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Guma S, Namisango E, Ddungu H. Advance Care Planning and palliative care for patients with advanced cancer in Uganda. Z Evid Fortbild Qual Gesundhwes 2023; 180:29-35. [PMID: 37550121 DOI: 10.1016/j.zefq.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
The study sought to identify the extent to which Advance Care Planning (ACP) is practised by palliative care health professionals providing care to patients with advanced cancer and their families in Uganda. A mixed methods study design using qualitative and quantitative methods was used for the assessment. In-depth interviews with a group of nine highly experienced health professionals were conducted using a semi-structured interview guide. Quantitative data were retrieved and analysed from a survey administered to 124 health professionals of whom only 57 (45.9%) responded. The qualitative data were analysed using inductive thematic analysis and descriptive analysis was used for the quantitative data. Of the 57 health professionals who participated in the survey, 87% were aware of ACP and 55% reported regular practice. Fifty-five (55%) percent reported regular provision of ACP for their patients and 46% reported engaging in informal ACP practices. However, 58.5% resp. 37.5% reported that they routinely provide ACP to more than 50% resp. 75% of their patients. A group of nine highly experienced palliative care professionals had a pooled ACP prevalence of only 1.2%. There was a generally good attitude towards ACP with 98.2% acknowledging that patients should be able to determine their future care. However, 32% reported being uncomfortable withholding or withdrawing life sustaining treatment. There are a number of socio-cultural beliefs and barriers, for instance that discussing death and dying is a "taboo", as well as witchcraft, family influence in decision-making, religious beliefs that do not agree with palliative care practices and a preference to use aggressive treatment like chemotherapy for terminally ill, etc. Institutional barriers like lack of a legal framework for ACP, limited time for health professionals to engage in ACP and other patient factors such as denial of diagnosis and collusion to withhold information from patients were reported by 78.2% resp. 84% of the respondents. Despite the good awareness and attitude to ACP, there is a range of barriers that are affecting the implementation of ACP in Uganda. There is need for development of a legal framework for ACP, more research to understand the contextual barriers and develop appropriate education and public sensitisation programs.
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Affiliation(s)
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
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Natukunda B, Omoding A, Bongomin F, Mubiru KR, Ddungu H, Sekaggya-Wiltshire C, Mayanja-Kizza H. One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute. JCO Glob Oncol 2023; 9:e2200244. [PMID: 37499182 PMCID: PMC10581653 DOI: 10.1200/go.22.00244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/01/2023] [Accepted: 05/26/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Acute leukemias are associated with substantial morbidity and mortality, particularly in the adult population. Despite an increasing burden of acute leukemia in developing countries, there are limited data on clinical outcomes and prognostic factors in this setting. In this study, we aimed to describe the clinical characteristics, survival, and prognostic factors of adults with acute leukemia at the Uganda Cancer Institute (UCI). METHODS A retrospective cohort study was conducted between January 2009 and December 2018, reviewing data of patients 18 years or older with a cytopathologic diagnosis of acute leukemia at UCI. Data were extracted on clinical and laboratory characteristics, response to treatment, and survival. Cox-proportional hazards regression and survival analysis were performed to determine survival rates and associated factors. P < .05 was considered statistically significant. RESULTS In total, 233 participants were enrolled. Most (59.2%. n = 138) participants were male, with a median age of 32 years (IQR, 23-48 years), and 136 (58.4%) had AML. Overall, the 1-year survival was 16.5%, with a median survival time of 47 (IQR, 21-219) days. Predictors of mortality were being a female (adjusted hazard ratio [aHR], 2.8; 95% CI, 1.2 to 6.7; P = .022) and overweight (aHR, 4.2; 95% CI, 1.3 to 13.4; P = .015). Among the patients who had AML, the predictors were poor Eastern Cooperative Oncology Group (ECOG; aHR, 3.1; 95% CI, 1.6 to 6.2; P = .001) and HIV (aHR, 6.0; 95% CI, 1.7 to 20.5; P = .004). Among the patients who had ALL, the predictors were poor ECOG (aHR, 2.3; 95% CI, 1.3 to 4.1; P = .006). CONCLUSION Patients with acute leukemia in Uganda have poor overall survival. Prospective studies are recommended to better understand causes of early mortality.
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Affiliation(s)
- Barbra Natukunda
- Uganda Cancer Institute, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | | | - Harriet Mayanja-Kizza
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Bloch EM, Kyeyune D, White JL, Ddungu H, Ashokkumar S, Habtehyimer F, Baker O, Kasirye R, Patel EU, Grabowski MK, Musisi E, Moses K, Hume HA, Lubega I, Shrestha R, Motevalli M, Fernandez RE, Reynolds SJ, Redd AD, Wambongo Musana H, Dhabangi A, Ouma J, Eroju P, de Lange T, Fowler MG, Musoke P, Stramer SL, Whitby D, Zimmerman PA, McCullough J, Sachithanandham J, Pekosz A, Goodrich R, Quinn TC, Ness PM, Laeyendecker O, Tobian AAR. SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019-2022. Transfusion 2023; 63:1354-1365. [PMID: 37255467 PMCID: PMC10525030 DOI: 10.1111/trf.17449] [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: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The true burden of COVID-19 in low- and middle-income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS-CoV-2 vaccines, countries in Africa had lower numbers of reported COVID-19 related hospitalizations and deaths than other regions globally. METHODS Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS-CoV-2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer-provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November-December 2021 were assessed by chi-square tests. RESULTS A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January-April 2022. Among seropositive individuals, N and S antibody levels increased ≥9-fold over the study period. In November-December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions (p = .007). Seropositivity to S antibody was significantly lower among HIV-seropositive individuals (58.8% vs. 84.9%; p = .009). CONCLUSIONS Despite previously reported low numbers of COVID-19 cases and related deaths in Uganda, high SARS-CoV-2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jodie L White
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Swetha Ashokkumar
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Feben Habtehyimer
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Owen Baker
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Eshan U Patel
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ezra Musisi
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Khan Moses
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Heather A Hume
- Department of Pediatrics, University of Montreal, Montréal, Quebec, Canada
| | | | - Ruchee Shrestha
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mahnaz Motevalli
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Aggrey Dhabangi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Peter A Zimmerman
- The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeffrey McCullough
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jaiprasath Sachithanandham
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Raymond Goodrich
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul M Ness
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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4
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Kauma G, Ddungu H, Ssewanyana I, Nyesiga S, Bogere N, Namulema-Diiro T, Byakika-Kibwika P, Namukwaya E, Kizza HM. Virologic Nonsuppression Among Patients With HIV Newly Diagnosed With Cancer at Uganda Cancer Institute: A Cross-Sectional Study. JCO Glob Oncol 2023; 9:e2200262. [PMID: 37043709 DOI: 10.1200/go.22.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
PURPOSE AIDS-related mortality declined markedly since the introduction of antiretroviral therapy (ART); however, cancer mortality in Africa was higher than its incidence in 2020. People living with HIV (PLWHIV) are at an increased risk of malignancy and death from malignancy compared with the general population. In Uganda, AIDS-defining malignancies (ADMs), including cervical cancer, Kaposi sarcoma, and non-Hodgkin lymphoma, are among the commonest malignancies. Virologic nonsuppression has been identified as an important predictor of mortality among PLWHIV diagnosed with cancer. This study aimed to determine the prevalence and to identify factors associated with virologic nonsuppression among PLWHIV newly diagnosed with cancer. METHODS This was a cross-sectional study that was carried out between December 2018 and April 2019 at the Uganda Cancer Institute. PLWHIV who had been on ART for at least 6 months and were newly diagnosed with cancer were enrolled. RESULTS A total of 167 participants were enrolled. Cervical cancer was the commonest ADM (n = 45; 50.6%) of all ADMs, while esophageal and breast cancers were the commonest non-ADMs, accounting for 17.5% (n = 14) each of all non-ADMs. The prevalence of virologic nonsuppression was 15%. Having Kaposi sarcoma (odds ratio [OR], 8.15; P = .003), being poorly adherent to ART (OR, 4.1; P = .045), and being on second-line ART (OR, 5.68; P = .011) were associated with virologic nonsuppression. CONCLUSION The prevalence of virologic nonsuppression is high among patients with HIV newly diagnosed with cancer. These findings emphasize the need for strengthening of adherence strategies, optimizing ART regimens, and prioritization of viral load testing among PLWHIV with newly diagnosed malignancy.
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Affiliation(s)
| | | | | | | | | | | | - Pauline Byakika-Kibwika
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Namukwaya
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harriet Mayanja Kizza
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Okello M, Nuwagaba J, Ddungu H, Okuku FM. Cytoreductive surgery for giant locally advanced intra-abdominal tumors in Uganda. J Surg Case Rep 2022; 2022:rjac178. [PMID: 35620232 PMCID: PMC9129259 DOI: 10.1093/jscr/rjac178] [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: 01/24/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022] Open
Abstract
Cytoreductive surgery is removal of tumor as much as possible when complete resection is impossible because of advanced disease. It is a management option for giant intra-abdominal tumors with pressure symptoms. We present three patients who underwent cytoreductive surgery for giant intra-abdominal tumors between May 2019 and November 2021. Patient 1 had a gastrointestinal stromal tumor (GIST) involving stomach, spleen and transverse colon. En bloc resection of the GIST with the involved viscera was done. Patient 2 had a liposarcoma measuring 25.8 × 19.6 × 15.3 cm infiltrating the stomach, spleen and the left hemidiaphragm. Involved viscera and liposarcoma were resected en bloc. Patient 3 had a liposarcoma measuring 40 × 35 × 12 cm and encasing the left ureter. Mass was excised together with part of the left ureter and left ureter reconstructed. Giant intra-abdominal tumors are rare. Involvement of adjacent structures may necessitate multivisceral resections with or without organ reconstruction.
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Affiliation(s)
- Michael Okello
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Surgery, Lubaga Hospital, Kampala, Uganda
| | - Julius Nuwagaba
- Department of Surgery, Lubaga Hospital, Kampala, Uganda
- Department of Global Health Security, Makerere University Infectious Disease Institute, Kampala, Uganda
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Kasirye R, Hume HA, Bloch EM, Lubega I, Kyeyune D, Shrestha R, Ddungu H, Musana HW, Dhabangi A, Ouma J, Eroju P, de Lange T, Tartakovsky M, White JL, Kakura C, Fowler MG, Musoke P, Nolan M, Grabowski MK, Moulton LH, Stramer SL, Whitby D, Zimmerman PA, Wabwire D, Kajja I, McCullough J, Goodrich R, Quinn TC, Cortes R, Ness PM, Tobian AAR. The Mirasol Evaluation of Reduction in Infections Trial (MERIT): study protocol for a randomized controlled clinical trial. Trials 2022; 23:257. [PMID: 35379302 PMCID: PMC8978156 DOI: 10.1186/s13063-022-06137-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transfusion-transmitted infections (TTIs) are a global health challenge. One new approach to reduce TTIs is the use of pathogen reduction technology (PRT). In vitro, Mirasol PRT reduces the infectious load in whole blood (WB) by at least 99%. However, there are limited in vivo data on the safety and efficacy of Mirasol PRT. The objective of the Mirasol Evaluation of Reduction in Infections Trial (MERIT) is to investigate whether Mirasol PRT of WB can prevent seven targeted TTIs (malaria, bacteria, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, hepatitis E virus, and human herpesvirus 8). METHODS MERIT is a randomized, double-blinded, controlled clinical trial. Recruitment started in November 2019 and is expected to end in 2024. Consenting participants who require transfusion as medically indicated at three hospitals in Kampala, Uganda, will be randomized to receive either Mirasol-treated WB (n = 1000) or standard WB (n = 1000). TTI testing will be performed on donor units and recipients (pre-transfusion and day 2, day 7, week 4, and week 10 after transfusion). The primary endpoint is the cumulative incidence of one or more targeted TTIs from the Mirasol-treated WB vs. standard WB in a previously negative recipient for the specific TTI that is also detected in the donor unit. Log-binomial regression models will be used to estimate the relative risk reduction of a TTI by 10 weeks associated with Mirasol PRT. The clinical effectiveness of Mirasol WB compared to standard WB products in recipients will also be evaluated. DISCUSSION Screening infrastructure for TTIs in low-resource settings has gaps, even for major TTIs. PRT presents a fast, potentially cost-effective, and easy-to-use technology to improve blood safety. MERIT is the largest clinical trial designed to evaluate the use of Mirasol PRT for WB. In addition, this trial will provide data on TTIs in Uganda. TRIAL REGISTRATION Mirasol Evaluation of Reduction in Infections Trial (MERIT) NCT03737669 . Registered on 9 November 2018.
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Affiliation(s)
- Ronnie Kasirye
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Heather A. Hume
- grid.14848.310000 0001 2292 3357Department of Pediatrics, University of Montreal, Montréal, QC Canada
| | - Evan M. Bloch
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Irene Lubega
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Ruchee Shrestha
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Henry Ddungu
- grid.512320.70000 0004 6015 3252Uganda Cancer Institute, Kampala, Uganda
| | | | - Aggrey Dhabangi
- grid.11194.3c0000 0004 0620 0548Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Michael Tartakovsky
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, MD USA
| | - Jodie L. White
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Ceasar Kakura
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Philippa Musoke
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| | - Monica Nolan
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - M. Kate Grabowski
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Lawrence H. Moulton
- grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Susan L. Stramer
- grid.281926.60000 0001 2214 8581Department of Scientific Affairs, American Red Cross, Gaithersburg, MD USA
| | - Denise Whitby
- grid.418021.e0000 0004 0535 8394Leidos Biomedical Research, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Peter A. Zimmerman
- grid.67105.350000 0001 2164 3847The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, OH USA
| | - Deo Wabwire
- grid.421981.7MUJHU Research Collaboration, Kampala, Uganda
| | - Isaac Kajja
- grid.11194.3c0000 0004 0620 0548Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeffrey McCullough
- grid.215654.10000 0001 2151 2636College of Health Solutions, Arizona State University, Phoenix, AZ USA
| | - Raymond Goodrich
- grid.47894.360000 0004 1936 8083Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO USA
| | - Thomas C. Quinn
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, MD USA ,grid.94365.3d0000 0001 2297 5165Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | | | - Paul M. Ness
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Aaron A. R. Tobian
- grid.21107.350000 0001 2171 9311Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,grid.11194.3c0000 0004 0620 0548Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Downing J, Niyonzima N, Mwebesa E, Mutyaba I, Ddungu H, Irumba LC, Zirimenya L, Basirika D, Mbarusha I, Kobusingye C, Happy M, Jatho A, Adong DO, Kabagambe C, Mpamani C, Nalukwago Z, Kyomuhangi Z, Zalwango J, Orem J, Mwesiga M. Cancer and palliative care in COVID-19 and other challenging situations-highlights from the Uganda Cancer Institute-Palliative Care Association of Uganda 3rd Uganda Conference on Cancer and Palliative Care, 23-24 September 2021, held in Kampala, Uganda and virtually. Ecancermedicalscience 2022; 15:1333. [PMID: 35211202 PMCID: PMC8816507 DOI: 10.3332/ecancer.2021.1333] [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: 10/07/2021] [Indexed: 11/06/2022] Open
Abstract
The 3rd Uganda Conference on Cancer and Palliative Care was held in September 2021 with the theme: cancer and palliative care in COVID-19 and other challenging situations. It was hosted by the Uganda Cancer Institute and the Palliative Care Association of Uganda (UCI-PCAU). The conference was held virtually, with a mix of pre-recorded sessions, plenary sessions being broadcast live on television (TV) by the Uganda Broadcasting Corporation TV, live speakers at the studio and others presenting in real time via Zoom. The conference brought together >350 participants who participated on Zoom, along with those attending in person at the studio and those watching the plenary sessions on TV. At the heart of this joint UCI-PCAU conference was the commitment to not only continue but to improve the provision of cancer care and palliative care within Uganda. Key themes from the conference included: the importance of Universal Health Coverage; the impact of COVID-19 on the provision of cancer and palliative care; that both cancer care and palliative care are available in Uganda; education for all; the importance of working together to provide care and overcome challenges, e.g. through technology; the resilience shown by those working in cancer and palliative care; the grief experienced by so many people who have lost loved ones during the pandemic; the importance of good health seeking behaviour – prevention is better than cure; the challenge of funding; the need for health care equity for marginalised and vulnerable populations and finally we can’t wait for the world to stop COVID-19 – COVID-19 is here to stay – we need to find solutions. The last few years have seen significant challenges due to the COVID-19 pandemic; however, despite this, cancer and palliative care service provision has continued. This conference, whilst unique and very different from previous conferences, was a great opportunity to share not only amongst each other, but also to share key messages with the public through the live broadcasting of the plenary sessions of the conference.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, Suite 1b, Whitefrairs, Lewins Mead, Bristol BS1 2NT, UK.,Palliative care Education and Research Consortium, PO Box 6245, Kyadondo Block 262, Plot 9, Kibuye, Makindye, Kampala, Uganda.,Makerere University, University Rd, Kampala, Uganda
| | - Nixon Niyonzima
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda
| | | | | | - Henry Ddungu
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda.,Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Lisa Christine Irumba
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Ludoviko Zirimenya
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59, Nakiwogo Road, Entebbe, Uganda
| | | | | | | | - Margaret Happy
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda
| | - Alfred Jatho
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda
| | | | - Cynthia Kabagambe
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Collins Mpamani
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda
| | - Zaitun Nalukwago
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Zipporah Kyomuhangi
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Joyce Zalwango
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda
| | - Mark Mwesiga
- Palliative Care Association of Uganda, Block 383, Plot 8804, Kitende, Entebbe Road, Uganda
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8
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Wendelboe AM, Langenfeld H, Ageno W, Castellucci L, Cesarman-Maus G, Ddungu H, De Paula EV, Dumantepe M, Forgo G, Guillermo Esposito MC, McLintock C, Ní Áinle F, Spyropoulos AC, Urano T, Barco S, Hunt BJ. Current practices of standardized risk assessment for venous thromboembolism: Results from a global survey from the World Thrombosis Day steering committee. J Thromb Haemost 2022; 20:532-535. [PMID: 34826190 DOI: 10.1111/jth.15608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron M Wendelboe
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hannah Langenfeld
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Walter Ageno
- Department of Clinical Medicine, University of Insubria, Varese, Italy
| | - Lana Castellucci
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Mert Dumantepe
- Department of Cardiovascular Surgery, Uskudar University School of Medicine, Istanbul, Turkey
| | - Gabor Forgo
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Maria Cecilia Guillermo Esposito
- Department of Hematology, Hospital de Clinicas Facultad de Medicina, Universidad de la República Montevideo, Montevideo, Uruguay
| | - Claire McLintock
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Fionnuala Ní Áinle
- Department of Haematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Alex C Spyropoulos
- Institute for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research and the Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, USA
| | - Tetsumei Urano
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, Guys & St Thomas' NHS Foundation Trust, London, UK
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9
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Forgo G, Micieli E, Ageno W, Castellucci LA, Cesarman‐Maus G, Ddungu H, De Paula EV, Dumantepe M, Guillermo Esposito MC, Konstantinides SV, Kucher N, McLintock C, Ní Áinle F, Spyropoulos AC, Urano T, Hunt BJ, Barco S. An update on the global use of risk assessment models and thromboprophylaxis in hospitalized patients with medical illnesses from the World Thrombosis Day steering committee: Systematic review and meta-analysis. J Thromb Haemost 2022; 20:409-421. [PMID: 34822215 PMCID: PMC9299991 DOI: 10.1111/jth.15607] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. The majority of VTE events are hospital-associated. In 2008, the Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) multinational cross-sectional study reported that only approximately 40% of medical patients at risk of VTE received adequate thromboprophylaxis. METHODS In our systematic review and meta-analysis, we aimed at providing updated figures concerning the use of thromboprophylaxis globally. We focused on: (a) the frequency of patients with an indication to thromboprophylaxis according with individual models; (b) the use of adequate thromboprophylaxis; and (c) reported contraindications to thromboprophylaxis. Observational nonrandomized studies or surveys focusing on medically ill patients were considered eligible. RESULTS After screening, we included 27 studies from 20 countries for a total of 137 288 patients. Overall, 50.5% (95% confidence interval [CI]: 41.9-59.1, I2 99%) of patients had an indication to thromboprophylaxis: of these, 54.5% (95% CI: 46.2-62.6, I2 99%) received adequate thromboprophylaxis. The use of adequate thromboprophylaxis was 66.8% in Europe (95% CI: 50.7-81.1, I2 98%), 44.9% in Africa (95% CI: 31.8-58.4, I2 96%), 37.6% in Asia (95% CI: 25.7-50.3, I2 97%), 58.3% in South America (95% CI: 31.1-83.1, I2 99%), and 68.6% in North America (95% CI: 64.9-72.6, I2 96%). No major differences in adequate thromboprophylaxis use were found across risk assessment models. Bleeding, thrombocytopenia, and renal/hepatic failure were the most frequently reported contraindications to thromboprophylaxis. CONCLUSIONS The use of anticoagulants for VTE prevention has been proven effective and safe, but thromboprophylaxis prescriptions are still unsatisfactory among hospitalized medically ill patients around the globe with marked geographical differences.
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Affiliation(s)
- Gabor Forgo
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Evy Micieli
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Walter Ageno
- Department of Clinical MedicineUniversity of InsubriaVareseItaly
| | - Lana A. Castellucci
- Department of MedicineOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada
| | | | | | | | - Mert Dumantepe
- Department of Cardiovascular SurgeryUskudar University School of MedicineIstanbulTurkey
| | | | | | - Nils Kucher
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Claire McLintock
- National Women's Health Auckland City Hospital Auckland New ZealandAucklandNew Zealand
| | - Fionnuala Ní Áinle
- Department of HaematologyMater Misericordiae University Hospital and Rotunda HospitalDublinIreland
- School of MedicineUniversity College DublinDublinIreland
| | - Alex C. Spyropoulos
- Institute for Health Innovations and Outcomes ResearchFeinstein Institutes for Medical Research and the Zucker School of Medicine at Hofstra/NorthwellNew YorkNew YorkUSA
- Department of Medicine, Anticoagulation and Clinical Thrombosis ServicesNorthwell Health at Lenox Hill HospitalNew YorkNew YorkUSA
| | - Tetsumei Urano
- Shizuoka Graduate University of Public HealthShizuokaJapan
| | - Beverley J. Hunt
- Thrombosis & Haemophilia CentreGuys & St Thomas’ NHS Foundation TrustLondonUK
| | - Stefano Barco
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
- Center for Thrombosis and HemostasisUniversity Medical Center MainzMainzGermany
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10
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Kirenga B, Byakika-Kibwika P, Muttamba W, Kayongo A, Loryndah NO, Mugenyi L, Kiwanuka N, Lusiba J, Atukunda A, Mugume R, Ssali F, Ddungu H, Katagira W, Sekibira R, Kityo C, Kyeyune D, Acana S, Aanyu-Tukamuhebwa H, Kabweru W, Nakwagala F, Bagaya BS, Kimuli I, Nantanda R, Buregyeya E, Byarugaba B, Olaro C, Mwebesa H, Joloba ML, Siddharthan T, Bazeyo W. Efficacy of convalescent plasma for treatment of COVID-19 in Uganda. BMJ Open Respir Res 2021; 8:e001017. [PMID: 34376401 PMCID: PMC8354811 DOI: 10.1136/bmjresp-2021-001017] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 06/11/2021] [Accepted: 07/23/2021] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Convalescent plasma (CCP) has been studied as a potential therapy for COVID-19, but data on its efficacy in Africa are limited. OBJECTIVE In this trial we set out to determine the efficacy of CCP for treatment of COVID-19 in Uganda. MEASUREMENTS Patients with a positive SARS-CoV-2 reverse transcriptase (RT)-PCR test irrespective of disease severity were hospitalised and randomised to receive either COVID-19 CCP plus standard of care (SOC) or SOC alone. The primary outcome was time to viral clearance, defined as having two consecutive RT-PCR-negative tests by day 28. Secondary outcomes included time to symptom resolution, clinical status on the modified WHO Ordinal Clinical Scale (≥1-point increase), progression to severe/critical condition (defined as oxygen saturation <93% or needing oxygen), mortality and safety. MAIN RESULTS A total of 136 patients were randomised, 69 to CCP+SOC and 67 to SOC only. The median age was 50 years (IQR: 38.5-62.0), 71.3% were male and the median duration of symptom was 7 days (IQR=4-8). Time to viral clearance was not different between the CCP+SOC and SOC arms (median of 6 days (IQR=4-11) vs 4 (IQR=4-6), p=0.196). There were no statistically significant differences in secondary outcomes in CCP+SOC versus SOC: time to symptom resolution (median=7 (IQR=5-7) vs 7 (IQR=5-10) days, p=0.450), disease progression (9 (22.0%) vs 7 (24.0%) patients, p=0.830) and mortality (10 (14.5%) vs 8 (11.9%) deaths, p=0.476). CONCLUSION In this African trial, CCP therapy did not result in beneficial virological or clinical improvements. Further trials are needed to determine subgroups of patients who may benefit from CCP in Africa.Trial registration number NCT04542941.
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Affiliation(s)
- Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winters Muttamba
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Kayongo
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Namakula Olive Loryndah
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Levicatus Mugenyi
- Biostatistics Department, The AIDS Support Organisation (TASO), Kampala, Uganda, Uganda
| | - Noah Kiwanuka
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
| | - John Lusiba
- Clinical services, Uganda Peoples Defense Forces Medical Services, Kampala, Uganda, Uganda
- Clinical services, Uganda Heart Institute, Kampala, Uganda, Uganda
| | - Angella Atukunda
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Raymond Mugume
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Henry Ddungu
- Research Department, Uganda Cancer Institute, Kampala, Uganda, Uganda
| | - Winceslaus Katagira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rogers Sekibira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Dorothy Kyeyune
- Clinical services, Uganda Blood Transfusion Services, Kampala, Uganda, Uganda
| | - Susan Acana
- Clinical services, Uganda Blood Transfusion Services, Kampala, Uganda, Uganda
| | | | | | - Fred Nakwagala
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Bernard Sentalo Bagaya
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Esther Buregyeya
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
| | - Baterana Byarugaba
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Charles Olaro
- Clinical services, Ministry of Health, Kampala, Uganda, Uganda
| | - Henry Mwebesa
- Clinical services, Ministry of Health, Kampala, Uganda, Uganda
| | - Moses Lutaakome Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Trishul Siddharthan
- Division of Respiratory and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - William Bazeyo
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
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11
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Muttamba W, Lusiba J, Namakula LO, Byakika-Kibwika P, Ssali F, Ddungu H, Mugenyi L, Kiwanuka N, Sekibira R, Kityo C, Keyune D, Acana S, Musinguzi A, Masasi A, Byamugisha J, Mpanju D, Musoki WJ, Tukamuhebwa HA, Nakwagala F, Bagaya BS, Kayongo A, Kimuli I, Nantanda R, Katagira W, Buregyeya E, Byanyima R, Byarugaba B, Siddharthan T, Mwebesa H, Charles O, Joloba ML, Bazeyo W, Kirenga B. Feasibility of collecting and processing of COVID-19 convalescent plasma for treatment of COVID-19 in Uganda. PLoS One 2021; 16:e0252306. [PMID: 34138909 PMCID: PMC8211202 DOI: 10.1371/journal.pone.0252306] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Evidence that supports the use of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 is increasingly emerging. However, very few African countries have undertaken the collection and processing of CCP. The aim of this study was to assess the feasibility of collecting and processing of CCP, in preparation for a randomized clinical trial of CCP for treatment of COVID-19 in Uganda. Methods In a cross-sectional study, persons with documented evidence of recovery from COVID-19 in Uganda were contacted and screened for blood donation via telephone calls. Those found eligible were asked to come to the blood donation centre for further screening and consent. Whole blood collection was undertaken from which plasma was processed. Plasma was tested for transfusion transmissible infections (TTIs) and anti-SARS CoV-2 antibody titers. SARS-CoV-2 testing was also done on nasopharyngeal swabs from the donors. Results 192 participants were contacted of whom 179 (93.2%) were eligible to donate. Of the 179 eligible, 23 (12.8%) were not willing to donate and reasons given included: having no time 7(30.4%), fear of being retained at the COVID-19 treatment center 10 (43.5%), fear of stigma in the community 1 (4.3%), phobia for donating blood 1 (4.3%), religious issues 1 (4.4%), lack of interest 2 (8.7%) and transport challenges 1 (4.3%). The median age was 30 years and females accounted for 3.7% of the donors. A total of 30 (18.5%) donors tested positive for different TTIs. Antibody titer testing demonstrated titers of more than 1:320 for all the 72 samples tested. Age greater than 46 years and female gender were associated with higher titers though not statistically significant. Conclusion CCP collection and processing is possible in Uganda. However, concerns about stigma and lack of time, interest or transport need to be addressed in order to maximize donations.
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Affiliation(s)
| | - John Lusiba
- Uganda Peoples Defense Forces Medical Services, Kampala, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | | | | | | | | | | | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Susan Acana
- Uganda Blood Transfusion Services, Kampala, Uganda
| | | | - Ayub Masasi
- Mulago National Referral Hospital, Kampala, Uganda
| | - Joseph Byamugisha
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mpanju
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Walter Jack Musoki
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Bernard Sentalo Bagaya
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Kayongo
- Makerere University Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Kampala, Uganda
| | | | | | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Trishul Siddharthan
- Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Henry Mwebesa
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Olaro Charles
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Moses Lutaakome Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
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12
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Barco S, Valerio L, Gallo A, Turatti G, Mahmoudpour SH, Ageno W, Castellucci LA, Cesarman-Maus G, Ddungu H, De Paula EV, Dumantepe M, Goldhaber SZ, Guillermo Esposito MC, Klok FA, Kucher N, McLintock C, Ní Áinle F, Simioni P, Spirk D, Spyropoulos AC, Urano T, Zhai ZG, Hunt BJ, Konstantinides SV. Global reporting of pulmonary embolism-related deaths in the World Health Organization mortality database: Vital registration data from 123 countries. Res Pract Thromb Haemost 2021; 5:e12520. [PMID: 34263098 PMCID: PMC8268665 DOI: 10.1002/rth2.12520] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Pulmonary embolism (PE) has not been accounted for as a cause of death contributing to cause‐specific mortality in global reports. Methods We analyzed global PE‐related mortality by focusing on the latest year available for each member state in the World Health Organization (WHO) mortality database, which provides age‐sex–specific aggregated mortality data transmitted by national authorities for each underlying cause of death. PE‐related deaths were defined by International Classification of Diseases, Tenth Revision codes for acute PE or nonfatal manifestations of venous thromboembolism (VTE). The 2001 WHO standard population served for standardization. Results We obtained data from 123 countries covering a total population of 2 602 561 422. Overall, 50 (40.6%) were European, 39 (31.7%) American, 13 (10.6%) Eastern Mediterranean, 13 (10.6%) Western Pacific, 3 (2.4%) Southeast Asian, and 2 (1.6%) African. Of 116 countries classifiable according to population income, 57 (49.1%) were high income, 42 (36.2%) upper‐middle income, 14 (12.1%) lower‐middle income, and 3 (2.6%) low income. A total of 18 726 382 deaths were recorded, of which 86 930 (0.46%) were attributed to PE. PE‐related mortality rate increased with age in most countries. The reporting of PE‐related deaths was heterogeneous, with an age‐standardized mortality rate ranging from 0 to 24 deaths per 100 000 population‐years. Income status only partially explained this heterogeneity. Conclusions Reporting of PE‐related mortality in official national vital registration was characterized by extreme heterogeneity across countries. These findings mandate enhanced efforts toward systematic and uniform coverage of PE‐related mortality and provides a case for full recognition of PE and VTE as a primary cause of death.
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Affiliation(s)
- Stefano Barco
- Clinic of Angiology University Hospital Zurich Zurich Switzerland.,Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
| | - Andrea Gallo
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany.,Department of Medicine and Surgery University of Insubria Varese Italy
| | - Giacomo Turatti
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany.,General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit Department of Medicine University of Padua Medical School Padua Italy
| | | | - Walter Ageno
- Department of Medicine and Surgery University of Insubria Varese Italy
| | - Lana A Castellucci
- Department of Medicine Faculty of Medicine Ottawa Hospital Research Institute University of Ottawa Ottawa ON Canada
| | | | | | - Erich Vinicius De Paula
- School of Medical Sciences University of Campinas Campinas SP Brazil.,Hematology and Hemotherapy Center University of Campinas Campinas SP Brazil
| | - Mert Dumantepe
- Department of Cardiovascular Surgery Florence Nightingale Hospital Istanbul Turkey
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | | | - Frederikus A Klok
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany.,Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
| | - Nils Kucher
- Clinic of Angiology University Hospital Zurich Zurich Switzerland
| | - Claire McLintock
- National Women's Health Auckland City Hospital Auckland New Zealand
| | - Fionnuala Ní Áinle
- Department of Haematology Mater Misericordiae University Hospital Dublin Ireland.,University College Dublin School of Medicine Dublin Ireland.,Irish Network for VTE Research Dublin Ireland
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit Department of Medicine University of Padua Medical School Padua Italy
| | - David Spirk
- Institute of Pharmacology University of Bern Bern Switzerland
| | - Alex C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Institute for Health Innovations and Outcomes Research Feinstein Institutes for Medical Research Manhasset NY USA.,Department of Medicine, Anticoagulation and Clinical Thrombosis Services Northwell Health at Lenox Hill Hospital New York NY USA
| | - Tetsumei Urano
- Department of Medical Physiology Hamamatsu University School of Medicine Hamamatsu Japan
| | - Zhen-Guo Zhai
- Department of Pulmonary and Critical Care Medicine Center of Respiratory Medicine China-Japan Friendship Hospital Institute of Respiratory Medicine Chinese Academy of Medical Sciences National Clinical Research Center for Respiratory Diseases Beijing China
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre Guys & St Thomas' NHS Foundation Trust London UK
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany.,Department of Cardiology Democritus University of Thrace Alexandroupolis Greece
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13
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Okello CD, Mulumba Y, Omoding A, Ddungu H, Orem J. Survival of patients with cancer associated thrombosis at the Uganda Cancer Institute. Ecancermedicalscience 2021; 15:1212. [PMID: 33912237 PMCID: PMC8057783 DOI: 10.3332/ecancer.2021.1212] [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: 11/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background The occurrence of venous thromboembolism (VTE) in patients with cancer leads to a reduced life expectancy. There is an increased incidence of cancer and its associated mortality in Uganda. We described the survival and characteristics of patients with cancer associated thrombosis (CAT) in a tertiary oncology centre in Uganda. Methods We performed a retrospective study on patients with CAT at the Uganda Cancer Institute (UCI) using a homogenous purposive sampling method. Results One hundred and eleven patients with documented VTE were included in the analysis. At entry, the mean age was 52.4 years, and 69 were female. Ninety eight had deep venous thrombosis, while 12 had pulmonary embolism. The most common cancer diagnoses were haematologic (30), gynaecologic (20) and prostate (17) cancers. Treatment regimens included anticoagulation with low-molecular weight heparin (LMWH) (72) and combined LMWH with warfarin (22). The median overall survival (OS) was 6.3 months, with a 1-year survival rate of 41.5%. Patients with significantly increased hazard of mortality were those with upper gastrointestinal (UGI) malignancies, colorectal and breast cancers. Patients with a body mass index of 25–29.9 kg/m2 (overweight) had a slightly reduced hazard of mortality. Conclusion The OS of patients with CAT at the UCI is short. Most patients with CAT presented with advanced stage cancers and at a relatively young age. Patients with UGI, colorectal and breast cancers had increased hazards of mortality, whereas those who were overweight had a slight reduction in the hazard of mortality.
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Affiliation(s)
- Clement D Okello
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Abrahams Omoding
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Henry Ddungu
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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14
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Okello CD, Mulumba Y, Omoding A, Ddungu H, Welch K, Thompson CL, Cowan AJ, Cooney MM, Orem J. Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute. Afr Health Sci 2021; 21:67-74. [PMID: 34394283 PMCID: PMC8356586 DOI: 10.4314/ahs.v21i1.11] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Data on multiple myeloma (MM) in sub-Sahara Africa is scarce. In Uganda, there is a progressively increasing incidence of MM over the years. METHODS We performed a retrospective study on 217 patients with MM at the UCI using purposive sampling method. The objectives of the study were to determine the clinical characteristics, treatment outcomes, 5 year overall survival and predictors of survival of patients with MM at the UCI from 01 January 2008 to 31 December 2012. RESULTS There were 119 (54.8%) males; the mean(SD) age of the study population at presentation was 59(12.8) years; 183(84.3%) patients presented with bone pain, and 135 (61.9%) had skeletal pathology; 186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III. The median overall survival was 2.5 years, (95% CI, 0.393-0.595); factors significantly associated with worse survival were Durie-Salmon stage III disease, HR=5.9, 95% CI (1.61 - 21.74; P=0.007) and LDH >225 U/L HR=3.3, 95% CI (0.57 - 5.92; P=0.029). CONCLUSION Most patients with multiple myeloma at the UCI were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter survival time. Factors associated with worse survival were Durie-Salmon stage III and LDH >225 U/L.
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15
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Okello CD, Omoding A, Ddungu H, Mulumba Y, Orem J. Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting. BMC Cancer 2020; 20:798. [PMID: 32831073 PMCID: PMC7446121 DOI: 10.1186/s12885-020-07305-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 to 2018 was done. Results One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8–64.8) and 80.2% (95% CI, 40.3–94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5–24.9 kg/m2, (p = 0.03) and completion of 6 or more cycles of chemotherapy, (p < 0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP = 13, 12%; DA-EPOCH = 2, 17%), anaemia (CHOP = 12, 12%; DA-EPOCH = 1, 8%), thrombocytopenia (CHOP = 7, 6%; DA-EPOCH = 0), sepsis (CHOP = 1), treatment related death (DA-EPOCH = 1) and hepatic encephalopathy (CHOP = 1). Conclusion Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with > 50% 1 year survival.
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Affiliation(s)
- Clement D Okello
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Abrahams Omoding
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Henry Ddungu
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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Murphy KJ, Conroy AL, Ddungu H, Shrestha R, Kyeyune-Byabazaire D, Petersen MR, Musisi E, Patel EU, Kasirye R, Bloch EM, Lubega I, John CC, Hume HA, Tobian AA. Malaria parasitemia among blood donors in Uganda. Transfusion 2020; 60:955-964. [PMID: 32282944 PMCID: PMC7908807 DOI: 10.1111/trf.15775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Malaria remains a leading transfusion associated infectious risk in endemic areas. However, the prevalence of malaria parasitemia has not been well characterized in blood donor populations. This study sought to determine the prevalence of Plasmodium in red blood cell (RBC) and whole blood (WB) units after the rainy season in Uganda. METHODS AND MATERIALS Between May and July 2018, blood was collected from the sample diversion pouch of 1000 WB donors in Kampala and Jinja, Uganda. The RBC pellet from ethylenediamine tetraacetic acid (EDTA) anticoagulated blood was stored at -80°C until testing. DNA was extracted and nested PCR was used to screen samples at the genus level for Plasmodium, with positive samples further tested for species identification. RESULTS Malaria parasitemia among asymptomatic, eligible blood donors in two regions of Uganda was 15.4%; 87.7% (135/154) of infections were with P. falciparum, while P. malariae and P. ovale were also detected. There were 4.3% of blood donors who had mixed infection with multiple species. Older donors (>30 years vs. 17-19 years; aPR = 0.31 [95% CI = 0.17-0.58]), females (aPR = 0.60 [95% CI = 0.42-0.87]), repeat donors (aPR = 0.44 [95% CI = 0.27-0.72]) and those donating near the capital city of Kampala versus rural Jinja region (aPR = 0.49 [95% CI = 0.34-0.69]) had a lower prevalence of malaria parasitemia. CONCLUSIONS A high proportion of asymptomatic blood donors residing in a malaria endemic region demonstrate evidence of parasitemia at time of donation. Further research is needed to quantify the risk and associated burden of transfusion-transmitted malaria (TTM) in order to inform strategies to prevent TTM.
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Affiliation(s)
- Kristin J. Murphy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea L. Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Ruchee Shrestha
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Molly R. Petersen
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ezra Musisi
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Eshan U. Patel
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Evan M. Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Chandy C. John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Heather A. Hume
- Department of Pediatrics, CHU Ste-Justine, University of Montreal, Montreal, Canada
| | - Aaron A.R. Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Ddungu H, Krantz EM, Kajja I, Naluzze S, Nabbanja H, Nalubwama F, Phipps W, Orem J, Wald A, Kiwanuka N. Transfusion Challenges in Patients with Hematological Malignancies in Sub-Saharan Africa: A Prospective Observational Study from the Uganda Cancer Institute. Sci Rep 2020; 10:2825. [PMID: 32071350 PMCID: PMC7028934 DOI: 10.1038/s41598-020-59773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/03/2020] [Indexed: 12/03/2022] Open
Abstract
Blood transfusion is fundamental in managing hematologic malignancies. We sought to evaluate the need and availability of blood products for patients with hematological malignancies at Uganda Cancer Institute. We prospectively studied the demand and supply of blood for patients with thrombocytopenia (platelet count ≤50 × 109/L), anemia (hemoglobin ≤10 g/dL), and bleeding (WHO grade ≥2). We used Poisson generalized estimating equation regression models for longitudinal binary outcomes. Among 91 patients, the median age was 26 years (IQR, 11–47). Thrombocytopenia occurred on ≥1 day in 58% of patients and on 49% of hospital days. Platelets were transfused to 39% of patients. The mean number of platelet units requested per day was 16.2 (range 0–30); 5.1 (range 0–15) were received. Anemia occurred on ≥1 day in 90% of patients; on 78% of days; and 68% received at least one blood transfusion. The mean number of blood units requested was 36.3 (range 8–57) units per day; 14 (range 0–30) were received. Bleeding occurred on ≥1 day in 19% of patients on 8% of hospital days. Thrombocytopenia and anemia were common, but product availability was substantially below that requested. We recommend increased blood collection and adherence to strict transfusion triggers as strategies to improve blood availability.
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Affiliation(s)
- Henry Ddungu
- Uganda Cancer Institute, Kampala, Uganda. .,School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Elizabeth M Krantz
- Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Isaac Kajja
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Warren Phipps
- Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Anna Wald
- Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Noah Kiwanuka
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Bender Ignacio R, Ddungu H, Uldrick TS. Untangling the Effects of Chemotherapy and HIV on CD4 Counts-Implications for Immunotherapy in HIV and Cancer. JAMA Oncol 2020; 6:235-236. [PMID: 31804653 DOI: 10.1001/jamaoncol.2019.4634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel Bender Ignacio
- Department of Medicine, Allergy and Infectious Disease Division, University of Washington, Seattle, Washington
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Thomas S Uldrick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, Medical Oncology Division, University of Washington, Seattle, Washington
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19
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Downing J, Niyonzima N, Guma S, Batuli M, Kiwanuka R, Atuhe I, Nalukwago Z, Mwesiga M, Phipps W, Ddungu H. Towards universal coverage-highlights from the 2nd Uganda Conference on Cancer and Palliative Care, 5-6 September 2019, Kampala, Uganda. Ecancermedicalscience 2020; 13:976. [PMID: 31921347 PMCID: PMC6946418 DOI: 10.3332/ecancer.2019.976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Indexed: 12/05/2022] Open
Abstract
The 2nd Uganda Conference on Cancer and Palliative Care was held in September 2019 in Kampala, Uganda under the theme: Towards Universal Coverage. It was hosted by the Uganda Cancer Institute and the Palliative Care Association of Uganda (PCAU). The conference brought together 350 delegates from eight countries. Key themes from the conference included: universal health coverage (UHC), service provision and public health; resources for achieving UHC; capacity building; human rights and engagement on the implementation of the recommendations made by the Uganda Human Rights Commission; provision of cancer and palliative care to ‘hard to reach’ and ‘vulnerable’ groups; paediatrics; health promotion and prevention; policy and advocacy and digital technology. The conference also gave opportunity to celebrate the 20th Anniversary of the work of PCAU, with a celebration dinner attended by the Minister of Health. The past few years have seen significant developments in both cancer and palliative care in Uganda, and this was evident in the presentations, and the way that provision has changed and improved since the first cancer and palliative care conference in 2017. Emphasis on UHC, along with the support of government and other stakeholders, is important in the ongoing development of cancer and palliative care services in Uganda.
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Affiliation(s)
- Julia Downing
- Makerere University and International Children's Palliative Care Network, Kampala, Uganda
| | | | - Sam Guma
- Kawempe Home Care, Kampala, Uganda
| | - Mwazi Batuli
- Islamic University in Uganda (IUIU), Kampala, Uganda
| | - Rose Kiwanuka
- Palliative Care Association of Uganda, Kampala, Uganda
| | | | | | - Mark Mwesiga
- Palliative Care Association of Uganda, Kampala, Uganda
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Okunade K, Bashan Nkhoma K, Salako O, Akeju D, Ebenso B, Namisango E, Soyannwo O, Namukwaya E, Dandadzi A, Nabirye E, Mupaza L, Luyirika E, Ddungu H, Chirenje ZM, Bennett MI, Harding R, Allsop MJ. Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study. BMJ Open 2019; 9:e032166. [PMID: 31676657 PMCID: PMC6830840 DOI: 10.1136/bmjopen-2019-032166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Palliative care is a clinically and cost-effective component of cancer services in sub-Saharan Africa (SSA). Despite the significant need for palliative cancer care in SSA, coverage remains inadequate. The exploration of digital health approaches could support increases in the quality and reach of palliative cancer care services in SSA. However, there is currently a lack of any theoretical underpinning or data to understand stakeholder drivers for digital health components in this context. This project addresses this gap through engaging with key stakeholders to determine data and information needs that could be supported through digital health interventions. METHODS AND ANALYSIS This is a multicountry, cross-sectional, qualitative study conducted in Nigeria, Uganda and Zimbabwe. In-depth interviews will be conducted in patients with advanced cancer (n=20), caregivers (n=15), health professionals (n=20) and policy-makers (n=10) in each of the three participating countries. Data from a total of 195 interviews will transcribed verbatim and translated into English before being imported into NVivo software for deductive framework analysis. The analysis will seek to understand the acceptability and define mechanisms of patient-level data capture and usage via digital technologies. ETHICS AND DISSEMINATION Ethics approvals have been obtained from the Institutional Review Boards of University of Leeds (Ref: MREC 18-032), Research Council of Zimbabwe (Ref: 03507), Medical Research Council of Zimbabwe (Ref: MRCZ/A/2421), Uganda Cancer Institute (Ref: 19-2018), Uganda National Council of Science and Technology (Ref: HS325ES) and College of Medicine University of Lagos (Ref: HREC/15/04/2015). The project seeks to determine optimal mechanisms for the design and development of subsequent digital health interventions to support development, access to, and delivery of palliative cancer care in SSA. Dissemination of these findings will occur through newsletters and press releases, conference presentations, peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER ISRCTN15727711.
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Affiliation(s)
| | - Kennedy Bashan Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Omolola Salako
- Department of Radiation Oncology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Olaitan Soyannwo
- Centre for Palliative Care, University College Hospital, Ibadan, Nigeria
| | | | - Adlight Dandadzi
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | | | | | | | - Z Mike Chirenje
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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21
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Ddungu H, Krantz EM, Phipps W, Naluzze S, Orem J, Kiwanuka N, Wald A, Kajja I. Survey to Assess Knowledge and Reported Practices Regarding Blood Transfusion Among Cancer Physicians in Uganda. J Glob Oncol 2019; 4:1-12. [PMID: 30307805 PMCID: PMC6818296 DOI: 10.1200/jgo.18.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/15/2022] Open
Abstract
Purpose Optimal decision making regarding blood transfusion for patients with cancer
requires appropriate knowledge of transfusion medicine among physicians. We
assessed blood transfusion knowledge, attitudes, and reported practices
among physicians working at Uganda Cancer Institute (UCI). Materials and Methods A cross-sectional self-administered survey of UCI physicians on their
knowledge, attitudes, and practices regarding blood transfusion was
conducted from June to September 2014. In consultation with transfusion
medicine experts, 30 questions were developed, including 10 questions for
each of the following three domains: knowledge, attitudes, and practices.
For the knowledge domain, we created a knowledge score equal to the number
of questions correctly answered out of 10. Results Of 31 physicians approached, 90% participated. The mean knowledge score was
5.3 (median, 5.5), and 32% correctly answered at least seven of 10
questions. Almost all (96%) understood the importance of proper patient
identification before transfusion and indicated identification error as the
most common cause of fatal transfusion reactions. More than 60% of
physicians acknowledged they lacked knowledge and needed training in
transfusion medicine. Most physicians reported sometimes changing their mind
about whether to provide a patient with a transfusion on the basis of
opinion of colleagues and sometimes administering unnecessary transfusions
because of influence from others. Conclusion Although UCI physicians have some basic knowledge in transfusion, most
reported gaps in their knowledge, and all expressed a need for additional
education in the basics of blood transfusion. Transfusion training and
evidence-based guidelines are needed to reduce inappropriate transfusions
and improve patient care. Greater understanding of peer influence in
transfusion decision making is required.
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Affiliation(s)
- Henry Ddungu
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Elizabeth M Krantz
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Warren Phipps
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Sandra Naluzze
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Jackson Orem
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Noah Kiwanuka
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Anna Wald
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Isaac Kajja
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
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Lubwama M, Phipps W, Najjuka CF, Kajumbula H, Ddungu H, Kambugu JB, Bwanga F. Bacteremia in febrile cancer patients in Uganda. BMC Res Notes 2019; 12:464. [PMID: 31362783 PMCID: PMC6668181 DOI: 10.1186/s13104-019-4520-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. Results We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby–Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.
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Affiliation(s)
- Margaret Lubwama
- Department of Medical Microbiology, Makerere University, Kampala, Uganda.
| | - Warren Phipps
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | | | | | - Freddie Bwanga
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
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Ddungu H, Kumaketch E, Namisango E. Assessment of Clinical and Psychological Needs of Patients With Metastatic Breast Cancer: Challenges and Gaps in Meeting Their Needs in Uganda. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Uganda has one of the highest age-standardized incidence rates for breast cancer (38.3/100,000) occurring among women age 35 to 45 years. The disease is associated with increased biomedical and psychological demands on affected women and their families. Clinical and supportive care services are offered to patients with metastatic breast cancer (MBC) to meet their needs and improve survival and quality of life. However, the existence of challenges and barriers to health care access affect the satisfaction of the needs of patients with MBC and imply that available services cannot meet every clinical and psychological need these patients. No previous assessment has been done in Uganda of the clinical and psychological needs of patients with MBC. The aim of the current study was to generate data that can be used to increase awareness of the unmet clinical and psychological needs of patients with MBC and their families to inform advocacy strategies for supportive care services in Uganda. Methods We conducted interviews, in-depth interviews, focus group discussions, and document review. Results Patients with MBC (n = 67), survivors (n = 185), clinical providers (n = 24), family (n = 134), and VHT (n = 12) participated in this work. The patient’s most important needs include physical and daily living needs (relieving pain, 85.69%; nutrition and diet, 83.69%; wound management, 80.69%; help when tired, 74.6%; help with house cores, 73.19%); health system, information, and patient support (treatment with dignity, 86.6%; pleasant environment, 83.6%; sensitivity to feelings, 80.6%; counseling, 79.1%; choice of cancer specialists, 77.6%; treatment plan, 76.1%; respect for a patient’s opinion, 74.6%); and psychological (close family concerns, 79.1%; advice on faith, 79.6%; comforting when sad, 74.6%; positive outlook, 73.3%; how to disclose, 71.6%). Long waiting times, out-of-stock medicines, inadequate hospital amenities, family exclusion during patient review conversations, caregiver burnout, cost of care, limited funding, and spiritual, legal, and human resource shortages were needs and challenges identified by survivors, family caregivers, clinical providers, and policymakers. Polices on supportive care for patients with MBC are also unclear. Conclusion There exists a mismatch between patients with MBC, survivors, and health care providers with regard to knowledge of some of the needs of patients with MBC, particularly clinical-related information needs. Dialogue between patients with MBC, survivors, family caregivers, clinical providers, and VHTs is recommended to harmonize knowledge and perceptions of the needs of patients with MBC. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
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Affiliation(s)
- Henry Ddungu
- Henry Ddungu, Uganda Cancer Institute; Eva Namisango, African Palliative Care Association, Kampala; Eva Namisango, Uganda Women Cancer Support Organisation; and Edward Kumaketch, University of Lira, Lira, Uganda
| | - Edward Kumaketch
- Henry Ddungu, Uganda Cancer Institute; Eva Namisango, African Palliative Care Association, Kampala; Eva Namisango, Uganda Women Cancer Support Organisation; and Edward Kumaketch, University of Lira, Lira, Uganda
| | - Eva Namisango
- Henry Ddungu, Uganda Cancer Institute; Eva Namisango, African Palliative Care Association, Kampala; Eva Namisango, Uganda Women Cancer Support Organisation; and Edward Kumaketch, University of Lira, Lira, Uganda
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Orem J, Ddungu H, Karsan F, Nafuna S, Okuku F, Kanyike D, Kavuma A, Luutu I, Bolouki S. Challenges of Building and Sustaining Radiation Therapy Capacity in Low-Resource Settings: A Case of the Breakdown of Cobalt 60 Teletherapy in Uganda and Lessons Learned. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.23500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: The use of radiotherapy in developing countries is slowly gaining momentum but the gains are accompanied by some pitfalls. The breakdown of a teletherapy (cobalt 60) machine in Uganda is an example of the challenges to be considered while expanding access to treatment. It was a major test for the country and the Uganda Cancer Institute the agency of government responsible for provision of cancer services. It attracted a national and international outcry. This unprecedented response was based on the importance a seemingly old equipment in Kampala was playing in the entire region (Kenya, Tanzania, Rwanda, Burundi, Democratic Republic of Congo and southern Sudan). However, the manner in which the crisis was handled demonstrated clearly how to turn a misfortune into an opportunity given the many lessons learnt. Aim: In this paper we aim to highlight how the breakdown of the equipment triggered a major crisis and the response to the crisis resulting in the restoration of services within a reasonable time frame. We also want to show the long-term service modernization and expansion drive this has triggered within Uganda and the entire region. Strategy/Tactics: The restoration process comprised planning, decommissioning, renovation, security and safety systems, procurement of new machine, installation and commissioning. As this was ongoing there was the need for care provision for patient in need. Concurrently undertaken was public reassurance through building confidence and trust in the capacity for speedy restoration of services. Program/Policy process: All these steps were taken collaboratively within country, region and internationally. In the region there was support from the Aga Khan University Hospital Nairobi and internationally, technical support from the IAEA. Outcomes: Service has been fully restored, a new teletherapy cobalt machines installed and commissioned. The machine has modern capabilities compared with the previous. So far more than 200 patients have been treated. The numbers of patients are steadily increasing hence the government has embarked on modernization and expansion of the radiotherapy services in the country. What was learned: The breakdown of Uganda's radiotherapy machines has provided lessons that are important for handling health system operational crisis which may occur as we try to build complex delivery systems. It provided lessons that are important in the drive for expansion of radiotherapy services in developing countries. In particular that benefit of investments in modern equipment transcends national boundaries. Secondly how to limit potential impact of major crisis through regional and international collaboration. Further that the needs of patients is central in crisis management. Finally need to consider pooling infrastructure investments in tackling NCD's such as the East Africa's centre of excellence for skills and tertiary education project of the East African community.
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Affiliation(s)
- J. Orem
- Uganda Cancer Institute, Kampala, Uganda
| | - H. Ddungu
- Uganda Cancer Institute, Kampala, Uganda
| | - F. Karsan
- Aga Khan University Hospital Nairobi, Radiotherapy, Nairobi, Kenya
| | - S. Nafuna
- Ministry of Energy and Mineral Development, IAEA National Liason, Kampala, Uganda
| | - F. Okuku
- Uganda Cancer Institute, Medical Oncology, Kampala, Uganda
| | - D. Kanyike
- Uganda Cancer Institute, Radiotherapy, Kampala, Uganda
| | - A. Kavuma
- Uganda Cancer Institute, Radiotherapy, Kampala, Uganda
| | - I. Luutu
- Uganda Cancer Institute, Radiotherapy, Kampala, Uganda
| | - S. Bolouki
- Aga Khan University Hospital Nairobi, Nairobi, Kenya
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Vululi ST, Bugeza S, Zeridah M, Ddungu H, Openy AB, Frank M, Parkes-Ratanshi R. Prevalence of lower limb deep venous thrombosis among adult HIV positive patients attending an outpatient clinic at Mulago Hospital. AIDS Res Ther 2018; 15:3. [PMID: 29370816 PMCID: PMC5784710 DOI: 10.1186/s12981-018-0191-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 08/21/2017] [Accepted: 01/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Deep venous thrombosis (DVT) and its major complication pulmonary embolism (PE) are collectively known as venous thromboembolism. In Uganda, the prevalence of DVT among HIV patients has not been previously published. The aim of the study was to determine the prevalence and sonographic features of lower limb deep venous thrombosis among HIV positive patients on anti-retroviral treatment (ART). Methods This was a cross sectional study in which HIV positive patients on ART were recruited from an out-patient HIV clinic at Mulago National Referral Hospital. Patients were randomly selected and enrolled until a sample size of 384 was reached. Study participants underwent compression and Doppler ultrasound studies of both lower limb deep veins using Medison Sonoacer7 ultrasound machine. Resuts We found a prevalence of DVT of 9.1% (35 of 384 participants) among HIV patients on ART. The prevalence of latent (asymptomatic) DVT was 2.3%. Among 35 patients with DVT, 42.8% had chronic DVT; 31.1% had acute DVT and the rest had latent DVT. Among the risk factors, the odds of occurrence of DVT among patients with prolonged immobility were 4.81 times as high as in those with no prolonged immobility (p = 0.023; OR = 4.81; 95% CI 1.25–18.62). Treatment with second line anti-retroviral therapy (ART) including protease inhibitors (PIs) was associated with higher odds of DVT occurrence compared with first line ART (p = 0.020; OR = 2.38; 95% CI 1.14–4.97). The odds of DVT occurrence in patients with a lower CD4 count (< 200 cells/µl) were 5.36 times as high as in patients with CD4 counts above 500 cells/µl (p = 0.008). About 48.6% patients with DVT had a low risk according to Well’s score. Conclusion DVT was shown in nearly 10% of HIV patients attending an out-patient clinic in an urban setting in Uganda. Risk factors included protease inhibitors in their ART regimen, prolonged immobility, and low CD4 count (< 200 cells/µl). Clinicians should have a low threshold for performing lower limb Doppler ultrasound scan examination on infected HIV patients on ART who are symptomatic for DVT. Therefore, clinicians should consider anti-coagulant prophylaxis and lower deep venous ultrasound screening of patients who are on second line ART regimen with low CD4 cell counts and/or with prolonged immobility or hormonal contraception.
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Wendelboe AM, Raskob GE, Angchaisuksiri P, Blanco AN, Büller H, Ddungu H, Dvorak JD, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, McLintock C, Urano T, Weitz JI. Global public awareness about atrial fibrillation. Res Pract Thromb Haemost 2018; 2:49-57. [PMID: 30046706 PMCID: PMC6055485 DOI: 10.1002/rth2.12051] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is an important cause of ischemic stroke that often remains undetected until stroke occurs. Awareness of the risk factors and symptoms is important so that AF can be diagnosed and thromboprophylaxis given. However, the extent of public awareness of AF is uncertain. We assessed public awareness of AF across six continents and compared it with that of other thrombotic and non-thrombotic disorders. METHODS In collaboration with Ipsos-Reid, we conducted an internet-based, cross-sectional survey between September and October of 2016 in 10 countries: Argentina, Australia, Canada, Germany, Japan, Thailand, the Netherlands, Uganda, United Kingdom, and United States. Participants were selected from survey panels in weighted, age-stratified categories (40-60, 61-74, and ≥75 years). The survey included 11 questions about demographics and assessed awareness about AF, as well as that of other thrombotic and non-thrombotic disorders. Proportions and 95% confidence intervals (CI) were calculated. RESULTS Of a total of 6312 respondents, overall awareness of AF was 48% (95% CI, 46-50%), which was lower than awareness about other thrombotic and non-thrombotic disorders except for deep vein thrombosis (awareness 43%, 95% CI, 41-45%). Awareness about AF ranged from 25% to 69% across countries, while awareness of the risk factors for AF ranged from 8% to 52%, and awareness that AF leads to stroke ranged from 36% to 46%. Among those reporting awareness of AF, 82% correctly identified palpitations as an AF symptom. CONCLUSIONS Global public awareness of AF is low. Improving awareness may empower patients to seek timelier stroke preventive care.
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Affiliation(s)
- Aaron M. Wendelboe
- College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Gary E. Raskob
- College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | | | - Alicia N. Blanco
- División HemostasiaIIHEMAAcademia Nacional de MedicinaBuenos AiresArgentina
| | - Harry Büller
- Department of Vascular MedicineAcademic Medical CenterAmsterdamthe Netherlands
| | | | - Justin D. Dvorak
- College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Beverley J. Hunt
- Thrombosis & Thrombophilia CentreGuy's & St Thomas’, NHS Foundation TrustLondonUK
| | | | | | | | - Micah McCumber
- College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Claire McLintock
- National Women's HealthAuckland City HospitalAucklandNew Zealand
| | - Tetsumei Urano
- Department of Medical PhysiologyHamamatsu University School of MedicineHamamatsuJapan
| | - Jeffrey I. Weitz
- McMaster University and the Thrombosis and Atherosclerosis Research InstituteHamiltonONCanada
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Downing J, Ddungu H, Kiyange F, Batuli M, Kafeero J, Kebirungi H, Kiwanuka R, Mugisha N, Mwebesa E, Mwesiga M, Namukwaya E, Niyonzima N, Phipps W, Orem J. United against cancer: prevention to end-of-life care-highlights from the Uganda Cancer Institute-Palliative Care Association of Uganda Joint International Conference on Cancer and Palliative Care and the 7th Palliative Care Conference, 24-25 August 2017, Kampala, Uganda. Ecancermedicalscience 2017; 11:790. [PMID: 29290759 PMCID: PMC5739871 DOI: 10.3332/ecancer.2017.790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 11/20/2022] Open
Abstract
The Uganda Cancer Institute (UCI) and the Palliative Care Association of Uganda (PCAU) jointly hosted an international conference on cancer and palliative care in August 2017 in Kampala, Uganda. At the heart of the conference rested a common commitment to see patient care improved across Uganda and the region. The theme – United Against Cancer: Prevention to End-of-Life Care – reflected this joint vision and the drive to remember that cancer care should include prevention, early diagnosis and screening, treatment, rehabilitation and palliative care. The conference brought together 451 delegates from 17 countries. The key themes of the conference included: the importance of the World Health Assembly Resolutions on Palliative Care (2014) and cancer care (2017); the need to develop a National Cancer Control Programme; strategies for effective cancer diagnosis and treatment in low- and middle-income countries; advocacy, human rights and access to essential medicines, including access to opioids and nurse prescribing; paediatric care; leadership and commitment; collaboration; resources (financial and human), the recognition that palliative care is not limited to cancer care and the importance of learning from each other. The conference also gave the opportunity to celebrate the 50th Anniversary of the UCI, with a celebration dinner attended by the Minister of Health and the US Ambassador. Participants reported that the conference was a forum that updated them in all aspects of cancer and palliative care, which challenged their knowledge, and was enlightening in terms of current treatment options for individuals with cancer. The benefits of having a joint conference were recognised, allowing for further networking between cancer and palliative care organisations. This conference, highlighting many developments in cancer and palliative care, served as a unique opportunity to bring people together and unite them in developing cancer and palliative care.
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Affiliation(s)
- Julia Downing
- Makerere University, International Children's Palliative Care Network, Uganda.,Palliative Care Association of Uganda, Kampala, Uganda
| | | | - Fatia Kiyange
- Palliative Care Association of Uganda, Kampala, Uganda.,African Palliative Care Association, Kampala, Uganda
| | - Mwazi Batuli
- Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | | | | | - Rose Kiwanuka
- Palliative Care Association of Uganda, Kampala, Uganda
| | | | | | - Mark Mwesiga
- Palliative Care Association of Uganda, Kampala, Uganda
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Low D, Merkel EC, Menon M, Loggers E, Ddungu H, Leng M, Namukwaya E, Casper C. End-of-Life Palliative Care Practices and Referrals in Uganda. J Palliat Med 2017; 21:328-334. [PMID: 29058504 DOI: 10.1089/jpm.2017.0257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa. OBJECTIVE We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda. DESIGN We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care. SETTING All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed. MEASUREMENTS Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management. RESULTS Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2-13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos. CONCLUSION Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.
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Affiliation(s)
- Daniel Low
- 1 University of Washington School of Medicine , Seattle, Washington
| | - Emily C Merkel
- 1 University of Washington School of Medicine , Seattle, Washington
| | - Manoj Menon
- 1 University of Washington School of Medicine , Seattle, Washington.,2 Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Elizabeth Loggers
- 1 University of Washington School of Medicine , Seattle, Washington.,2 Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Henry Ddungu
- 2 Fred Hutchinson Cancer Research Center , Seattle, Washington.,3 Uganda Cancer Institute , Kampala, Uganda
| | - Mhoira Leng
- 4 Makerere/Mulago Palliative Care Unit, Mulago Hospital , Kampala, Uganda
| | | | - Corey Casper
- 1 University of Washington School of Medicine , Seattle, Washington.,2 Fred Hutchinson Cancer Research Center , Seattle, Washington
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Buyego P, Nakiyingi L, Ddungu H, Walimbwa S, Nalwanga D, Reynolds SJ, Parkes-Ratanshi R. Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute. AIDS Res Ther 2017; 14:13. [PMID: 28292305 PMCID: PMC5351163 DOI: 10.1186/s12981-017-0139-x] [Citation(s) in RCA: 21] [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] [Received: 11/18/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022] Open
Abstract
Background Early diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagnosis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI). Methods A retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio-demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form. Results A total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28–45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1–5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89–10.58, p < 0.001) and stage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08–9.63, p < 0.037) for possible misdiagnosis of lymphoma as TB. Conclusion A high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdiagnosis of lymphoma as TB.
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Abstract
Purpose Avoiding chemotherapy during the last 30 days of life has become a goal of cancer care in the United States and Europe, yet end-of-life chemotherapy administration remains a common practice worldwide. The purpose of this study was to determine the frequency of and factors predicting end-of-life chemotherapy administration in Uganda. Methods Retrospective chart review and surveys and interviews of providers were performed at the Uganda Cancer Institute (UCI), the only comprehensive cancer center in the area, which serves a catchment area of greater than 100 million people. All adult patients at the UCI with reported cancer deaths between January 1, 2014, and August 31, 2015 were included. All UCI physicians were offered a survey, and a subset of physicians were also individually interviewed. Results Three hundred ninety-two patients (65.9%) received chemotherapy. Age less than 55 years (odds ratio [OR], 2.30; P = .004), a cancer diagnosis greater than 60 days before death (OR, 9.13; P < .001), and a presenting Eastern Cooperative Oncology Group performance status of 0 to 2 (OR, 2.47; P = .001) were associated with the administration of chemotherapy. More than 45% of patients received chemotherapy in the last 30 days of life. No clinical factors were predictive of chemotherapy use in the last 30 days of life, although doctors reported using performance status, cancer stage, and tumor chemotherapy sensitivity to determine when to administer chemotherapy. Patient expectations and a lack of outcomes data were important nonclinical factors influencing chemotherapy administration. Conclusion Chemotherapy is administered to a high proportion of patients with terminal cancer in Uganda, raising concern about efficacy. Late presentation of cancer in Uganda complicates end-of-life chemotherapy recommendations, necessitating guidelines specific to sub-Saharan Africa.
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Affiliation(s)
- Daniel Low
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Emily C Merkel
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Manoj Menon
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Gary H Lyman
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Henry Ddungu
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Elizabeth Namukwaya
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Mhoira Leng
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
| | - Corey Casper
- Daniel Low, Emily C. Merkel, Manoj Menon, Gary H. Lyman, and Corey Casper, University of Washington School of Medicine; Manoj Menon, Gary H. Lyman, Henry Ddungu, and Corey Casper, Fred Hutchinson Cancer Research Center, Seattle, WA; Henry Ddungu, Uganda Cancer Institute; and Elizabeth Namukwaya and Mhoira Leng, Makerere/Mulago Palliative Care Unit, Kampala, Uganda
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Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, Ddungu H, Kyeyune D, Musisi E, Opoka R, Stowell CP, Dzik WH. B-type natriuretic peptide and plasma hemoglobin levels following transfusion of shorter-storage versus longer-storage red blood cells: Results from the TOTAL randomized trial. Am Heart J 2017; 183:129-136. [PMID: 27302626 DOI: 10.1016/j.ahj.2016.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/16/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prior studies have suggested that transfusion of stored red blood cells (RBCs) with increased levels of cell-free hemoglobin might reduce the bioavailability of recipient nitric oxide (NO) and cause myocardial strain. METHODS Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk for reduced NO bioavailability. RESULTS Seventy patients received RBCs stored 1-10 days, and 77 received RBCs stored 25-35 days. The median (interquartile range) cell-free hemoglobin was nearly 3 times higher in longer-storage RBCs (26.4 [15.5-43.4] μmol/L) than in shorter-storage RBCs (10.8 [7.8-18.6] μmol/L), P < .0001. Median (interquartile range) BNP 2 hours posttransfusion was 156 (59-650) pg/mL (shorter storage) versus 158 (59-425) pg/mL (longer storage), P = .76. BNP values 22 hours posttransfusion were 110 (46-337) pg/mL (shorter storage) versus 96 (49-310) pg/mL (longer storage), P = .76. Changes in BNP within individuals from pretransfusion to 2 hours (or 22 hours) posttransfusion were not significantly different between the study groups. BNP change following transfusion did not correlate with the concentration of cell-free hemoglobin in the RBC supernatant. Blood pressure, blood urea nitrogen, creatinine, and change in plasma hemoglobin were not significantly different in the 2 groups. CONCLUSION In a randomized trial among children at risk for reduced NO bioavailability, we found that BNP, blood pressure, creatinine, and plasma hemoglobin were not higher in patients receiving RBCs stored for 25-35 versus 1-10 days.
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Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, Ddungu H, Kyeyune D, Musisi E, Opoka R, Stowell CP, Dzik WH. Cerebral Oximetry in Ugandan Children With Severe Anemia: Clinical Categories and Response to Transfusion. JAMA Pediatr 2016; 170:995-1002. [PMID: 27532507 DOI: 10.1001/jamapediatrics.2016.1254] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Severe anemia, defined as a hemoglobin level of less than 5.0 g/dL, affects millions of children worldwide. The brain has a high basal demand for oxygen and is especially vulnerable to hypoxemia. Previous studies have documented neurocognitive impairment in children with severe anemia. Data on cerebral tissue oxygenation in children with severe anemia and their response to blood transfusion are limited. OBJECTIVE To measure hemoglobin saturation in cerebral tissue (cerebral tissue oxygen saturation [tSo2]) before, during, and after blood transfusion in a cohort of children presenting to hospital with severe anemia. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, observational cohort study conducted from February 2013 through May 2015 and analyzed in July 2015 at a university hospital pediatric acute care facility in Kampala, Uganda, of 128 children, ages 6 to 60 months who were enrolled in a larger clinical trial, with a presenting hemoglobin level of less than 5.0 g/dL and a blood lactate level greater than 5mM. Most children had either malaria or sickle cell disease. EXPOSURES Red blood cell (RBC) transfusion given as 10 mL/kg over 120 minutes. MAIN OUTCOMES AND MEASURES Clinical and laboratory characteristics of children with pretransfusion cerebral tSo2 levels less than 65%, 65% to 75%, and greater than 75%. Change in cerebral tSo2 as a result of transfusion. RESULTS Of 128 children included in the study, oximetry results in 8 cases were excluded owing to motion artifacts; thus, 120 were included in this analysis. Cerebral tSo2 values prior to transfusion ranged from 34% to 87% (median, 72%; interquartile range [IQR], 65%-76%). Eighty-one children (67%) demonstrated an initial cerebral tSo2 level (≤75%) corresponding to an oxygen extraction ratio greater than 0.36. Patients with sickle cell disease (n = 17) and malaria (n = 15) contributed in nearly equal numbers to the subgroup with an initial cerebral tSo2 (<65%). The level of consciousness, hemoglobin concentration, blood lactate level, and thigh muscle tSo2 level were poor predictors of cerebral oxygen saturation. Following RBC transfusion, the median (IQR) cerebral tSo2 level increased to 78% (73%-82%) (P < .001), but 21% of children failed to achieve a tSo2 level greater than 75%. CONCLUSIONS AND RELEVANCE Severe anemia in children is frequently associated with low cerebral oxygenation levels as measured by near-infrared spectroscopy. Hemoglobin level and lactate concentration did not predict low cerebral tSo2 levels. Cerebral tSo2 levels increase with RBC transfusion with different patterns of response. More studies are needed to evaluate the use of noninvasive cerebral tissue oximetry in the care of children with severe anemia.
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Affiliation(s)
- Aggrey Dhabangi
- Department of Pediatrics, Child Health and Development Centre, Makerere University, Kampala, Uganda
| | | | | | - Henry Ddungu
- Uganda Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Ezra Musisi
- Uganda National Blood Transfusion Service, Kampala, Uganda
| | - Robert Opoka
- Department of Pediatrics, Mulago Hospital, Kampala, Uganda7Makerere University, Kampala, Uganda
| | - Christopher P Stowell
- Department of Pathology, Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Walter H Dzik
- Department of Pathology, Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston
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Hume HA, Ddungu H, Angom R, Baluku H, Kajumbula H, Kyeyune-Byabazaire D, Orem J, Ramirez-Arcos S, Tobian AA. Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions. Transfusion 2016; 56:1951-9. [PMID: 27079627 PMCID: PMC5518785 DOI: 10.1111/trf.13594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 12/31/2015] [Revised: 02/20/2016] [Accepted: 02/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS This prospective, observational study evaluated the rate of BC in whole blood-derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.
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Affiliation(s)
- Heather A. Hume
- CHU Ste Justine, University of Montreal, Montreal, QC, Canada
| | | | | | | | - Henry Kajumbula
- College of Health Sciences, Makerere University, Kampala, Uganda
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Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, Ddungu H, Kyeyune D, Musisi E, Opoka R, Stowell CP, Dzik WH. Effect of Transfusion of Red Blood Cells With Longer vs Shorter Storage Duration on Elevated Blood Lactate Levels in Children With Severe Anemia: The TOTAL Randomized Clinical Trial. JAMA 2015; 314:2514-23. [PMID: 26637812 DOI: 10.1001/jama.2015.13977] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although millions of transfusions are given annually worldwide, the effect of red blood cell (RBC) unit storage duration on oxygen delivery is uncertain. OBJECTIVE To determine if longer-storage RBC units are not inferior to shorter-storage RBC units for tissue oxygenation as measured by reduction in blood lactate levels and improvement in cerebral tissue oxygen saturation among children with severe anemia. DESIGN, SETTING, AND PARTICIPANTS Randomized noninferiority trial of 290 children (aged 6-60 months), most with malaria or sickle cell disease, presenting February 2013 through May 2015 to a university-affiliated national referral hospital in Kampala, Uganda, with a hemoglobin level of 5 g/dL or lower and a lactate level of 5 mmol/L or higher. INTERVENTIONS Patients were randomly assigned to receive RBC units stored 25 to 35 days (longer-storage group; n = 145) vs 1 to 10 days (shorter-storage group; n = 145). All units were leukoreduced prior to storage. All patients received 10 mL/kg of RBCs during hours 0 through 2 and, if indicated per protocol, an additional 10 mL/kg during hours 4 through 6. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with a lactate level of 3 mmol/L or lower at 8 hours using a margin of noninferiority equal to an absolute difference of 25%. Secondary measures included noninvasive cerebral tissue oxygen saturation during the first transfusion, clinical and laboratory changes up to 24 hours, and survival and health at 30 days after transfusion. Adverse events were monitored up to 24 hours. RESULTS In the total population of 290 children, the mean (SD) presenting hemoglobin level was 3.7 g/dL (1.3) and mean lactate level was 9.3 mmol/L (3.4). Median (interquartile range) RBC unit storage was 8 days (7-9) for shorter storage vs 32 days (30-34) for longer storage without overlap. The proportion achieving the primary end point was 0.61 (95% CI, 0.52 to 0.69) in the longer-storage group vs 0.58 (95% CI, 0.49 to 0.66) in the shorter-storage group (between-group difference, 0.03 [95% CI, -0.07 to ∞], P < .001), meeting the prespecified margin of noninferiority. Mean lactate levels were not statistically different between the 2 groups at 0, 2, 4, 6, 8, or 24 hours. Kaplan-Meier analysis and global nonlinear regression revealed no statistical difference in lactate reduction between the 2 groups. Clinical assessment, cerebral oxygen saturation, electrolyte abnormalities, adverse events, survival, and 30-day recovery were also not significantly different between the groups. CONCLUSIONS AND RELEVANCE Among children with lactic acidosis due to severe anemia, transfusion of longer-storage compared with shorter-storage RBC units did not result in inferior reduction of elevated blood lactate levels. These findings have relevance regarding the efficacy of stored RBC transfusion for patients with critical tissue hypoxia and lactic acidosis due to anemia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01586923.
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Affiliation(s)
- Aggrey Dhabangi
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | | | | | - Henry Ddungu
- Uganda Cancer Institute, Makerere University, Kampala, Uganda
| | | | - Ezra Musisi
- Uganda National Blood Transfusion Service, Kampala, Uganda
| | - Robert Opoka
- Mulago Hospital Department of Paediatrics, Makerere University, Kampala, Uganda
| | - Christopher P Stowell
- Blood Transfusion Service, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Walter H Dzik
- Blood Transfusion Service, Harvard Medical School, Massachusetts General Hospital, Boston
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Dzik WS, Kyeyune D, Otekat G, Natukunda B, Hume H, Kasirye PG, Ddungu H, Kajja I, Dhabangi A, Mugyenyi GR, Seguin C, Barnes L, Delaney M. Transfusion Medicine in Sub-Saharan Africa: Conference Summary. Transfus Med Rev 2015; 29:195-204. [PMID: 25752939 DOI: 10.1016/j.tmrv.2015.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/04/2015] [Accepted: 02/12/2015] [Indexed: 11/27/2022]
Abstract
In November 2014, a 3-day conference devoted to transfusion medicine in sub-Saharan Africa was held in Kampala, Uganda. Faculty from academic institutions in Uganda provided a broad overview of issues pertinent to transfusion medicine in Africa. The conference consisted of lectures, demonstrations, and discussions followed by 5 small group workshops held at the Uganda Blood Transfusion Service Laboratories, the Ugandan Cancer Institute, and the Mulago National Referral Hospital. Highlighted topics included the challenges posed by increasing clinical demands for blood, the need for better patient identification at the time of transfusion, inadequate application of the antiglobulin reagent during pretransfusion testing, concern regarding proper recognition and evaluation of transfusion reactions, the expanded role for nurse leadership as a means to improve patient outcomes, and the need for an epidemiologic map of blood usage in Africa. Specialty areas of focus included the potential for broader application of transcranial Doppler and hydroxyurea therapy in sickle cell disease, African-specific guidelines for transfusion support of cancer patients, the challenges of transfusion support in trauma, and the importance of African-centered clinical research in pediatric and obstetric transfusion medicine. The course concluded by summarizing the benefits derived from an organized quality program that extended from the donor to the recipient. As an educational tool, the slide-audio presentation of the lectures will be made freely available at the International Society of Blood Transfusion Academy Web site: http://www.isbtweb.org/academy/.
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Affiliation(s)
| | - Dorothy Kyeyune
- Uganda Blood Transfusion Service, Kampala, Uganda; Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Otekat
- Uganda Blood Transfusion Service, Kampala, Uganda
| | | | - Heather Hume
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Henry Ddungu
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Kajja
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Aggrey Dhabangi
- Makerere University College of Health Sciences, Kampala, Uganda
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Butler EK, Hume H, Birungi I, Ainomugisha B, Namazzi R, Ddungu H, Kajja I, Nabadda S, McCullough J. Blood utilization at a national referral hospital in sub-Saharan Africa. Transfusion 2015; 55:1058-66. [PMID: 25646993 DOI: 10.1111/trf.13010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND A safe and adequate supply of blood is critical to improving health care systems in sub-Saharan Africa, where little is known about the current use of blood. The aim of this study was to comprehensively describe the use of blood at a tertiary care hospital to inform future efforts to strengthen blood programs in resource-limited settings. STUDY DESIGN AND METHODS Data were collected from blood bank documentation for all units issued at Mulago Hospital Complex in Kampala, Uganda, from mid-January to mid-April 2014. RESULTS A total of 6330 units (69% whole blood, 32% red blood cells, 6% platelets, 2% plasma) were issued over the 3-month study period to 3662 unique patients. Transfusion recipients were 58% female and median age was 27 years (interquartile range [IQR], 14-41). Median pretransfusion hemoglobin was 5.6 g/dL (IQR, 4.0-7.2 g/dL, n = 1090). Strikingly, cancer was the top indication for transfusion (33.5%), followed by pregnancy-related complications (12.4%) and sickle cell disease (6.9%). CONCLUSION This study provides a comprehensive picture of blood use at a national referral hospital in sub-Saharan Africa. Noncommunicable diseases, particularly oncologic conditions, represent a large proportion of demand for transfusion services.
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Affiliation(s)
- Elissa K Butler
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Heather Hume
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | | | - Brenda Ainomugisha
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ruth Namazzi
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Ddungu
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Cancer Institute, Kampala, Uganda
| | - Isaac Kajja
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Waiswa M, Seremba E, Ocama P, Ddungu H, Opio K, Okello C, O'shea T, Verhovsek M, Mutyabule R. Splanchnic venous thrombosis driven by a constitutively activated JAK2 V617F philadelphia-negative myeloproliferative neoplasm: a case report. Afr Health Sci 2014; 14:1069-73. [PMID: 25834519 DOI: 10.4314/ahs.v14i4.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Splanchnic venous thrombosis (SVT) has varied etiology with Philadelphia-negative myeloproliferative neoplasms (MPNs) being the most frequent underlying prothrombotic factor. Hematological indices often remain within normal range because of portal hypertension and its sequelae, causing diagnostic challenges. The high frequency of JAK2 mutation among patients with SVT reinforces the diagnostic utility of JAK2V617F testing. CASE REPORT We report a case of a 62-year-old black man with progressive abdominal swelling and features of decompensated chronic liver disease found to have SVT-portal vein thrombosis and how JAK2 V617F was useful in unmasking an underlying myeloproliferative neoplasm. CONCLUSION A high index of suspicion for an underlying prothrombotic factor is critical for patients presenting with thrombosis in unusual sites. This is useful in prognostic stratification and patient outcomes. JAK2 mutation screening is now part of the standard diagnostic workup in SVT.
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Affiliation(s)
- Musa Waiswa
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Emmanuel Seremba
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Ponsiana Ocama
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Henry Ddungu
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Keneth Opio
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Clement Okello
- Department of Medicine, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Timothy O'shea
- Department of Medicine, McMaster University, Hamilton Ontario, Canada
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Bwayo D, Kaddumukasa M, Ddungu H, Kironde F. Prevalence of glucose-6-phosphate dehydrogenase deficiency and its association with Plasmodium falciparum infection among children in Iganga distric in Uganda. BMC Res Notes 2014; 7:372. [PMID: 24943486 PMCID: PMC4080728 DOI: 10.1186/1756-0500-7-372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 09/13/2013] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) is a metabolic enzyme involved in the pentose phosphate pathway, its especially important in red blood cell metabolism. Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive hereditary disease characterised by abnormally low levels of G6PD. About 400 million people worldwide have a deficiency of this enzyme. The remarkable geographic correlation of G6PD deficiency distribution with historical endemicity patterns of malaria has led to suggestions that the two could be linked. Some studies have concluded that G6PD deficiency confers resistance to malaria. Objective To determine the prevalence of G6PD deficiency, and determine its relationship with prevalence and incidence of P. falciparum infection among children in Uganda. Methods This was longitudinal study involving 245 children, 135 were actively followed up for 12 months. G6PD status was assessed for using PCR-RFLP method. A thick smear was done to determine presence of plasmodium trophozoites and parasite densities. Results A total of 245 children between 6 months and 9 years were recruited. Of these 46.5% were males. Overall prevalence for the X-linked G6PD A- mutation was; 79.59% wild type, 12.65% heterozygous and 7.76% homozygous or hemizygous. Among the males 14% were hemizygous. At baseline, 40.8% had asymptomatic P falciparum infection. There was no statistically significant difference in prevalence and incidence rates of malaria infection among the different G6PD genotypes with prevalence among heterozygous, homozygous, and wild type being 29%, 42.6% and 43% respectively (p = 0.11) and incidence among heterozygous and wild type being 0.56 and 0.52 episodes/year (p = 0.5). The heterozygous G6PD A- females had a lower parasite density compared to the wild type (2505 vs 941 parasites/μL; P = 0.024). Conclusions This study showed that 20.41% of the population in this part of Uganda carry the G6PD A-mutation, within the range of 15-32% seen in other parts of Africa. P. falciparum infection incidence and prevalence rates are similar among the G6PD genotypes though, once infected, P. falciparum parasite densities are lowest among G6PD A- heterozygous females. This suggests differences in P. falciparum infection rates and severity of disease could be mediated by differences in parasite densities among the different G6PD genotypes.
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Affiliation(s)
| | - Mark Kaddumukasa
- Department of Medicine, Makerere University College of Health, Sciences, Kampala, Uganda.
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Waiswa MK, Moses A, Seremba E, Ddungu H, Hume HA. Acute transfusion reactions at a national referral hospital in Uganda: a prospective study. Transfusion 2014; 54:2804-10. [PMID: 24805348 DOI: 10.1111/trf.12684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very little has been published about acute transfusion reactions (ATRs) in developing countries. This study was undertaken to determine the incidence, type, imputability, severity, and possible associated factors of ATRs observed in a university-affiliated hospital in Uganda. STUDY DESIGN AND METHODS We prospectively followed the transfusion of blood units issued over a 7-week period from the hospital blood bank during regular working hours to nonbleeding patients. For each transfusion, we recorded the patient's status before, during, at the end of, and 4 hours after transfusion. Three physicians independently reviewed all reports of suspected ATRs and related hospital charts. Using predefined criteria, the presence, type, imputability, and severity of ATRs were adjudicated by consensus of two of three physicians. Factors potentially associated with ATRs were analyzed for statistical significance. RESULTS A total of 507 transfusions were analyzed. Fifty-three acute transfusion events were recorded and 49 of 53 or 9.6% of the 507 transfusions were confirmed to be ATRs by physician consensus: 24 febrile, seven allergic, five hypertensive, three hypotensive, three transfusion-associated circulatory overload, two acute hemolytic, and five others. Imputability of ATRs was definite, probable, or possible in 45 of 49 ATRs (92% of ATRs or 8.9% of transfusions) and judged to be severe in nine of 45. No significant associated factors were identified. CONCLUSIONS Our findings suggest that ATRs may occur more commonly in resource-limited settings than in high-income countries. Although some reactions are unavoidable, improved surveillance of transfusions and implementation of transfusion guidelines could improve the safety of transfusions in these settings.
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Affiliation(s)
- Musa K Waiswa
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Cleary J, Ddungu H, Distelhorst SR, Ripamonti C, Rodin GM, Bushnaq MA, Clegg-Lamptey JN, Connor SR, Diwani MB, Eniu A, Harford JB, Kumar S, Rajagopal MR, Thompson B, Gralow JR, Anderson BO. Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast 2013; 22:616-27. [PMID: 23972474 DOI: 10.1016/j.breast.2013.07.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 12/25/2022] Open
Abstract
Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.
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Affiliation(s)
- James Cleary
- University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum MALARIA in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 2013; 88:747-756. [PMID: 23358640 PMCID: PMC3617864 DOI: 10.4269/ajtmh.12-0668] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Walter H. Dzik
- *Address correspondence to Walter H. Dzik, Department of Pathology, Blood Transfusion Service, J224, Harvard University, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail:
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Namisango E, Harding R, Atuhaire L, Ddungu H, Katabira E, Muwanika FR, Powell RA. Pain among ambulatory HIV/AIDS patients: multicenter study of prevalence, intensity, associated factors, and effect. J Pain 2012; 13:704-13. [PMID: 22748803 DOI: 10.1016/j.jpain.2012.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/05/2012] [Accepted: 04/30/2012] [Indexed: 12/01/2022]
Abstract
UNLABELLED This study aimed to determine the prevalence, intensity, associated factors, and effect of pain among ambulatory HIV/AIDS patients. Three-hundred two adult ambulatory HIV/AIDS patients were consecutively recruited from HIV/AIDS outpatient clinics at 2 teaching hospitals in Uganda. The presence and intensity of pain were self-reported using the Brief Pain Inventory (BPI); symptom data were collected using the Memorial Symptom Assessment Scale (MSAS-SF); and quality of life (QOL) was assessed using the Medical Outcome Scale-HIV. Forty-seven percent reported pain in the 7 days prior to the survey and pain was a symptom at the time of diagnosis for 68%. On the 0 to 10 numeric scale, 53% reported mild pain (1-4 rating), 20% reported moderate pain (5-6 rating) while 27% reported severe pain (7-10 rating). Gender was not associated with pain intensity, but reduced functional performance, increasing number of symptoms, advanced HIV disease , physical symptom distress (MSAS-SF), and number of health comorbidities were significantly associated with pain intensity (P < .04). Increasing pain intensity was associated with greater functional ability impairment (BPI functional interference index) and poorer QOL. Pain is a common symptom among ambulatory HIV/AIDS patients and has a debilitating effect on QOL. There is a significant unmet need for pain relief in the population. PERSPECTIVE This article discusses the characteristics and effect of pain on function and QOL in East African patients. It also contributes information on characteristics of HIV/AIDS adult patients in the East Africa demonstrating the aspects in which pain is similar across different cultures.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda.
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Mpalampa L, Ndugwa CM, Ddungu H, Idro R. Foetal haemoglobin and disease severity in sickle cell anaemia patients in Kampala, Uganda. BMC Blood Disord 2012; 12:11. [PMID: 22958547 PMCID: PMC3520739 DOI: 10.1186/1471-2326-12-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022]
Abstract
UNLABELLED BACKGROUND Sickle cell anaemia (SCA) is a major chronic health problem in Uganda. In patients with SCA, the level of foetal haemoglobin (HbF) has been found to be important in influencing the clinical course of the disease. Thus populations with high levels of HbF like those in Saudi Arabia have been described as having a milder clinical course with fewer complications as compared to populations with lower levels. Disease modifying drugs can increase the Hb F levels and modify the presentation of SCA. METHODS This was a cross sectional study in which we determined foetal haemoglobin levels and examined the relationship between HbF levels and disease severity in SCA patients in Mulago Hospital, Kampala, Uganda. We consecutively enrolled 216 children aged 1 year to 18 years with SCA attending the Sickle Cell Clinic at Mulago Hospital whose guardians had given consent. The history included age at onset of initial symptoms and diagnosis, number of hospitalisations and blood transfusions and other complications of SCA (cardiovascular accidents, avascular hip necrosis and priapism). A detailed physical examination was performed to assess the current state and help describe the disease severity for each patient. Blood samples were drawn for HbF levels. HbF levels ≥10% was defined as high. RESULTS Of the 216 children, (80) 37% had HbF levels ≥10%. Significant correlations were observed between HbF level and several clinical parameters independent of age including age at diagnosis (p value 0.013), number of hospitalisations (p value 0.024) and transfusions (p value 0.018) since birth. CONCLUSION A third of the children with SCA attending the Sickle cell clinic in Mulago Hospital have high HbF levels. Higher HbF level is associated with later onset of symptoms and presentation, and less severe disease characterised by fewer hospitalisations and blood transfusions. We suggest HbF levels should be determined at initial contact for patients with SCA to guide counselling and identify those who may need closer follow up and consideration for disease modifying drugs.
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Affiliation(s)
| | - Christopher M Ndugwa
- Department of Paediatrics, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Henry Ddungu
- Department of Medicine and Uganda Cancer Institute, Mulago Hospital, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics, Mulago Hospital/ Makerere University, College of Health Sciences, Kampala, Uganda
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, UK
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Cytoadherence in paediatric malaria: ABO blood group, CD36, and ICAM1 expression and severe Plasmodium falciparum infection. Br J Haematol 2012; 159:223-36. [PMID: 22909232 PMCID: PMC3470923 DOI: 10.1111/bjh.12014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 05/21/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
Abstract
As a leading cause of childhood mortality worldwide, selection pressure by Plasmodium falciparum continues to shape the human genome. Severe disturbances within the microcirculation result from the adhesion of infected erythrocytes to host receptors on monocytes, platelets, and endothelium. In this prospective study, we compared expression of all major host cytoadhesion receptors among Ugandan children presenting with uncomplicated malaria (n = 1078) versus children with severe malaria (n = 855), including cerebral malaria (n = 174), severe anaemia (n = 522), and lactic acidosis (n = 154). We report a significant survival advantage attributed to blood group O and increased monocyte expression of CD36 and ICAM1 (CD54). The high case fatality rate syndromes of cerebral malaria and lactic acidosis were associated with high platelet CD36 expression and thrombocytopenia, and severe malaria anaemia was characterized by low ICAM1 expression. In a logistic regression model of disease severity, odds ratios for the mitigating effects of blood group O, CD36, and ICAM1 phenotypes were greater than that of sickle haemoglobin. Host genetic adaptations to Plasmodium falciparum suggest new potential malaria treatment strategies.
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Semeere AS, Nakanjako D, Ddungu H, Kambugu A, Manabe YC, Colebunders R. Sub-optimal vitamin B-12 levels among ART-naïve HIV-positive individuals in an urban cohort in Uganda. PLoS One 2012; 7:e40072. [PMID: 22768330 PMCID: PMC3388039 DOI: 10.1371/journal.pone.0040072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 05/31/2012] [Indexed: 11/19/2022] Open
Abstract
Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART) naïve adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals' Joint AIDS Program (MJAP) or the Infectious Diseases Institute (IDI) clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200-900). Sub-optimal vitamin B-12 levels (<300 pg/ml) were found in 75/204 (36.8%). Twenty-one of 204 (10.3%) had vitamin B-12 deficiency (<200 pg/ml) while 54/204 (26.5%) had marginal depletion (200-300 pg/ml). Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1-5.6, P=0.03). Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (± 5.1) vs. 83 fl (± 8.4) vs. 82 fl (± 8.4) for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P=0.017). Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (± 27.1) vs. 29.4 months (± 23.8; P=0.02). Participants eligible for ART (CD4<350 cells/µl) with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (± 145) vs. 22 (± 115) cells/µl/year, P=0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal vitamin B-12, and explore the role of vitamin B-12 supplementation in immune recovery.
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Affiliation(s)
- Aggrey S Semeere
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
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Powell RA, Kaye RM, Ddungu H, Mwangi-Powell F. Advancing drug availability-experiences from Africa. J Pain Symptom Manage 2010; 40:9-12. [PMID: 20619205 DOI: 10.1016/j.jpainsymman.2010.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 04/07/2010] [Accepted: 04/16/2010] [Indexed: 11/21/2022]
Abstract
International health and drug regulatory authorities acknowledge that analgesics (especially opioids) are insufficiently available for pain management in many countries. In Africa, reported morphine consumption is far below the global mean, with multiple factors hampering opioid supply. Since 2006, the African Palliative Care Association has hosted three regional drug availability workshops across the continent to address this issue. Using an interactive format, the workshops have identified country-specific barriers to opioid and other essential medication accessibility before supporting participants to develop action plans to address recognized impediments. Despite multiple challenges, a number of successes have arisen from the implementation of the plans. However, key issues remain, including the introduction of supportive policy environments, effective educational initiatives, and measures to address supply-chain obstacles impeding drug availability.
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Mukaya JE, Ddungu H, Ssali F, O'Shea T, Crowther MA. Prevalence and morphological types of anaemia and hookworm infestation in the medical emergency ward, Mulago Hospital, Uganda. S Afr Med J 2009; 99:881-886. [PMID: 20459999] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 07/09/2009] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Anaemia is common worldwide, although the burden is highest in developing countries where nutrient deficiencies and chronic infections are prevalent. OBJECTIVE To determine the prevalence and morphological types of anaemia and assess the hookworm burden among patients in the medical emergency ward at Mulago national referral hospital, Uganda. METHODS In a cross-sectional descriptive study 395 patients were recruited by systematic random sampling and their socio-demographic characteristics and clinical details collected. A complete blood count and peripheral film examination were done and stool examined for hookworm ova. STATISTICAL ANALYSIS Data were processed using Epi-Info version 6 and Stata version 9. The chi-square test was used for categorical variables and Student's t-test for non-categorical variables. Multiple logistic regression was used to determine factors predictive of anaemia. RESULTS Of the patients 255 (64.6%) had anaemia. The prevalence was higher among males (65.8%) than females (63.7%). Fatigue (odds ratio (OR) 2.1, confidence interval (CI) 1.37 - 3.24), dizziness (OR 1.64, CI 1.07 - 2.44), previous blood transfusion (OR 2.83, CI 1.32 - 6.06), lymphadenopathy (OR 2.99, CI 1.34 - 6.66) and splenomegaly (OR 5.22, CI 1.78 - 15.28) were significantly associated with anaemia. Splenomegaly, low body mass index (BMI) (<19) and being HIV positive were independently associated with anaemia. The commonest type of anaemia was hypochromic microcytic (34.1%). Only 10.6% of anaemic patients had hookworm infestation. CONCLUSIONS In our study the prevalence of anaemia (64.6%) was very high. Splenomegaly, HIV infection and low BMI were independently associated with anaemia. The commonest type of anaemia was microcytic hypochromic (34.1%). There was a low prevalence of hookworm infestation.
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Ddungu H, Johnson JL, Smieja M, Mayanja-Kizza H. Digital clubbing in tuberculosis--relationship to HIV infection, extent of disease and hypoalbuminemia. BMC Infect Dis 2006; 6:45. [PMID: 16529654 PMCID: PMC1462994 DOI: 10.1186/1471-2334-6-45] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 03/10/2006] [Indexed: 11/29/2022] Open
Abstract
Background Digital clubbing is a sign of chest disease known since the time of Hippocrates. Its association with tuberculosis (TB) has not been well studied, particularly in Africa where TB is common. The prevalence of clubbing in patients with pulmonary TB and its association with Human Immunodeficiency Virus (HIV), severity of disease, and nutritional status was assessed. Methods A cross-sectional study was carried out among patients with smear-positive TB recruited consecutively from the medical and TB wards and outpatient clinics at a public hospital in Uganda. The presence of clubbing was assessed by clinical signs and measurement of the ratio of the distal and inter-phalangeal diameters (DPD/IPD) of both index fingers. Clubbing was defined as a ratio > 1.0. Chest radiograph, serum albumin and HIV testing were done. Results Two hundred patients (82% HIV-infected) participated; 34% had clubbing by clinical criteria whilst 30% had clubbing based on DPD/IPD ratio. Smear grade, extensive or cavitary disease, early versus late HIV disease, and hypoalbuminemia were not associated with clubbing. Clubbing was more common among patients with a lower Karnofsky performance scale score or with prior TB. Conclusion Clubbing occurs in up to one-third of Ugandan patients with pulmonary TB. Clubbing was not associated with stage of HIV infection, extensive disease or hypoalbuminemia.
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Affiliation(s)
- Henry Ddungu
- Department of Medicine, Makerere University and Mulago Hospital, Kampala, Uganda
| | - John L Johnson
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Marek Smieja
- Departments of Pathology and Molecular Medicine, Medicine, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON, Canada
- L424 St. Joseph's Hospital, 50 Charlton Ave. E., Hamilton ON L8N 4A6, Canada
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