 evaluations of childhood TB diagnostic scoring systems and algorithms. Among these algorithms and scoring systems, only 3 were evaluated more than once. These were the Keith Edwards scoring system with 5 studies (sensitivity, 81.9%; specificity, 81.2%), Kenneth Jones criteria with 3 studies (sensitivity, 80.1%; specificity, 45.7%), and the Ministry of Health-Brazil algorithm with 3 studies (sensitivity, 79.9%; specificity, 73.2%). Conclusions We recommend using the Keith Edwards scoring system because of its high sensitivity and specificity. Further research is necessary to assess the effectiveness of scoring systems and algorithms in identifying TB in children with HIV and malnutrition.
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Affiliation(s)
- Michael Kakinda
- Clinical Directorate, Joint Clinical Research Center, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
- Network for Infectious Diseases Epidemiology and Research (NIDER) Platform, Kampala, Uganda
| | - Joseph Baruch Baluku
- Network for Infectious Diseases Epidemiology and Research (NIDER) Platform, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Network for Infectious Diseases Epidemiology and Research (NIDER) Platform, Kampala, Uganda
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Ndibarema ER, Olum R, Ogavu J, Makhoba A. A rare case of multi-drug resistant Raoultella ornithinolytica-induced sepsis in a healthy young man in Uganda. Clin Case Rep 2024; 12:e8402. [PMID: 38173896 PMCID: PMC10761617 DOI: 10.1002/ccr3.8402] [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: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Key Clinical Message Antimicrobial resistance (AMR) is a public health challenge. It causes unresponsiveness to treatment with antimicrobials, leads to sepsis, septic shock, and increased hospital mortality. This is compounded by new multidrug resistant organisms. We present and discuss a case of sepsis caused by a rare multi-drug resistant bacterium Raoultella ornithinolytica. Abstract Antimicrobial resistance is a major public health concern worldwide, associated with nearly 5 million deaths. The highest mortality attributed to AMR is seen in sub-Saharan Africa. Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa contribute to most deaths attributed to AMR globally. However, other uncommon microorganisms have been implicated. Few cases of resistant, extended-spectrum beta-lactamase (ESBL) producing Raoultella ornithinolytica have been reported to cause sepsis worldwide. To our knowledge, no case of R. ornithinolytica-induced sepsis has been reported in our settings. We report a case of sepsis due to R. ornithinolytica in an injured young adult. We received a 36-year-old man, a professional banker involved in a road traffic accident 2 h before admission. He sustained a deep degloving wound on the right ankle with exposure of the lateral malleolus and presented with severe pain, and bleeding at the injury site. x-Rays confirmed a comminuted intra-articular distal tibia and fibular fracture. Surgical debridement and external fixation were aseptically done on the same day. Below knee amputation was done on the 7th day post-admission due to extensively injured and infected limb with sepsis. Local pus culture isolated ESBL-positive R. ornithinolytica susceptible only to meropenem, ciprofloxacin, and amikacin. Introducing these antibiotics on the 11th post-admission day averted sepsis and enhanced patient recovery. With the threat of AMR, newly emerging highly resistant microbes should be expected and suspected. Early recognition of sepsis and its focus and precise intervention with antimicrobials guided by specimen culture and susceptibility profile is highly recommended and should be standard practice. It highly reduces morbidity and mortality due to sepsis.
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Affiliation(s)
- Elias Rugaatwa Ndibarema
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
| | - Ronald Olum
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- School of Public HealthMakerere UniversityKampalaUganda
- School of Public HealthImperial College LondonUnited Kingdom
| | - Joseph Ogavu
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
| | - Anthony Makhoba
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
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Bongomin F, Olum R, Kibone W, Namusobya M, van Rhijn N, Denning DW. Prevalence of chronic pulmonary aspergillosis along the continuum of pulmonary tuberculosis care: A protocol for a living systematic review and meta-analysis. PLoS One 2023; 18:e0294634. [PMID: 38100446 PMCID: PMC10723662 DOI: 10.1371/journal.pone.0294634] [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: 09/19/2023] [Accepted: 11/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Chronic pulmonary aspergillosis (CPA) is a debilitating disease estimated to affect over 3 million people worldwide. Pulmonary tuberculosis (PTB) is the most significant risk factor for CPA. However, the true burden of CPA at the time of PTB diagnosis, during, and after PTB treatment remains unknown. In this paper, we present a protocol for a living systematic review aimed at estimating the current burden of CPA along the continuum of PTB care. MATERIALS AND METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines to formulate this protocol, which is registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023453900). We will identify primary literature through various electronic databases, including CINAHL, Ovid MEDLINE, MEDLINE (PubMed), EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and African Journal Online. The search will encompass articles from inception to December 31st, 2023, using medical subject heading search terms "pulmonary tuberculosis" AND "chronic pulmonary aspergillosis". Two reviewers will independently assess titles, abstracts, and full texts for eligibility using the Covidence web-based software. The eligible studies will comprise original observational research that reports on the prevalence of CPA diagnosed in individuals with PTB, based on established criteria, without language or geographic restriction. We intend to exclude single case reports and case series with fewer than 10 participants, as well as review articles, guidelines, and letters to the editors. Cochrane Risk of Bias Tools (ROB2 and ROBINS-I) will used to assess study quality and risk of bias and the quality of the evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Our data syntheses will encompass meta-analysis and meta-regression, conducted using STATA version 18 and R- Studio version 4.0.2. This systematic review will be updated every 3-5 years as more data emerges. CONCLUSIONS The findings of this proposed systematic review will summarize the available evidence on the occurrence of CPA, at the time of PTB diagnosis, during and after PTB treatment. The study results have the potential to guide healthcare policies regarding screening for CPA, enhance clinical decision-making, and catalyse further research into understanding the interplay between PTB and CPA. By shedding light on the current burden of CPA along the continuum of PTB care, we aspire to contribute to the betterment of patient care, disease management, and global health outcomes. PROSPERO REGISTRATION CRD42023453900.
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Affiliation(s)
- Felix Bongomin
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Martha Namusobya
- Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - David W. Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Nakireka S, Mukunya D, Tumuhaise C, Olum R, Namulema E, Napyo A, Serwanja Q, Ingabire PM, Muyinda A, Bongomin F, Musaba M, Mutaki V, Nantale R, Akunguru P, Ainembabazi R, Nomujuni D, Olwit W, Nakawunde A, Nyiramugisha S, Aol PM, Rujumba J, Munabi I, Kiguli S. "I thought I was going to die": Experiences of COVID-19 patients managed at home in Uganda. PLoS One 2023; 18:e0295113. [PMID: 38085728 PMCID: PMC10715664 DOI: 10.1371/journal.pone.0295113] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 home-based care strategy had neither been piloted nor tested in Uganda. OBJECTIVE To explore the experiences of COVID-19 patients managed at home in Uganda. METHODS This was a qualitative study that was conducted to explore the lived experiences of COVID-19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA). RESULTS Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing home-based care and that COVID-19 treatment should be free of charge. CONCLUSION COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care.
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Affiliation(s)
- Susan Nakireka
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Crescent Tumuhaise
- Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Mpigi, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Edith Namulema
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Public Health, Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | | | - Asad Muyinda
- Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Milton Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Vivian Mutaki
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | | | | | - William Olwit
- Department of Radiology, Uganda Cancer Institute, Kampala, Uganda
| | - Aisha Nakawunde
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | | | | | - Joseph Rujumba
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Ian Munabi
- Department of Anatomy, School of Medicine, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Metabolic characterisation of adult Ugandan patients with TB and diabetes mellitus comorbidity. Int J Tuberc Lung Dis 2023; 27:944-945. [PMID: 38042976 DOI: 10.5588/ijtld.23.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Affiliation(s)
- D Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Non-communicable Diseases Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe
| | - I Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala
| | - R Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala
| | - S Adakun
- Adult Tuberculosis Ward, Mulago National Referral, and Teaching Hospital, Kampala
| | | | | | - I Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Uganda
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12
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Miiro E, Olum R, Baluku JB. Clinical features, resistance patterns and treatment outcomes of drug-resistant extra-pulmonary tuberculosis: A scoping review. J Clin Tuberc Other Mycobact Dis 2023; 33:100390. [PMID: 37588726 PMCID: PMC10425399 DOI: 10.1016/j.jctube.2023.100390] [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] [Indexed: 08/18/2023] Open
Abstract
Background Drug-resistant tuberculosis (DR-TB) is a threat to tuberculosis (TB) control. Extra-pulmonary forms of DR-TB (DR-epTB) are not well characterized. This review summarizes the clinical features, resistance patterns and treatment outcomes of DR-epTB. Methods We searched EMBASE to identify studies that reported drug-resistance among extra-pulmonary TB sites. All age groups were included in this review. Studies which did not describe drug-resistance patterns at extra-pulmonary TB sites were excluded. We summarized the proportion of resistance to individual anti-TB drugs as well as multi-drug resistant (MDR), pre-extensively drug resistant (pre-XDR) and extensively drug-resistant (XDR) TB. Results Eighteen studies with a total of 10,222 patients with extra-pulmonary TB of whom 1,236 (12.0%) had DR-epTB, were included in this review. DR-epTB was mostly reported in young people aged 28 to 46 years. While TB meningitis is the most commonly studied form, adenitis is the commonest form of DR-epTB reported in 21% to 47%. Central nervous system TB (3.8% to 51.6%), pleural TB (11.3% to 25.9%), skeletal TB (9.4% to 18.1%), abdominal TB (4.3% to 6.5%), and disseminated TB (3.8%) are also encountered. The HIV co-infection rate is reported to be 5.0% to 81.3% while 2.6% to 25.4 % have diabetes mellitus. Clinical symptoms of DR-epTB are consistent with morbidity in the affected body system. Among patients with DR-epTB, the proportion of MDR TB was 5% to 53% while that for pre-XDR TB and XDR TB was 3% to 40% and 4% to 33%, respectively. Treatment success is achieved in 26% to 83% of patients with DR-epTB while death, treatment loss-to-follow up, and treatment failure occur in 2% to 76%, 7% to 15%, and 0% to 4% respectively. Patients with DR-epTB were reported to have poorer outcomes than those with pulmonary DR-TB and extra-pulmonary drug-susceptible TB. Conclusion Clinical features of DR-epTB are similar to those observed among people with drug-susceptible EPTB but patients with DR-epTB post worse treatment outcomes.
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Affiliation(s)
- Emmanuel Miiro
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Olum
- St Francis Hospital Nsambya, Kampala, Uganda
| | - Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
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13
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Kibirige D, Andia-Biraro I, Kyazze AP, Olum R, Bongomin F, Nakavuma RM, Ssekamatte P, Emoru R, Nalubega G, Chamba N, Kilonzo K, Laizer SN, Mrema LE, Olomi W, Minja LT, Ntinginya NE, Sabi I, Hill PC, Te Brake L, van Crevel R, Sharples K, Critchley J. Burden and associated phenotypic characteristics of tuberculosis infection in adult Africans with diabetes: a systematic review. Sci Rep 2023; 13:19894. [PMID: 37963989 PMCID: PMC10645877 DOI: 10.1038/s41598-023-47285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/11/2023] [Indexed: 11/16/2023] Open
Abstract
Diabetes mellitus (DM) increases the risk of developing tuberculosis infection (TBI). However, the evidence on the burden and phenotypic characteristics of TBI in African patients with DM is limited. This study aimed to determine the prevalence and characterisation of TBI in native African patients living with DM. We searched PubMed, EMBASE, and African Journals Online for original studies reporting information on the prevalence and characteristics of TBI in adult Africans with DM. A forest plot was used to describe the pooled prevalence estimate of TBI and the corresponding 95% confidence intervals (CI). Six studies conducted in four African countries involving 721 participants with DM were included in this systematic review. The pooled prevalence estimate of TBI was 40% (95% CI 20-60%, I2 = 98.52%, p < 0.001). Age ≥ 40 years and glycated haemoglobin levels independently predicted TBI positivity in patients with DM in three studies. Africans with DM have a high prevalence of TBI, especially those who are older or with poorly controlled diabetes. This justifies the need for studies to explore how to screen and manage TBI to avert the progression to active TB disease.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs' Hospital Lubaga, Kampala, Uganda.
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda.
| | - Irene Andia-Biraro
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Peter Kyazze
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rose Mwanje Nakavuma
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Phillip Ssekamatte
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Reagan Emoru
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Goretti Nalubega
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Nyasatu Chamba
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sweetness Naftal Laizer
- Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lucy Elauteri Mrema
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Willyhelmina Olomi
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Lilian Tina Minja
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Issa Sabi
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Philip C Hill
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Lindsey Te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katrina Sharples
- Centre for International Health, Otago University, Dunedin, New Zealand
| | - Julia Critchley
- Population Health Research Institute, St. George's University of London, London, UK
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Hassan MY, Mohamud RYH, Kassim MM, Hussein AI, Adam MK, Akbulut UE, Olum R, Okot J, Bongomin F, Ahmed MA. Clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia. IJID Reg 2023; 8:31-35. [PMID: 37415953 PMCID: PMC10320069 DOI: 10.1016/j.ijregi.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
Objectives Measles is a contagious disease associated with significant morbidity and mortality. This paper describes the clinical characteristics and outcomes of patients hospitalized with measles during an outbreak in Somalia from January 2018 to December 2021. Methods This retrospective study was conducted at Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital. Children aged 6 months to 17 years who were hospitalized with clinical signs and symptoms of measles and its complications were recruited. Results In total, 110 participants were enrolled. The median age was 16 [interquartile range (IQR) 12-36] years, and 87 (79.1%) were male. All participants presented with fever, typical measles rash, cough and conjunctivitis, and 43 (39.1%) had received the measles vaccine. Overall, 104 (94.6%) participants were admitted with severe respiratory symptoms, and six (5.4%) were admitted due to poor feeding and/or significant dehydration. Overall, all-cause mortality was 1.8% (n=2). The median duration of hospitalization was longer among participants who died compared with those who survived [11 (IQR 8-14) vs 4 (IQR 2-6) days; P=0.046]. Unvaccinated participants were significantly younger than vaccinated participants [36 (IQR 24-72) vs 12 (IQR 9-16) months; P<0.001]. There was a trend towards higher mortality [0/43 (0%) vs 2/67 (3%); P=0.519] and longer length of hospitalization [3 (IQR 2-6) vs 4 (IQR 3-7) days; P=0.056] among unvaccinated participants compared with vaccinated participants. Both the median total leukocyte count [5.7 (IQR 3.9-8.5) vs 11.6 (IQR 5.9-46.3) x 109/L; P<0.001] and platelet count [239 (IQR 202-358) vs 308 (IQR 239-404) x 109/L; P=0.032] were significantly higher among unvaccinated participants compared with vaccinated participants. However, the median haemoglobin concentration was significantly higher among vaccinated participants compared with unvaccinated participants [11.1 (IQR 9.9-12.3) vs 10.1 (IQR 9.1-11.2) g/dL; P=0.006]. Conclusions Patients with measles in Somalia have a short hospital stay, low mortality rate and low vaccination rate. Timely vaccination and the need for improved care of patients with measles, particularly vulnerable groups including children and those with undernutrition, are encouraged.
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Affiliation(s)
- Mohamed Yaqub Hassan
- Department of Paediatrics, Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Rahma Yusuf Haji Mohamud
- Department of Education, Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Mukhtar Kassim
- Department of Paediatrics, Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Issak Hussein
- Department of Obstetrics and Gynaecology, Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mesut Kayse Adam
- Department of Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Ulaş Emre Akbulut
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jerom Okot
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gul University, Gulu, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gul University, Gulu, Uganda
| | - Mohammed A.M. Ahmed
- Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
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15
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Andia-Biraro I, Baluku JB, Olum R, Bongomin F, Kyazze AP, Ninsiima S, Ssekamatte P, Kibirige D, Biraro S, Seremba E, Kabugo C. Effect of COVID-19 pandemic on inpatient service utilization and patient outcomes in Uganda. Sci Rep 2023; 13:9693. [PMID: 37322097 PMCID: PMC10272226 DOI: 10.1038/s41598-023-36877-9] [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] [Received: 08/20/2022] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
COVID-19 has had devastating effects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January-July 2019 (before the pandemic) and January-July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were significantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.04-1.5, p = 0.018), patients aged ≥ 60 years (aOR 1.6, 95% CI 1.2-2.1, p = 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2-1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2-1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.
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Affiliation(s)
- Irene Andia-Biraro
- Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Samuel Biraro
- Clockworks Research Company Limited, Kampala, Uganda
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Kakinda M, Olum R, Baluku JB, Bongomin F. Diagnostic accuracy of clinical diagnostic scoring systems for childhood tuberculosis: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069448. [PMID: 37085315 PMCID: PMC10124241 DOI: 10.1136/bmjopen-2022-069448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Diagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, clinical signs and symptoms, radiological studies, laboratory examinations, point-based scoring systems or diagnostic algorithms have been developed to improve diagnostic yields in this population. However, there are limited data on the diagnostic test accuracy of paediatric TB scoring systems. Therefore, this systematic review and meta-analysis aims to synthesise the available evidence on the diagnostic accuracy of childhood TB diagnostic scoring systems. METHODS AND ANALYSIS This protocol describes a systematic review, developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy. We will conduct a comprehensive literature search for relevant articles in the following databases: PubMed, CINAHL, Embase, Scopus and Cochrane Databases. The eligibility criteria for studies will be formulated based on the Participants (Population), Index Test, Comparator Test and Target Condition criteria for the review question. The index test will be defined as any attempt to diagnose childhood TB using either a scoring system or a diagnostic algorithm, whereas a composite reference standard will be used as a reference standard. This will include any attempt to confirm diagnosis of TB. Where bacteriological confirmation is not obtained and there are at least two of the following features: chest radiograph consistent with TB, immunological evidence of Mycobacterium tuberculosis infection and/or positive response to TB treatment will also be considered. The QUADAS-2 Tool will be used to assess the quality of the studies. The diagnostic accuracy measures (ie, sensitivity, specificity, negative predictive and positive predictive values) will be pooled with the random-effects or fixed-effects models, as appropriate. All statistical analyses will be performed using the Review Manager V.5.4. ETHICS AND DISSEMINATION This research is exempt from ethics approval given that this is a protocol for a systematic review, which uses published data. The findings from this review will be disseminated through peer-reviewed publications and scientific conferences. PROSPERO REGISTRATION NUMBER CRD42022367049.
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Affiliation(s)
- Michael Kakinda
- Clinical Directorate, Joint Clinical Research Center, Wakiso, Uganda
- Lifebox Foundation, New York, New York, USA
| | - Ronald Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Gulu University, Gulu, Uganda
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Acen EL, Worodria W, Kateete DP, Olum R, Joloba ML, Akintola A, Bbuye M, Andia IB. Association of circulating serum free bioavailable and total vitamin D with cathelicidin levels among active TB patients and household contacts. Sci Rep 2023; 13:5365. [PMID: 37005478 PMCID: PMC10067953 DOI: 10.1038/s41598-023-32543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
The free hormone hypothesis postulates that the estimation of free circulating 25 (OH)D may be a better marker of vitamin D status and is of clinical importance compared to total vitamin D fraction. The unbound fraction is involved in biological activities since it is able to penetrate into the cell. Studies have shown that cathelicidin/LL-37 inhibits the growth of Mycobacterium tuberculosis in a vitamin D-dependent manner and therefore adequate vitamin D is required for its expression. The study aimed to determine the association between serum bioavailable and total vitamin D with LL-37 levels in ATB patients, LTBI, and individuals with no TB infection. This was a cross-sectional study in which bioavailable vitamin D and LL-37 levels were measured using competitive ELISA kits and total vitamin D was measured using electrochemilumiscence and consequently determined their association. The mean (SD) bioavailable vitamin D levels of the study participants were 3.8 ng/mL (2.6) and the median (IQR) of LL-37 levels were 320 ng/mL (160, 550 ng/mL). The mean (SD) of total vitamin D levels was 19.0 ng/mL (8.3) ng/mL. Similar weak correlations were observed between the bioavailable and total vitamin D with LL-37 levels, therefore, deviating from our hypothesis.
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Affiliation(s)
- Ester Lilian Acen
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - William Worodria
- Pulmonary Division, Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- Department of Internal Medicine, School of Medicine, College of Health Sciences Unit, Makerere University, Kampala, Uganda
| | - Moses L Joloba
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ashraf Akintola
- Department of Biomedical Convergence Science and Technology, School of Industrial Technology Advances, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Mudarshiru Bbuye
- Makerere Lung Institute College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Biraro Andia
- Department of Internal Medicine, School of Medicine, College of Health Sciences Unit, Makerere University, Kampala, Uganda
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Bongomin F, Morgan B, Ekeng BE, Mushi MF, Kibone W, Olum R, Meya DB, Hamer DH, Denning DW. Isolated renal and urinary tract aspergillosis: a systematic review. Ther Adv Urol 2023; 15:17562872231218621. [PMID: 38130371 PMCID: PMC10734358 DOI: 10.1177/17562872231218621] [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: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August 2023 using the key terms 'renal' OR 'kidney*' OR 'prostate' OR 'urinary bladder' OR 'urinary tract*AND 'aspergillosis' OR 'aspergillus' OR 'aspergilloma' OR 'mycetoma'. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies, protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925-2023. Among the participants, 79 (86.8%) were male, with a median age of 46 years. Predominantly, presentations consisted of isolated renal infections (74 instances, 81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens (p = 0.739) or nephrectomy status (p = 0.8). Conclusion Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management. PROSPERO registration number CRD42023430959.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bethan Morgan
- Trust Library Services, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Emerging Infectious Disease Laboratory, Boston, MA, USA
- Center for Emerging Infectious Diseases Policy & Research, Boston University, Boston, MA, USA
| | - David W. Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Baluku JB, Olum R, Sanya RE, Ocama P. Respiratory morbidity in Schistosoma mansoni infection: a rapid review of literature. Ther Adv Infect Dis 2023; 10:20499361231220152. [PMID: 38152611 PMCID: PMC10752101 DOI: 10.1177/20499361231220152] [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: 09/11/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
Background Schistosomiasis contributes to 2.5 million disability-adjusted life years globally. Acute and chronic respiratory morbidity of Schistosoma mansoni (S. mansoni) is poorly documented in the literature. We conducted a rapid literature review of the burden of respiratory symptoms and lung function abnormalities among patients with S. mansoni. We also report the immunologic and lung imaging findings from the studies reviewed. Methods We carried out a comprehensive literature search in Embase and MEDLINE from the inception of the databases to 13th March 2023. Results A total of 2243 patients with S. mansoni were reported from 24 case reports, 11 cross-sectional studies, 7 case series, 2 cohort studies and 2 randomized controlled trials. The prevalence of any respiratory symptom was 13.3-63.3% (total number of patients studied, n = 149). The prevalence of the individual symptoms among patients with S. mansoni in whom respiratory symptoms were sought for was as follows: cough (8.3-80.6%, n = 338), dyspnea (1.7-100.0%, n = 200), chest pain (9.0-57.1%, n = 86), sputum production (20.0-23.3%, n = 30) and wheezing (0.0 - 20.0%, n = 1396). The frequency of the symptoms tended to be higher in acute schistosomiasis. Restrictive lung disease was prevalent in 29.0% (9/31). The commonest chest imaging findings reported were nodules (20-90%, n = 103) and interstitial infiltrates (12.5-23.0%, n = 89). Peripheral blood eosinophilia was prevalent in 72.0-100.0% of patients (n = 130) with acute schistosomiasis and correlated with symptoms and imaging abnormalities. Three case reports in chronic S. mansoni reported elevated C-reactive protein, leucocyte, neutrophil and absolute eosinophil counts, eosinophil percentage, IgE and IgG4. Conclusion There is a high prevalence of respiratory morbidity among patients with S. mansoni, particularly in the acute stage of the infection, although the studies are relatively small. Larger studies are needed to characterize respiratory morbidity in chronic schistosomiasis and determine the underlying clinical and immunological mechanisms.
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Affiliation(s)
- Joseph Baruch Baluku
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, PO Box 26343, Kampala, Uganda
| | - Ronald Olum
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Richard E. Sanya
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Uganda
| | - Ponsiano Ocama
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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20
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Kibirige D, Zawedde-Muyanja S, Andia-Biraro I, Olum R, Adakun S, Sekaggya-Wiltshire C, Kimuli I. Diagnostic accuracy of two confirmatory tests for diabetes mellitus in adult Ugandans with recently diagnosed tuberculosis. Ther Adv Infect Dis 2023; 10:20499361231216799. [PMID: 38145193 PMCID: PMC10748612 DOI: 10.1177/20499361231216799] [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: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The optimal confirmatory tests for diabetes mellitus (DM) in patients with tuberculosis (TB) vary across populations. This study aimed to evaluate the performance of two confirmatory tests for DM against the oral glucose tolerance test (OGTT) as the reference test in adult Ugandans with recently diagnosed TB. Methods A total of 232 adult participants receiving TB treatment underwent initial screening for DM with random blood glucose (RBG) measurement. Participants with a RBG level ⩾6.1 mmol/l received additional screening with fasting blood glucose (FBG), laboratory-measured glycated haemoglobin (HbA1c) and an OGTT. Using the latter as the gold standard and reference test, we evaluated the diagnostic accuracy of laboratory-measured HbA1c and FBG. Results Of the 232 participants initially screened for DM using RBG measurement, 117 participants (50.4%) had RBG level ⩾6.1 mmol/l and were scheduled to return for additional blood glucose testing. Of these, 75 (64.1%) participants returned for FBG and HbA1c measurements. A diagnosis of DM was made in 32 participants, corresponding to a prevalence of 13.8% [95% CI 9.9-18.9].The areas under the curve (AUC) for FBG and laboratory-measured HbA1c were 0.69 [95% CI 0.47-0.90] and 0.65 [95% CI 0.43-0.87], respectively. The sensitivity and specificity of a FBG level of ⩾7 mmol/l were 57.1% [95% CI 18.4-90.1] and 74.6% [95% CI 62.5-84.5], respectively, whereas the sensitivity and specificity for laboratory-measured HbA1c of ⩾6.5 mmol/l (48 mmol/mol) were 14.3% [95% CI 0.40-57.9] and 95.3% (86.9-99.0%), respectively. Conclusion FBG may be better than laboratory-measured HbA1c in confirming DM in adult Ugandans with recently diagnosed TB. However, because of the small study sample size, larger studies evaluating the diagnostic utility of these diabetes screening tests in adult Ugandans with TB are needed to confirm these findings.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. BOX 14130 Kampala, Entebbe +256, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis Unit, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
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21
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Ingabire PM, Nantale R, Sserwanja Q, Nakireka S, Musaba MW, Muyinda A, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Ainembabazi R, Olum R, Munabi I, Kiguli S, Mukunya D. Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study. Trop Med Health 2022; 50:100. [PMID: 36578071 PMCID: PMC9795158 DOI: 10.1186/s41182-022-00491-8] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. METHODS We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. RESULTS Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1-89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9-16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65-3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01-10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55-0.83) were associated with prolonged hospitalization. CONCLUSION One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.
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Affiliation(s)
- Prossie M. Ingabire
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ritah Nantale
- grid.448602.c0000 0004 0367 1045Department of Nursing, Busitema University, Tororo, Uganda
| | - Quraish Sserwanja
- Department of Programmes, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - Susan Nakireka
- grid.461227.40000 0004 0512 5435Department of Medicine, Mengo Hospital, Kampala, Uganda ,grid.442658.90000 0004 4687 3018Department of Medicine and Dentistry, Uganda Christian University, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Asad Muyinda
- grid.461350.50000 0004 0504 1186Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Criscent Tumuhaise
- grid.461252.60000 0004 0514 4556Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Nkozi, Uganda
| | - Edith Namulema
- grid.461227.40000 0004 0512 5435Covid Task Force Institution, Mengo Hospital, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology, Gulu University, Gulu, Uganda
| | - Agnes Napyo
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
| | | | - Ronald Olum
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ian Munabi
- grid.11194.3c0000 0004 0620 0548Department of Anatomy, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
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22
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Onen BC, Semulimi AW, Bongomin F, Olum R, Kurigamba G, Mbiine R, Kituuka O. Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study. BMC Surg 2022; 22:433. [PMID: 36529732 PMCID: PMC9759870 DOI: 10.1186/s12893-022-01883-7] [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] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Postoperative complications and mortality following laparotomy have remained high worldwide. Early postoperative risk stratification is essential to improve outcomes and clinical care. The surgical Apgar score (SAS) is a simple and objective bedside prediction tool that can guide a surgeon's postoperative decision making. The objective of this study was to evaluate the performance of SAS in predicting outcomes in patients undergoing laparotomy at Mulago hospital. METHOD A prospective observational study was conducted among eligible adult patients undergoing laparotomy at Mulago hospital and followed up for 4 months. We collected data on the patient's preoperative and intraoperative characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups namely: low (8-10), medium (5-7), and high (0-4). Primary outcomes were in-hospital major complications and mortality. Data was presented as proportions or mean (standard deviation) or median (interquartile range) as appropriate. We used inferential statistics to determine the association between the SAS and the primary outcomes while the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis. RESULTS Of the 151 participants recruited, 103 (68.2%) were male and the mean age was 40.6 ± 15. Overall postoperative in-hospital major complications and mortality rates were 24.2% and 10.6%, respectively. The participants with a high SAS category had an18.4 times risk (95% CI, 1.9-177, p = 0.012) of developing major complications, while those in medium SAS category had 3.9 times risk (95% CI, 1.01-15.26, p = 0.048) of dying. SAS had a fair discriminatory ability for in-hospital major complications and mortality with the area under the curve of 0.75 and 0.77, respectively. The sensitivity and specificity of SAS ≤ 6 for major complications were 60.5% and 81.14% respectively, and for death 54.8% and 81.3%, respectively. CONCLUSION SAS of ≤ 6 is associated with an increased risk of major complications and/or mortality. SAS has a high specificity with an overall fair discriminatory ability of predicting the risk of developing in-hospital major complications and/or death following laparotomy.
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Affiliation(s)
- Bruno Chan Onen
- grid.11194.3c0000 0004 0620 0548Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Andrew Weil Semulimi
- grid.11194.3c0000 0004 0620 0548Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, 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
| | - Ronald Olum
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Gideon Kurigamba
- grid.416252.60000 0000 9634 2734Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Ronald Mbiine
- grid.11194.3c0000 0004 0620 0548Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Olivia Kituuka
- grid.11194.3c0000 0004 0620 0548Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Kanyike AM, Olum R, Kajjimu J, Owembabazi S, Ojilong D, Nassozi DR, Amongin JF, Atulinda L, Agaba K, Agira D, Wamala NK, Buule R, Nabukeera G, Kyomuhendo R, Luwano R, Owobusingye W, Matovu D, Musoke P, Bongomin F, Kiyimba K. Antimicrobial resistance and rational use of medicine: knowledge, perceptions, and training of clinical health professions students in Uganda. Antimicrob Resist Infect Control 2022; 11:145. [PMID: 36434685 PMCID: PMC9700951 DOI: 10.1186/s13756-022-01186-9] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials. METHODS An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom's cut-off. One-way ANOVA, Chi-square or Fisher's exact test, and logistic regression were used to assess the association between dependent and independent variables. A p < 0.05 was considered statistically significant. RESULTS We surveyed 681 participants, most were pursuing a Bachelor of Medicine and Surgery degree (n = 433, 63.6%), with a mean age of 24 (standard deviation: 3.6) years. Most participants (n = 596, 87.5%) had sufficient knowledge about antimicrobial resistance with a mean score of 85 ± 14.2%. There was a significant difference in mean knowledge scores of year 4 (86.6%) compared to year 3 (82.4%) (p = 0.002) and year 5 (88.0%) compared to year 3 (82.4%) (p < 0.001). Most participants (n = 456, 66.9%), were confident on making an accurate diagnosis of infection, and choosing the correct antimicrobial agent to use (n = 484, 71.1%). CONCLUSION Health profession students exhibited good knowledge on antimicrobial resistance and high self-perceived confidence that should be leveraged to foster better future antimicrobial prescription practices. However, they still agreed that a separated course unit on AMR is necessary which responsible authorities should consider to consolidate the efforts.
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Affiliation(s)
- Andrew Marvin Kanyike
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ronald Olum
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Kajjimu
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Shebah Owembabazi
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Daniel Ojilong
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Dianah Rhoda Nassozi
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Linda Atulinda
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kenneth Agaba
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Drake Agira
- grid.449527.90000 0004 0534 1218School of Medicine, Kabale University, Kabale, Uganda
| | - Nicholas Kisaakye Wamala
- grid.440478.b0000 0004 0648 1247Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka-Bushenyi, Uganda
| | - Richard Buule
- grid.440478.b0000 0004 0648 1247Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka-Bushenyi, Uganda
| | - Germinah Nabukeera
- grid.449527.90000 0004 0534 1218School of Medicine, Kabale University, Kabale, Uganda
| | - Robert Kyomuhendo
- grid.442626.00000 0001 0750 0866Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rehema Luwano
- grid.442655.40000 0001 0042 4901Faculty of Medicine, Islamic University in Uganda, Mbale, Uganda
| | - Whitney Owobusingye
- grid.448548.10000 0004 0466 5982Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Dissan Matovu
- Faculty of Biology, Medicine and Health, King Ceaser University, Kampala, Uganda
| | - Philip Musoke
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Kenedy Kiyimba
- grid.448602.c0000 0004 0367 1045Department of Pharmacology and Therapeutics, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Bongomin F, Ekeng BE, Kibone W, Nsenga L, Olum R, Itam-Eyo A, Kuate MPN, Pebolo FP, Davies AA, Manga M, Ocansey B, Kwizera R, Baluku JB. Invasive Fungal Diseases in Africa: A Critical Literature Review. J Fungi (Basel) 2022; 8:jof8121236. [PMID: 36547569 PMCID: PMC9853333 DOI: 10.3390/jof8121236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | - Winnie Kibone
- Department of Medicine, School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Lauryn Nsenga
- Department of Medicine, School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis’s Hospital Nsambya, Kampala P.O. Box 7176, Uganda
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | | | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Adeyinka A. Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu P.O. Box 121102, Nigeria
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4114 McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala P.O. Box 7178, Uganda
- Makerere Lung Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
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Muyinda A, Ingabire PM, Nakireka S, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Sserwanja Q, Ainembabazi R, Olum R, Nantale R, Akunguru P, Nomujuni D, Olwit W, Musaba MW, Namubiru B, Aol P, Babigumira PA, Munabi I, Kiguli S, Mukunya D. Survival analysis of patients with COVID-19 admitted at six hospitals in Uganda in 2021: a cohort study. Arch Public Health 2022; 80:233. [PMID: 36380388 PMCID: PMC9666944 DOI: 10.1186/s13690-022-00991-3] [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] [Received: 07/19/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Assessing factors associated with mortality among COVID-19 patients could guide in developing context relevant interventions to mitigate the risk. The study aimed to describe mortality and associated factors among COVID-19 patients admitted at six health facilities in Uganda.
Methods
We reviewed medical records of patients admitted with COVID-19 between January 1st 2021 and December 31st 2021 in six hospitals in Uganda. Using Stata version 17.0, Kaplan Meier and Cox regression analyses were performed to describe the time to death and estimate associations between various exposures and time to death. Finally, accelerated failure time (AFT) models with a lognormal distribution were used to estimate corresponding survival time ratios.
Results
Out of the 1040 study participants, 234 (22.5%: 95%CI 12.9 to 36.2%) died. The mortality rate was 30.7 deaths per 1000 person days, 95% CI (26.9 to 35.0). The median survival time was 33 days, IQR (9–82). Factors associated with time to COVID-19 death included; age ≥ 60 years [adjusted hazard ratio (aHR) = 2.4, 95% CI: [1.7, 3.4]], having malaria test at admission [aHR = 2.0, 95% CI:[1.0, 3.9]], a COVID-19 severity score of severe/critical [aHR = 6.7, 95% CI:[1.5, 29.1]] and admission to a public hospital [aHR = 0.4, 95% CI:[0.3, 0.6]]. The survival time of patients aged 60 years or more is estimated to be 63% shorter than that of patients aged less than 60 years [adjusted time ratio (aTR) 0.37, 95% CI 0.24, 0.56]. The survival time of patients admitted in public hospitals was 2.5 times that of patients admitted in private hospitals [aTR 2.5 to 95%CI 1.6, 3.9]. Finally, patients with a severe or critical COVID-19 severity score had 87% shorter survival time than those with a mild score [aTR 0.13, 95% CI 0.03, 0.56].
Conclusion
In-hospital mortality among COVID-19 patients was high. Factors associated with shorter survival; age ≥ 60 years, a COVID-19 severity score of severe or critical, and having malaria at admission. We therefore recommend close monitoring of COVID-19 patients that are elderly and also screening for malaria in COVID-19 admitted patients.
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Baluku JB, Nabwana M, Nalunjogi J, Muttamba W, Mubangizi I, Nakiyingi L, Ssengooba W, Olum R, Bongomin F, Andia-Biraro I, Worodria W. Cardiovascular risk factors among people with drug-resistant tuberculosis in Uganda. BMC Cardiovasc Disord 2022; 22:464. [PMID: 36333654 PMCID: PMC9636825 DOI: 10.1186/s12872-022-02889-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tuberculosis (TB) and its risk factors are independently associated with cardiovascular disease (CVD). We determined the prevalence and associations of CVD risk factors among people with drug-resistant tuberculosis (DRTB) in Uganda. Methods In this cross-sectional study, we enrolled people with microbiologically confirmed DRTB at four treatment sites in Uganda between July to December 2021. The studied CVD risk factors were any history of cigarette smoking, diabetes mellitus (DM) hypertension, high body mass index (BMI), central obesity and dyslipidaemia. We used modified Poisson regression models with robust standard errors to determine factors independently associated with each of dyslipidaemia, hypertension, and central obesity. Results Among 212 participants, 118 (55.7%) had HIV. Overall, 196 (92.5%, 95% confidence interval (CI) 88.0-95.3) had ≥ 1 CVD risk factor. The prevalence; 95% CI of individual CVD risk factors was: dyslipidaemia (62.5%; 55.4–69.1), hypertension (40.6%; 33.8–47.9), central obesity (39.3%; 32.9–46.1), smoking (36.3%; 30.1–43.1), high BMI (8.0%; 5.0–12.8) and DM (6.5%; 3.7–11.1). Dyslipidaemia was associated with an increase in glycated haemoglobin (adjusted prevalence ratio (aPR) 1.14, 95%CI 1.06–1.22). Hypertension was associated with rural residence (aPR 1.89, 95% CI 1.14–3.14) and previous history of smoking (aPR 0.46, 95% CI 0.21–0.98). Central obesity was associated with increasing age (aPR 1.02, 95%CI 1.00–1.03), and elevated diastolic blood pressure (aPR 1.03 95%CI 1.00–1.06). Conclusion There is a high prevalence of CVD risk factors among people with DRTB in Uganda, of which dyslipidaemia is the commonest. We recommend integrated services for identification and management of CVD risk factors in DRTB.
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Rugaatwa Ndibarema E, Olum R, Ayebare D, Kabakyenga J. Prevalence and Factors Associated with Hepatitis B Infection Among Outpatient Adults in South-Western Uganda. Hepat Med 2022; 14:163-172. [PMID: 36304917 PMCID: PMC9592731 DOI: 10.2147/hmer.s381809] [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] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Background About 2 billion people in the world are exposed to hepatitis B virus. Africa contributes 25% of the global Hepatitis B burden and prevalence in Uganda is 4.3%. Routine testing to establish the burden, improve prevention and control through early diagnosis and management are rare in hospital settings. We aimed at establishing the prevalence and factors associated with hepatitis B infection among adults attending outpatient clinic at Mbarara Regional Referral Hospital (MRRH) in Uganda. Methods A hospital-based cross-sectional study was conducted among outpatients attending MRRH. Consecutive sampling method was used to recruit participants. Interviewer-administered questionnaires were used to collect data. Blood samples were collected to test HBsAg. Summary statistics were used to describe the socio-demographic characteristics of study participants and the proportion of Serostatus for hepatitis B infection. Bivariate followed by multivariate logistic regression analysis was conducted to assess the factors associated with hepatitis B infections. All independent variables with p-values <0.2 were entered into a multivariate model to adjust for confounding. A p value <0.05 was considered statistically significant. Results A total of 400 participants were recruited. 64.5% were females (n=258) and aged 18–29 years (48.5%, n=193). Overall, 22(5.5%) participants were found to be seropositive for hepatitis B infection. Residing in Kiruhura district (AOR = 11.9, 95% CI: 2.40–59.25, p<0.003) was significantly associated with hepatitis B infection while being female (AOR = 0.3, 95% CI: 0.11–0.88, p<0.018) was protective. Conclusion Prevalence of hepatitis B infection among adult patients attending outpatient clinic at MRRH was 5.5% with male gender and residing in Kiruhura district as factors associated with high prevalence of hepatitis B infection. Ministry of Health should scale up hepatitis B routine testing and treatment at MRRH and its catchment area, with special control programs such as screening, vaccination, and sensitization involving men.
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Affiliation(s)
- Elias Rugaatwa Ndibarema
- Mbarara University of Science and Technology, Mbarara, Uganda,Mother Kevin Postgraduate Medical School / St. Francis Hospital Nsambya, Uganda Martyrs University, Kampala, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda,Correspondence: Elias Rugaatwa Ndibarema, Mother Kevin Postgraduate Medical School / St. Francis Hospital Nsambya, Uganda Martyrs University, Kampala, Uganda, Email
| | - Ronald Olum
- St Francis Hospital Nsambya, Kampala, Uganda
| | - David Ayebare
- Mbarara University of Science and Technology, Mbarara, Uganda
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Bongomin F, Olum R, Kajjimu J, Kanyike AM, Atulinda L, Ninsiima D, Wamala NK, Byakika-Kibwika P. Factors Associated with Medical Students' Career Choices Regarding Internal Medicine in Uganda. Adv Med Educ Pract 2022; 13:1293-1304. [PMID: 36267053 PMCID: PMC9578717 DOI: 10.2147/amep.s381161] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is an unmet need for internal medicine physicians in Uganda owing to the growing burden of diseases. This study aimed at evaluating the factors associated with career choices of undergraduate medical students regarding internal medicine in Uganda. METHODS We conducted a cross-sectional study in the first 3 weeks of October 2021 via WhatsApp messenger. Medical students in the 3rd to 5th year of study who had completed internal medicine clinical rotations and pursuing a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at 7 Ugandan universities (4 public and 3 private) were enrolled. Multivariable logistic regression model was constructed to determine factors associated with a career choice in internal medicine. RESULTS We enrolled 418 participants, median age was 24 (interquartile range (IQR): 23-26) years, 67.7% were male, and 36.1% had a family member or relative who was a doctor. Most of the students (84.0%) were interested in research. The top three most preferred specialties were internal medicine (52.6%), surgery (51.2%), and obstetrics and gynaecology (51.0%). Overall, 186 (44.5%) participants reported plans to pursue a Master of Medicine degree in internal medicine. Interest in research was the only factor independently associated with 2.5-fold higher odds of pursuing a career in internal medicine (adjusted odds ratio: 2.5, 95% CI: 1.4-4.6, p = 0.003). About 73% of the participants strongly agreed that internal medicine requires wide reading. CONCLUSION There is a strong interest to pursue a career in internal medicine among Ugandan medical students. We recommend an increase in training opportunities in Internal Medicine, especially in view of the growing disease burden and increasing population growth.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Kajjimu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Linda Atulinda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daphine Ninsiima
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicholas Kisaakye Wamala
- Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka, Bushenyi, Uganda
| | - Pauline Byakika-Kibwika
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Kibirige D, Olum R, Kyazze AP, Bongomin F, Sanya RE. Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa. Trop Med Int Health 2022; 27:942-960. [PMID: 36121433 DOI: 10.1111/tmi.13819] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. METHODS Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model meta-analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. RESULTS A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8% - 49.2%, I2 =95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3% - 39.9%, I2 =91.6%), premixed insulin 49.4% (95% CI: 24.9% - 73.9%, I2 =90.57%), glibenclamide 55.9% (95% CI: 43.8% - 68.0%, I2 =96.7%), and metformin 47.0% (95% CI: 34.6% - 59.4, I2 =97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9% - 61.1%, I2 =97.43%), for HbA1c 24.6% (95% CI: 3.1% - 46.1%, I2 =91.64), and for lipid profile tests 35.7% (95% CI: 19.4% - 51.9%, I2 =83.77%). The median (IQR) affordability in days' wages was 7 (4.7-7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7-0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin. CONCLUSION The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.
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Affiliation(s)
- Davis Kibirige
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda.,Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda
| | - Andrew Peter Kyazze
- Clinical Research Unit, Tuberculosis and Comorbidities Consortium, Kampala, Uganda
| | - Felix Bongomin
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda.,Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Richard E Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
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Fleischer B, Olum R, Nakwagala FN, Nassozi DR, Pitua I, Paintsil E, Baluku JB, Bongomin F. Higher intensive care unit consultations for COVID-19 patients living with HIV compared to those without HIV coinfection in Uganda. J Med Virol 2022; 94:4294-4300. [PMID: 35620807 PMCID: PMC9348484 DOI: 10.1002/jmv.27887] [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: 08/05/2021] [Revised: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Coronavirus disease-2019 (COVID-19) is the leading cause of death worldwide from a single infectious agent. Whether or not HIV infection affects clinical outcomes in patients with COVID-19 remains inconclusive. This study aimed to compare the clinical outcomes of people living with HIV (PLWH) and non-HIV-infected patients hospitalized during the second wave of the COVID-19 pandemic in Uganda. We retrospectively retrieved data on patients with COVID-19 who were admitted to the Mulago National Referral Hospital in Uganda between April 2021 and mid-July 2021. We performed propensity-score-matching of 1:5 to compare outcomes in COVID-19 patients living with and those without HIV coinfection (controls). We included 31 PLWH and 155 non-HIV controls. The baseline characteristics were similar across groups (all p values > 0.05). PLWH had close to threefold higher odds of having ICU consultation compared to controls (odds ratio [OR]: 2.9, 95% CI: 1.2-6.9, p = 0.015). There was a trend toward having a severe or critical COVID-19 illness among PLWHIH compared to controls (OR: 1.9, 95% CI: 0.8-4.7, p = 0.164). Length of hospitalization was not significantly different between PLWH and non-HIV controls (6 days vs. 7 days, p = 0.184). Seven-day survival was 63% (95% CI: 42%-78%) among PLWH and 72% (95% CI: 61%-82%) among controls while 14-day survival was 50% (95% CI: 28%-69%) among PLWH and 65% (95% CI: 55%-73%) among controls (p = 0.280). There was another trend toward having 1.7-fold higher odds of mortality among PLWH compared to controls (OR: 1.7, 95% CI: 0.8-3.8, p = 0.181). Our data suggest that PLWH may be at an increased risk of severe or critical COVID-19 illness requiring ICU consultation. Further studies with larger sample sizes are recommended.
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Affiliation(s)
- Brian Fleischer
- Department of PediatricsYale School of MedicineNew HavenConnecticutUSA
| | - Ronald Olum
- College of Health SciencesMakerere UniversityKampalaUganda
| | | | | | - Ivaan Pitua
- College of Health SciencesMakerere UniversityKampalaUganda
| | - Elijah Paintsil
- Department of PediatricsYale School of MedicineNew HavenConnecticutUSA
- Department of Pharmacology and Public HealthYale School of MedicineNew HavenConnecticutUSA
| | - Joseph Baruch Baluku
- Kiruddu National Referral HospitalKampalaUganda
- Makerere University Lung InstituteMakerere UniversityKampalaUganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of MedicineGulu UniversityGulu166Uganda
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Acen EL, Kateete DP, Worodria W, Olum R, Joloba ML, Bbuye M, Biraro IA. Evaluation of circulating serum cathelicidin levels as a potential biomarker to discriminate between active and latent tuberculosis in Uganda. PLoS One 2022; 17:e0272788. [PMID: 36018845 PMCID: PMC9416991 DOI: 10.1371/journal.pone.0272788] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/26/2022] [Indexed: 01/08/2023] Open
Abstract
Background
Tuberculosis remains a major public health problem worldwide accounting for 1.4 million deaths annually. LL-37 is an effector molecule involved in immunity with both antimicrobial and immunomodulatory properties. The purpose of this study was to compare LL-37 circulatory levels among participants with active and latent tuberculosis and to determine its ability to discriminate between the two infectious states.
Methods
A cross-sectional study was performed among 56 active tuberculosis patients, 49 latent tuberculosis individuals, and 43 individuals without tuberculosis infection. The enzyme-linked immunosorbent assay was used to assess LL-37 levels. Data analysis was performed using STATA software and Graph pad Prism version 8. Mann-Whitney U test was used for correlation between variables with two categories and the Kruskal-Wallis test for three or more categories.
Results
The study had more female participants than males, with similar median ages across the three groups, 29.5, 25.0, and 23.0 years respectively. Active tuberculosis patients had significantly higher LL-37 levels compared to those with latent tuberculosis and without tuberculosis. The median/interquartile ranges were 318.8 ng/ml (157.9–547.1), 242.2 ng/ml (136.2–579.3), 170.9 ng/ml (129.3–228.3); p = 0.002 respectively. Higher LL-37 was found in the male participant with median/interquartile range, 424.8 ng/ml (226.2–666.8) compared to the females 237.7 ng/ml (129.6–466.6); p = 0.045. LL-37 had better discriminatory potential between active tuberculosis and no tuberculosis (AUC = 0.71, sensitivity 71.4% specificity = 69.8%) than with latent tuberculosis (AUC = 0.55, sensitivity = 71.4%, specificity = 44.9%). There was moderate differentiation between latent tuberculosis and no tuberculosis (AUC = 0.63, sensitivity = 44.9% specificity = 90.7%).
Conclusion
Significantly higher LL-37 levels were observed among active tuberculosis patients than those without tuberculosis infection and were, therefore able to discriminate between active tuberculosis and other tuberculosis infectious states, especially with no tuberculosis. Further assessment of this biomarker as a screening tool to exclude tuberculosis is required.
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Affiliation(s)
- Ester Lilian Acen
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Worodria
- Pulmonary Division, Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences Unit, Makerere University, Kampala, Uganda
| | - Moses L. Joloba
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mudarshiru Bbuye
- Makerere Lung Institute College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Andia Biraro
- Department of Medicine, School of Medicine, College of Health Sciences Unit, Makerere University, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Ssanyu JN, Kiguba R, Olum R, Kiguli J, Kitutu FE. Using community influencer groups to address COVID-19 misinformation and vaccine hesitancy in Uganda: a protocol for a prospective quasi-experimental study. BMJ Open 2022; 12:e057994. [PMID: 36028272 PMCID: PMC9421914 DOI: 10.1136/bmjopen-2021-057994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Coronovirus disease 2019 (COVID-19) misinformation has been reported globally and locally. This has the potential to influence public risk perception and reduce the acceptance of the COVID-19 vaccine. This study aims to determine the prevalence of COVID-19 misinformation and vaccine hesitancy in Buikwe district. The study will also pilot a social mobilisation intervention using community influencers and determine its effect on COVID-19 misinformation and vaccine hesitancy. METHODS AND ANALYSIS The study will be conducted using a quasi-experimental study design, in which two villages will be assigned to the intervention arm and two villages assigned controls. A mixed-methods technique employing both quantitative and qualitative methods will be employed. Data will be collected from healthy men and women aged 18 years and older who reside in the selected villages. The study will be implemented in three phases. First, a baseline study of 12 in-depth interviews with key informants and 6 focus group discussions and a household survey among 632 participants will be done. Second, an intervention employing dialogue-based social mobilisation approach using 10-man community groups per village will be developed and implemented. These will be trained and facilitated to educate and sensitise their communities about COVID-19. Third, an end-line household survey done after 6-months of intervention implementation in the four villages to assess the effect of the intervention on COVID-19 misinformation and vaccine hesitancy. Post-intervention qualitative evaluation will be done after the endline quantitative assessment. Preliminary analysis of the endline quantitative analysis will inform any revisions of the discussion guides. Qualitative data collected will be analysed using thematic content analysis while quantitative data will be analysed using χ2 tests or logistic regression, by intention-to-treat analysis. ETHICS AND DISSEMINATION The study was reviewed for ethics and approved by the Makerere University School of Health Sciences Research Ethics Committee, reference number MakSHSREC-2020-45 and the Uganda National Council of Science and Technology, reference number HS1140ES. Study finding shall be presented to the district and national COVID-19 task force and at scientific gatherings and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER PACTR202102846261362.
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Affiliation(s)
- Jacquellyn Nambi Ssanyu
- Makerere University School of Health Sciences, Sustainable Pharmaceutical Systems (SPS) Unit, Kampala, Uganda
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Ronald Kiguba
- Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Makerere University School of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
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Olum R, Baluku JB. Commentary: Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital. Front Public Health 2022; 10:931309. [PMID: 35865243 PMCID: PMC9294281 DOI: 10.3389/fpubh.2022.931309] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald Olum
- Department of Internal Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- *Correspondence: Ronald Olum
| | - Joseph Baruch Baluku
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
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Mushi MF, Olum R, Bongomin F. Prevalence, Antifungal Susceptibility and Etiology of Vulvovaginal Candidiasis in Sub-Saharan Africa: A Systematic Review with Meta-analysis and Meta-regression. Med Mycol 2022; 60:6628797. [PMID: 35781514 DOI: 10.1093/mmy/myac037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/25/2021] [Revised: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is a commonly occurring form of mucocutaneous candidiasis in women. The aim of this study was to comprehensively investigate the prevalence, antifungal susceptibility, and etiology of VVC in sub-Saharan Africa (SSA). A search of studies was conducted in seven online databases and the reference lists of selected studies. Observational studies published between January 2000, to July 2021, that met the eligibility criteria were included. Meta-analyses with random and fixed-effects model, and subgroup analyses were performed using STATA 16.0. A total of 41 studies including 15 723 participants were included in the meta-analyses. The pooled prevalence of VVC was 33% (95% Confidence Interval (CI): 28 - 38%, I2 = 98%, p < 0.001). Pregnant women had 6% higher odds of having VVC compared to non-pregnant women (Odds Ratio (OR): 1.06, 95% CI: 0.99 - 1.13, p = 0.107). The odds of diagnosing VVC were 40% higher in symptomatic patients than general study population (OR: 1.4, 95% CI: 1.3 - 1.5, p < 0.0001). In 17 studies, a total of 2112 isolates of Candida species were reported: 1514 (71.7%) C. albicans, 510 (24.1%) non-albicans Candida (NAC) species and 88 (4.2%) unidentified Candida spp. Of the NAC species detected, C. glabrata (40.9%, n = 209), C. krusei (21.2%, n = 108) and C. tropicalis (22.7%, n = 116) were the most common. Resistance to fluconazole in C. albicans using disc diffusion methods ranged from 6.8% in Cameroon to 53.7% in Ethiopia. One-third of women in SSA have VVC, mainly caused by C. albicans. Data on the susceptibility of the Candida isolates to commonly used antifungal agents is limited and warrants further research.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. BOX 1464, Mwanza, Tanzania
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Ahmed MA, Hussein AM, Abdullahi AAM, Ahmed AY, Hussain HM, Ali AM, Barre AA, Yusuf FM, Olum R, Sereke SG, Elfadul MA, Colebunders R, Bongomin F. Cardiovascular risk factors and clinical outcomes of patients hospitalized with COVID-19 pneumonia in Somalia. Ther Adv Infect Dis 2022; 9:20499361221095731. [PMID: 35494493 PMCID: PMC9044783 DOI: 10.1177/20499361221095731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Coronavirus disease-2019 (COVID-19) is a potentially life-threatening illness with no established treatment. Cardiovascular risk factors (CRFs) exacerbate COVID-19 morbidity and mortality. Objective: To determine the prevalence of CRF and clinical outcomes of patients hospitalized with COVID-19 in a tertiary hospital in Somalia. Methods: We reviewed the medical records of patients aged 18 years or older with a real-time polymerase chain reaction (RT-PCR)–confirmed COVID-19 hospitalized at the De Martino Hospital in Mogadishu, Somalia, between March and July 2020. Results: We enrolled 230 participants; 159 (69.1%) males, median age was 56 (41–66) years. In-hospital mortality was 19.6% ( n = 45); 77.8% in the intensive care unit (ICU) compared with 22.2%, in the general wards ( p < 0.001). Age ⩾ 40 years [odds ratio (OR): 3.6, 95% confidence interval (CI): 1.2–10.6, p = 0.020], chronic heart disease (OR: 9.3, 95% CI: 2.2–38.9, p = 0.002), and diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.2, p < 0.001) were associated with increased odds of mortality. Forty-three (18.7%) participants required ICU admission. Age ⩾ 40 years (OR: 7.5, 95% CI: 1.7–32.1, p = 0.007), diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.3, p < 0.001), and hypertension (OR: 2.5, 95% CI: 1.2–5.2, p = 0.014) were associated with ICU admission. For every additional CRF, the odds of admission into the ICU increased threefold (OR: 2.7, 95% CI: 1.2–5.2, p < 0.001), while the odds of dying increased twofold (OR: 2.1, 95% CI: 1.3–3.2, p < 0.001). Conclusions: We report a very high prevalence of CRF among patients hospitalized with COVID-19 in Somalia. Mortality rates were unacceptably high, particularly among those with advanced age, underlying chronic heart disease, and diabetes.
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Affiliation(s)
- Mohammed A.M. Ahmed
- Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, P.O. Box 004 KM4, Mogadishu, Somalia
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | | | | | - Hamdi M.A. Hussain
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Abdiaziz Mohamed Ali
- Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
- De Martino Hospital, Mogadishu, Somalia
| | | | | | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maisa Ahmed Elfadul
- Public and Tropical Health Programs, University of Medical Sciences and Technology, Khartoum, Sudan
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Bongomin F, Kibone W, Okot J, Nsenga L, Olum R, Baluku JB. Fungal diseases in Africa: epidemiologic, diagnostic and therapeutic advances. Ther Adv Infect Dis 2022; 9:20499361221081441. [PMID: 35281765 PMCID: PMC8905202 DOI: 10.1177/20499361221081441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda
| | - Winnie Kibone
- School of Medicine, Makerere University, Kampala, Uganda
| | - Jerom Okot
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Lauryn Nsenga
- School of Medicine, Kabale University, Kabale, Uganda
| | - Ronald Olum
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, UgandaSchool of Medicine, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda; Makerere University Lung Institute, Kampala, Uganda
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Ssewante N, Wekha G, Namusoke M, Sanyu B, Nkwanga A, Nalunkuma R, Olum R, Ssentongo LK, Ahabwe R, Kalembe SE, Nantagya VN, Kalanzi J. Assessment of knowledge, attitude and practice of first aid among taxi operators in a Kampala City Taxi Park, Uganda: A cross-sectional study. Afr J Emerg Med 2022; 12:61-66. [PMID: 35070656 PMCID: PMC8761610 DOI: 10.1016/j.afjem.2021.10.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/15/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Road traffic accidents are among the leading causes of death in Uganda. Taxi operators are at a high risk of RTA and can potentially be first responders. This study, aimed to assess knowledge, attitude, and practice of first aid among taxi operators in the new taxi park, Kampala Uganda. METHODS A descriptive cross-sectional study was conducted in 2021 among taxi drivers and conductors in the New Taxi Park, Kampala City, Uganda. A semi-structured questionnaire was used to collect quantitative data from taxi operators after informed consent. Chi-square or Fisher's exact test and logistic regression were performed in STATA 16 to assess the association between first aid knowledge and demographics. P < 0.05 was statistically significant. RESULTS A total of 345 participants, majority males (n = 338, 98%) aged between 18 and 45 years (76.5%), were recruited. Although 97.7% (n = 337) had heard about first aid, only 19.4% (n = 67) had prior first aid training. Overall mean knowledge score was 40.1% (SD = 14.5%), with 29.9% (n = 103) having good knowledge (≥50%). Participants who had witnessed more than five accidents (aOR = 2.9, 95% CI = 1.7-4.8, p < 0.001), those with first aid kits (aOR = 1.7, 95% CI = 1.0-3.0, p = 0.38) were more likely to have good knowledge while those below post-secondary education level i.e., Primary (AOR = 0.2, 95% CI = 0.1-0.5, p ≤0.001) and secondary (aOR = 0.2, 95% CI = 0.1-0.6, p = 0.001), were less likely to have good knowledge. About 97% and 93% perceived first aid as important and were willing to undergo training, respectively; however, only 69% were willing to give first aid. Only 181(52.5%) had ever attended to accident victims. CONCLUSION Majority of taxi operators had poor first aid knowledge. Factors associated with good knowledge included level of education, number of accidents witnessed, having first aid kits. Although their attitudes were favorable, practice was poor. Comprehensive training and refresher courses can help increase first aid knowledge, and improving practice.
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Affiliation(s)
- Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Corresponding author.
| | - Godfrey Wekha
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moureen Namusoke
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bereta Sanyu
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ayub Nkwanga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Racheal Nalunkuma
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Rachel Ahabwe
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Esther Kalembe
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Joseph Kalanzi
- Department of Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Maria Najjuka S, Checkwech G, Olum R, Ashaba S, Mohan Kaggwa M. Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey. Afr Health Sci 2021; 21:1533-1543. [PMID: 35283951 PMCID: PMC8889827 DOI: 10.4314/ahs.v21i4.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background COVID19 pandemic forced most countries to lockdown, leading to the prolonged closure of many learning institutions. This dramatic shift led to increase of mental illness symptoms among university students. Objective To determine the prevalence and factors associated with symptoms of depression, anxiety, and stress among Uganda's university students during the COVID-19 lockdown. Methods We conducted a one-month online survey using the Depression Anxiety and Stress Scale (DASS-21). Results Participants n=321 were enrolled with mean age, 24.8(SD=5.1) years and 198(61.7%) were males. The prevalence of mental health symptoms among participants was 80.7%, 98.4%, and 77.9% for depression, high levels of anxiety, and stress, respectively. Statistically significant association between mental health symptoms on multi-logistic regression was found with Males (depression=2.97[1.61–5.48] and stress=1.90[1.07–3.35]), engagement in leisure activity (depression= 1.87[1.01–3.49] and stress=1.98[1.10–3.56]), and being finalist (stress=0.55[0.31- 0.97]). Use of addictive substances seem to potentially alleviate symptoms of depression, anxiety and stress in the short term. Conclusions The findings of this study suggest a high prevalence of symptoms of depression, anxiety and stress among university students during the COVID-19 lockdown. Students' mental health should be monitored by all stakeholders, especially as the pandemic progresses.
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Bongomin F, Fleischer B, Olum R, Natukunda B, Kiguli S, Byakika-Kibwika P, Baluku JB, Nakwagala FN. High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit. Open Forum Infect Dis 2021; 8:ofab530. [PMID: 34805440 PMCID: PMC8601041 DOI: 10.1093/ofid/ofab530] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n=91) or critical (66%, n=315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P=.011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91–0.95; P<.001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00–1.02; P=.042). The risk of death was 1.4-fold higher in female participants compared with their male counterparts (hazards ratio, 1.4; 95% CI, 1.0–2.0; P=.025). Conclusions In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.,Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Brian Fleischer
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ronald Olum
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbra Natukunda
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.,Directorate of Programs, Mildmay Uganda, Wakiso, Uganda
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Wekha G, Ssewante N, Iradukunda A, Jurua M, Nalwoga S, Lanyero S, Olum R, Bongomin F. Colorectal Cancer in Uganda: A 10-Year, Facility-Based, Retrospective Study. Cancer Manag Res 2021; 13:7697-7707. [PMID: 34675666 PMCID: PMC8504868 DOI: 10.2147/cmar.s334226] [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: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Colorectal cancer (CRC) is the most common type of gastrointestinal malignancies and the third leading cause of cancer-related deaths for both sexes worldwide. Although the burden of CRC is highest in developed countries, reports are indicating a rise in the incidence of early-onset CRC in developing countries. In this study, we aimed to determine the prevalence of CRC among patients hospitalized with lower gastrointestinal complaints at a tertiary health facility in Uganda. Methods We conducted a 10-year retrospective chart review of patients admitted to Mulago National Referral Hospital in Kampala, Uganda, between 1st January 2010 and 31st December 2020. We reviewed all charts of patients admitted to the lower gastrointestinal tract (GIT) ward. Charts with grossly missing data, pediatric patients, and those from other non-lower GIT specialties were excluded. Results Data of 1476 unique eligible patients were analyzed. Of these,138 had a diagnosis of CRC (prevalence: 9.3%, 95% confidence interval (95% CI): 6.5-11.7%). Among patients with CRC, the female:male ratio was 1:1. The most common site for CRC was the rectum (59.8%, n= 79). For the 138 participants with CRC, 44 had staging data with 72.8% (n=32) having advanced disease, that is, stage 3 or 4. Factors independently associated with CRC were age ≥50 years (adjusted odds ratio (aOR): 4.3, 95% CI: 2.6-7.1, p < 0.001), female sex (aOR: 1.8, 95% CI: 1.2 -2.8, p = 0.005), being widowed (aOR: 2.5, 95% CI: 1.3-5.0, p = 0.006), and presence of any risk factor for CRC (aOR: 5.3, 95% CI: 2.9-9.9, p < 0.001). Conclusion CRC is relatively common among patients hospitalized with lower GIT complaints, particularly among women and those with known risk factors for CRC. Awareness creation and screening programs should be instituted to allow early diagnosis of CRC in our setting.
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Affiliation(s)
- Godfrey Wekha
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angelique Iradukunda
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Micheal Jurua
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shadia Nalwoga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Lanyero
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Bongomin F, Sereke SG, Okot J, Katsigazi R, Kandole TK, Oriekot A, Olum R, Atukunda A, Baluku JB, Nakwagala F. COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome. Infect Drug Resist 2021; 14:4167-4171. [PMID: 34675561 PMCID: PMC8517634 DOI: 10.2147/idr.s335711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
Background Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke. Case Presentation A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were worsening cough, difficulty in breathing, fever and altered mental status for 3 days with a background of a 1-month history of coughing with associated drenching night sweats and weight loss. The reverse transcriptase-polymerase chain reaction for SARS-CoV-2 of her nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were positive. Urine lipoarabinomannan and sputum GeneXpert were positive for Mycobacterium tuberculosis. Computed tomography of the brain showed a large acute ischemic infarct in the territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is, fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and oxygen therapy, the patient passed on within 36 hours of admission. Conclusion Co-infections worsen COVID-19 outcomes.
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Affiliation(s)
- Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jerom Okot
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Katsigazi
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tadeo Kiiza Kandole
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anthony Oriekot
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Angella Atukunda
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda
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Kiyimba B, Onyait T, Kamoga L, Atuhaire A, Ssekatono P, Mujawamariya L, Olum R, Bongomin F, Kiguli S. Knowledge and preparedness for home-based, family-centered management of COVID-19 patients and dead bodies among residents in a COVID-19 high-risk setting. Res Sq 2021:rs.3.rs-942168. [PMID: 34611659 PMCID: PMC8491852 DOI: 10.21203/rs.3.rs-942168/v1] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The overwhelming coronavirus disease- 2019 (COVID-19) cases have called for inevitable home-based care for some cases and direct involvement in COVID-19 dead body burials by many families worldwide. However, data on the knowledge and readiness by families for these practices is still scarce, hence this study among residents of Wakiso district, Uganda. Methods We conducted a cross-sectional study between 6th March and 4th April 2021. Household heads aged 15years and above in 5 sub counties of Wakiso district were interviewed using a pre-tested questionnaire. Multivariable logistic regression analysis was used to assess the association between COVID-19 related knowledge on home-based care and burials with demographics characteristics. Results We enrolled 205 participants, with a median age of 28 (range: 25-35) years. Majority (n = 157, 76.6%) were female and had achieved at least secondary level of education (n = 117, 57.1%). The mean knowledge score on home-based care for COVID-19 patient was 49.5 %, while that on COVID-19 dead body management was 36.5%. Seven (3.4%) respondents were ready to undertake home-based care and dead body management. For the remainder 198 (96.6%) unready respondents reported inadequate knowledge (n = 166, 84%) and lack of personal protective equipment (PPE) (n = 17, 8.6%) as major barriers for their readiness. There was no statistically significant difference in both the knowledge on home-based COVID-19 patient care and dead body management stratified by demographics characteristics. Conclusion The knowledge and preparedness for home-based Covid-19 patient care and dead body management are suboptimal among Wakiso district residents. More public education programmes and PPE provision are recommended.
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Affiliation(s)
- Blaise Kiyimba
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
| | - Teddy Onyait
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
| | | | - Arnold Atuhaire
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
| | - Patrick Ssekatono
- Makerere University CHS: Makerere University College of Health Sciences
| | - Lucy Mujawamariya
- Makerere University CHS: Makerere University College of Health Sciences
| | - Ronald Olum
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
| | | | - Sarah Kiguli
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
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Olum R, Osaigbovo II, Baluku JB, Stemler J, Kwizera R, Bongomin F. Mapping of Chronic Pulmonary Aspergillosis in Africa. J Fungi (Basel) 2021; 7:jof7100790. [PMID: 34682212 PMCID: PMC8541146 DOI: 10.3390/jof7100790] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023] Open
Abstract
Africa has a high burden of tuberculosis, which is the most important risk factor for chronic pulmonary aspergillosis (CPA). Our goal was to systematically evaluate the burden of CPA in Africa and map it by country. We conducted an extensive literature search for publications on CPA in Africa using the online databases. We reviewed a total of 41 studies published between 1976 and 2021, including a total of 1247 CPA cases from 14 African countries. Most of the cases came from Morocco (n = 764, 62.3%), followed by South Africa (n = 122, 9.9%) and Senegal (n = 99, 8.1%). Seventeen (41.5%) studies were retrospective, 12 (29.3%) were case reports, 5 case series (12.2%), 5 prospective cohorts, and 2 cross-sectional studies. The majority of the cases (67.1%, n = 645) were diagnosed in men, with a median age of 41 years (interquartile range: 36–45). Active/previously treated pulmonary tuberculosis (n = 764, 61.3%), human immunodeficiency virus infection (n = 29, 2.3%), diabetes mellitus (n = 19, 1.5%), and chronic obstructive pulmonary disease (n = 10, 0.8%) were the common co-morbidities. Haemoptysis was the most frequent presenting symptom, reported in up to 717 (57%) cases. Smoking (n = 69, 5.5%), recurrent lung infections (n = 41, 3%) and bronchorrhea (n = 33, 3%) were noted. This study confirms that CPA is common in Africa, with pulmonary tuberculosis being the most important risk factor.
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Affiliation(s)
- Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City PMB 1154, Nigeria;
| | - Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala P.O Box 7272, Uganda;
- Makerere University Lung Institute, Kampala P.O. Box 7749, Uganda
| | - Jannik Stemler
- Excellence Center for Medical Mycology (ECMM), Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50973 Cologne, Germany;
- Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstr. 52, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Herderstr. 52, 50931 Cologne, Germany
| | - Richard Kwizera
- Translational Research Laboratory, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda;
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
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Musoke P, Nantaayi B, Kato Ndawula R, Wannyana B, Ssewante N, Wekha G, Olum R, Nakyagaba L, Rhoda Nassozi D, Nabukeera G, Marvin Kanyike A, Ojilong D, Madut Akech G, Kajjimu J, Kiwumulo J, Agira D, Okot J, Bongomin F. Fear of COVID-19 and the Media Influence on Herbal Medication Use in Uganda: A Cross-Sectional Study. Risk Manag Healthc Policy 2021; 14:3965-3975. [PMID: 34584474 PMCID: PMC8464377 DOI: 10.2147/rmhp.s332325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/02/2021] [Accepted: 09/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has created fear in people around the world. This has led to the widespread use of various herbal remedies in its prevention and treatment regardless of the paucity of scientific evidence about their safety and efficacy. This study assessed the fear of COVID-19 and the influence of media on the use of herbal medicine to prevent or treat COVID-19 in Uganda. METHODS In the first 2 weeks of July 2021, a descriptive online cross-sectional study was carried out anonymously in the general population in Uganda. A validated questionnaire was used to collect data on herbal medicine use and the influence of media. Fear of COVID-19 was rated using the Fear of COVID-19 Scale (FCV-19S). RESULTS We recruited 488 participants, 273 (55.9%) were female, with a median age of 25 (range: 18-73) years. Sixty-seven (57.8%) participants had a confirmed COVID-19 diagnosis. The mean FCV-19S score was 21.7 SD 5.9 with 53.3% reporting high levels of COVID-19 fear. About 57.4% of participants reported using herbal remedies either to prevent or treat COVID-19-like symptoms. Media was the main source of information, with more than 80% of the participants reporting seeing or accessing information about herbal medication use. Women (adjusted odds ratio (aOR): 1.74, 95% CI: 1.2-2.5, p=0.003) and people with a previously confirmed COVID-19 diagnosis (aOR: 3.1, 95% CI: 1.35-7.14, p=0.008) had a statistically significantly higher FCV-19S score. Being unemployed (aOR: 1.0, 95% CI: 1.1-2.3, p=0.008) and a female (aOR: 1.0, 95% CI: 1.1-2.3, p=0.012) were statistically significantly associated with herbal medicine use. Participants who used herbal remedies had a higher median FCV-19S score compared to non-users (23 versus 21, p<0.001). CONCLUSION The use of herbal medicines to treat or prevent COVID-19 is a widespread practice among the general population in Uganda amidst the high levels of fear of COVID-19.
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Affiliation(s)
- Phillip Musoke
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Brandy Nantaayi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rodney Kato Ndawula
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Babrah Wannyana
- School of Clinical Medicine and Dentistry, Kampala International University Western Campus, Bushenyi, Uganda
| | - Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Godfrey Wekha
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lourita Nakyagaba
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dianah Rhoda Nassozi
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Daniel Ojilong
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | - Jonathan Kajjimu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Drake Agira
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Felix Bongomin
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Ocwia J, Olum R, Atim P, Laker F, Okot J, Sereke SG, Baluku JB, Kiguli S, Bongomin F. Oral health seeking behaviors of adults in Nebbi District, Uganda: a community-based survey. BMC Oral Health 2021; 21:453. [PMID: 34535092 PMCID: PMC8447567 DOI: 10.1186/s12903-021-01824-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dental health is often neglected by the majority of the population and has contributed to the global burden of oral diseases. We assessed awareness, utilization and barriers to seeking oral health care among adults in Nebbi District, Uganda. Methods A community-based, cross sectional study was conducted in the central division, Nebbi District in Uganda among adults between the age of 18 years or older. An interviewer-administered, semi-structured questionnaire was used for data collection on socio-demographic characteristics, oral health awareness, oral health utilization, associated factors and barriers. Results A total of 400 adults with a median age of 32 years (interquartile range 24–43) years were enrolled. More than half (57.5%, n = 230) of the participants were female. Participants identified smoking (42.8%, n = 171) and consumption of sugary foodstuffs (29.0%, n = 116) as risk factors for oral disease. Not brushing was also identified by 260 participants (65.0%) as the cause of tooth decay and 95.8% (n = 383) believed brushing one’s teeth could prevent tooth decay. Of the 51.5% (n = 206) who had experienced a toothache or discomfort 12 months prior to the study but only about half (52%, n = 106) had sought healthcare from a dental clinic or facility. About 89.5% (n = 94) of the participants were able to see a dentist during their last visits. Dental carries (76.6%, n = 70) and gum bleeding (14.9%, n = 14) were the most frequent reasons for visiting a dental clinic, and 73.7% (n = 70) had their tooth extracted. Barriers to seeking oral healthcare were cost of treatment (47.5%, n = 190), and long waiting time (18.5%, n = 74). The odds of seeking oral healthcare was 2.8-fold higher in participants who were being married (Odds ratio (OR): 2.8, 95% CI 1.3–6.3, p = 0.011) and 3.5-fold higher among housewives (COR: 3.5, 95% CI 1.1–11.4, p = 0.040). Conclusion About half of the participants had sought healthcare following a dental condition. Cost of treatment seems to be an important factor affecting utilization of oral health services. Optimization of costs, and creating awareness regarding benefits of utilizing preventive dental services are recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01824-5.
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Affiliation(s)
- Juliet Ocwia
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Pamela Atim
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Senai Goitom Sereke
- School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | | | - Sarah Kiguli
- School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Faculty of Medicine, Gulu University, Gulu, Uganda. .,School of Medicine, College of Health Science, Makerere University, Kampala, Uganda.
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Olum R, Nabaggala C, Mwebe VK, Namazzi R, Munube D, Kitaka SB. Orbital compression syndrome in a Ugandan child with sickle cell disease: A case report. Clin Case Rep 2021; 9:e04766. [PMID: 34532046 PMCID: PMC8435225 DOI: 10.1002/ccr3.4766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 08/08/2021] [Indexed: 11/21/2022] Open
Abstract
Orbital compression syndrome is a rare acute complication of sickle cell disease that may impair vision. Assessment by a multidisciplinary team incorporates detailed history and physical examination, fundoscopy, and appropriate imaging to exclude infections or neoplasms. Supportive treatment is adequate unless there is evidence of life-threatening space-occupying lesion warranting surgery.
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Affiliation(s)
- Ronald Olum
- School of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Catherine Nabaggala
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | | | - Ruth Namazzi
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | - Deogratias Munube
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
- Directorate of PaediatricsMulago National Referral HospitalKampalaUganda
| | - Sabrina Bakeera Kitaka
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
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Olum R, Bongomin F, Kaggwa MM, Andia-Biraro I, Baluku JB. Anemia in diabetes mellitus in Africa: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102260. [PMID: 34479102 DOI: 10.1016/j.dsx.2021.102260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
AIMS Anemia accelerates chronic complications of diabetes mellitus (DM). We aimed to conduct a systematic review and meta-analysis to estimate the prevalence of anemia among people with DM in Africa. METHODS A search of studies was conducted in the main databases (Medline, EMBASE, Scopus, CINAHL, AJOL and Google Scholar) and the reference lists of selected studies. Observational studies that met the eligibility criteria were included in this meta-analysis. There was no limitation in terms of language. RESULTS We obtained data from 27 eligible studies, including 5913 patients. The pooled prevalence of anemia was 35% (95% CI: 28%-42%, I2 = 97.7%, p < 0.01). In sub-group analysis, the pooled prevalence was higher in people with diabetic foot lesions (56%, 95% CI: 49%-63%, I2 = 51.04%, p = 0.100) than in the general population of people with diabetes (30%, 95% CI: 23%-37%, I2 = 97.6%, p < 0.01). Pooled prevalence rates were also higher in; males than females (34% vs 31%), type II DM than type I DM (35% vs 26%), and in patients with poor glycemic control compared to those with good glycemic control (33% vs. 22%). CONCLUSIONS The prevalence of anemia in DM was high warranting enhanced clinical and public health interventions.
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Affiliation(s)
- Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Kaggwa MM, Kajjimu J, Sserunkuma J, Najjuka SM, Atim LM, Olum R, Tagg A, Bongomin F. Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2021; 16:e0256402. [PMID: 34460837 PMCID: PMC8405021 DOI: 10.1371/journal.pone.0256402] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs). OBJECTIVES This study aimed to systematically estimate the prevalence of burnout among university students in LMICs. METHODS We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively. RESULTS Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively. CONCLUSION Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Kajjimu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Sserunkuma
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Letizia Maria Atim
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Olum
- College of Health Science, Makerere University, Kampala, Uganda
| | - Andrew Tagg
- Emergency Department, Western Hospital-Footscray, Footscray, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Kwizera R, Bongomin F, Olum R, Worodria W, Bwanga F, Meya DB, Kirenga BJ, Gore R, Fowler SJ, Denning DW. Prevalence of Aspergillus fumigatus skin positivity in adults without an apparent/known atopic disease in Uganda. Ther Adv Infect Dis 2021; 8:20499361211039040. [PMID: 34422267 PMCID: PMC8371732 DOI: 10.1177/20499361211039040] [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: 04/30/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Skin prick testing (SPT) is an important investigation in the evaluation of
allergy to fungal pathogens. However, the background sensitivity to fungal
allergens among healthy people in Uganda is unknown. Our aim was to assess
the background prevalence of Aspergillus fumigatus SPT
positivity in apparently healthy adults without known atopic disease in
Uganda. Methods: For this pilot study, we recruited 50 healthy volunteers using convenience
sampling, 56% of whom were health workers. We performed the SPT for
A. fumigatus according to manufacturer’s instructions.
A wheal diameter of ⩾3 mm was considered positive. Results: The prevalence of A. fumigatus skin positivity was 60%
(30/50). Participants with a positive A. fumigatus SPT were
significantly younger than those with a negative result [median age (years):
28 versus 35; p = 0.005]. Conclusion: There is a high skin positivity against A. fumigatus among
non-atopic healthy Ugandan adults. There is an urgent need to establish a
normal wheal cut-off value for this population. SPT alone may be an
unreliable test for the diagnosis of A. fumigatus
associated allergic syndromes. More studies are needed to define the
prevalence of A. fumigatus skin positivity among non-atopic
healthy population in Africa.
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Affiliation(s)
- Richard Kwizera
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. BOX 22418, Kampala, Central, Uganda,Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Worodria
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda, Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University Kampala, Uganda
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bruce J Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda, Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, UK
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, UK
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Bongomin F, Olum R, Kwizera R, Baluku JB. Surgical management of chronic pulmonary aspergillosis in Africa: A systematic review of 891 cases. Mycoses 2021; 64:1151-1158. [PMID: 34363630 DOI: 10.1111/myc.13359] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/29/2022]
Abstract
Chronic pulmonary aspergillosis (CPA) is an emerging fungal infectious disease of public health importance. We conducted a systematic review of studies reporting the outcomes of patients with CPA managed surgically in Africa. A search of Medline, Embase, Web of Science, Google Scholar and African Journals Online was conducted to identify studies indexed from inception to June 2021 that examined surgical management of CPA in Africa. All articles that presented primary data, including case reports and case series, were included. We excluded review articles. A total of 891 cases (557 males (62.5%), mean age 39.3 years) extracted from 27 eligible studies published between 1976 and 2020 from 11 African countries were included. Morocco (524, 59%) and Senegal (99, 11%) contributed the majority of cases. Active or previous pulmonary tuberculosis was reported in 677 (76.0%) cases. Haemoptysis was reported in 682 (76.5%) cases. Lobectomy (either unilateral or bilateral, n = 493, 55.3%), pneumonectomy (n = 154, 17.3%) and segmentectomy (n = 117, 13.1%) were the most frequently performed surgical procedures. Thirty (4.9%) cases from South Africa received bronchial artery embolisation. Empyema (n = 59, 27.4%), significant haemorrhage (n = 38, 173.7%), incomplete lung expansion (n = 26, 12.1%) and prolonged air leak (n = 24, 11.2%) were the most frequent complications. Overall, 45 (5.1%) patients died. The causes of death included respiratory failure (n = 14), bacterial superinfection/sepsis (n = 10), severe haemorrhage (n = 5), cardiopulmonary arrest (n = 3) and complications of chronic obstructive pulmonary disease (n = 3). The cause of death was either unknown or unspecified in 9 cases. We conclude that surgical treatment had very low mortality rates and maybe considered as first-line management option in centres with experience and expertise in Africa.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.,Makerere Lung Institute, Kampala, Uganda
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