Isaac Sekitoleko - Academia.edu (original) (raw)

Papers by Isaac Sekitoleko

Research paper thumbnail of Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: Findings from four population cohorts

PLOS global public health, Dec 5, 2023

We investigated prevalence and demographic characteristics of adults living with multimorbidity (... more We investigated prevalence and demographic characteristics of adults living with multimorbidity (�2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling. Median participant age was 29 (Inter quartile range-IQR 22-38), 34 (IQR25-48), 32 (IQR 22-53) and 37 (IQR 26-51) in urban Malawi, rural Malawi, The Gambia, and Uganda, respectively. Age standardised multimorbidity prevalence was higher in urban and rural Malawi (22.5%;95% Confidence intervals-CI 21.6-23.4%) and 11.7%; 95%CI 11.1-12.3, respectively) than in The Gambia (2.9%; 95%CI 2.5-3.4%) and Uganda (8.2%; 95%CI 7.5-9%) cohorts. In multivariate models, females were at greater risk of multimorbidity than males in Malawi (Incidence rate ratio-IRR 1.97, 95% CI 1.79-2.16 urban and IRR 2.10; 95% CI 1.86-2.37 rural) and Uganda (IRR-1.60, 95% CI 1.32-1.95), with no evidence of difference between the sexes in The Gambia (IRR 1.16, 95% CI 0.86-1.55). There was strong evidence of greater multimorbidity risk with increasing age in all populations (p-value <0.001). Higher educational attainment was associated with increased multimorbidity risk in Malawi (IRR 1.78; 95% CI 1.60-1.98 urban and IRR 2.37; 95% CI 1.74-3.23 rural) and Uganda (IRR 2.40, 95% CI 1.76-3.26), but not in The Gambia (IRR 1.48; 95% CI 0.56-3.87). Further research is needed to study multimorbidity epidemiology in sub-Saharan Africa with an emphasis on robust population-level data collection for a wide variety of longterm conditions and ensuring proportionate representation from men and women, and urban and rural areas.

Research paper thumbnail of Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question

BMC Health Services Research

Background Interventions for non-communicable diseases are increasingly implemented and evaluated... more Background Interventions for non-communicable diseases are increasingly implemented and evaluated in sub-Saharan Africa, but little is known about their medium- to long-term sustainability beyond the end of research funding. A cluster randomised trial conducted between 2013 and 2016 in Uganda and Tanzania showed that an intervention package to improve hypertension (HT) and type-2 diabetes mellitus (DM) care was highly effective in increasing service readiness and quality of care. The present study assesses the sustainability of the intervention 4 years after the trial in Uganda. Methods The study was conducted in 2020 in 22 primary care health facilities (HFs) (3 referrals and 19 lower-level units) that had received the intervention package until trial end (2016), to assess their current capacity and practice to sustain ongoing intervention activities for HT and DM care. Through a cross-sectional survey, 4 pre-defined domains (i.e., cognitive participation, coherence, collective act...

Research paper thumbnail of Growth Profiles of Children and Adolescents Living with and without Perinatal HIV Infection in Southern Africa: A Secondary Analysis of Cohort Data

Nutrients

Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection.... more Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection. We characterised growth relative to population norms, among the full adolescent period in southern Africa to better understand processes leading to morbidity in adulthood. We conducted a secondary analysis of 945 adolescents aged 8–20 years from urban Malawi and Zimbabwe; we included children with HIV (CWH), an uninfected comparison group from a cohort study, and CWH with co-morbid chronic lung disease (CLD) from a randomised controlled trial. We used latent class analysis of anthropometric Z-scores generated from British 1990 reference equations at two annual time-points, to identify growth trajectory profiles and used multinomial logistic regression to identify factors associated with growth profiles. Growth faltering (one or more of weight-for-age, height-for-age, or BMI-for-age Z-scores < −2) occurred in 38% (116/303) of CWH from the cohort study, 62% (209/336) of CWH with CLD, a...

Research paper thumbnail of Mortality Among Smokers and Non-Smokers with COPD

Research paper thumbnail of Role of Health-Focused Economic Empowerment Programs Aimed at Increasing ART Adherence Among Adolescents Living with HIV in Uganda: A Randomized Controlled Trial

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 18, 2014

Research paper thumbnail of Understanding the pathogenesis of lean non-autoimmune diabetes in an African population with newly diagnosed diabetes

Diabetologia, Feb 9, 2022

Aims/hypothesis Apparent type 2 diabetes is increasingly reported in lean adult individuals in su... more Aims/hypothesis Apparent type 2 diabetes is increasingly reported in lean adult individuals in sub-Saharan Africa. However, studies undertaking robust clinical and metabolic characterisation of lean individuals with new-onset type 2 diabetes are limited in this population. This cross-sectional study aimed to perform a detailed clinical and metabolic characterisation of newly diagnosed adult patients with diabetes in Uganda, in order to compare features between lean and non-lean individuals. Methods Socio-demographic, clinical, biophysical and metabolic (including oral glucose tolerance test) data were collected on 568 adult patients with newly diagnosed diabetes. Participants were screened for islet autoantibodies to exclude those with autoimmune diabetes. The remaining participants (with type 2 diabetes) were then classified as lean (BMI <25 kg/m 2) or non-lean (BMI ≥25 kg/m 2), and their socio-demographic, clinical, biophysical and metabolic characteristics were compared. Results Thirty-four participants (6.4%) were excluded from analyses because they were positive for pancreatic autoantibodies, and a further 34 participants because they had incomplete data. For the remaining 500 participants, the median (IQR) age, BMI and HbA 1c were 48 years (39-58), 27.5 kg/m 2 (23.6-31.4) and 90 mmol/mol (61-113) (10.3% [7.7-12.5]), respectively, with a female predominance (approximately 57%). Of the 500 participants, 160 (32%) and 340 (68%) were lean and non-lean, respectively. Compared with non-lean participants, lean participants were mainly male (60.6% vs 35.3%, p<0.001) and had lower visceral adiposity level (5 [4-7] vs 11 [9-13], p<0.001) and features of the metabolic syndrome (uric acid, 246.5 [205.0-290.6] vs 289 [234-347] μmol/l, p<0.001; leptin, 660.9 [174.5-1993.1] vs 3988.0 [1336.0-6595.0] pg/ml, p<0.001). In addition, they displayed markedly reduced markers of beta cell function (oral insulinogenic index 0.

Research paper thumbnail of Influence of Lung Function and Cardiovascular Disease on Mortality

Research paper thumbnail of Level of education and preferred language of informed consent for clinical research in a multi-lingual community

African Health Sciences, Jul 22, 2020

Background: Low education levels and language barriers present challenges in obtaining informed c... more Background: Low education levels and language barriers present challenges in obtaining informed consent for clinical research. Objective: To describe and correlate the association between the level of education and the participant's preferred language of consent. Design: Descriptive-analytical cross-sectional study. Participants: Adults being consented for participation in tuberculosis(TB) research studies in an East African community with varying levels of education. Procedures: We analyzed data on demographic and educational characteristics collected from adults being consented for participation in TB studies .Only participants who could understand and speak Luganda (the main local language) or English (the official language of Uganda) were included in this analysis. Results: A total of 523 participants were consented between April 2015 and December 2017 and included in this analysis; 250 below Senior four (< 11yrs of education), 114 senior four (at 11yrs of education),73 senior five-senior six (12-13yrs of education) and 86 beyond senior six (> 13yrs of education). We noted that the preference for English rises with the rising levels of education and peaked at beyond senior six (83%Vs17%,OR=49,95%CI:22.8-106.3,p<0.001).Participants below senior four preferred Luganda Vs senior four and above(OR=16.9,95%CI:9.9-28.8,p<0.001) Conclusion: Rising education levels of participants were associated with preference for English language usage during initial consent for clinical research studies.

Research paper thumbnail of Burden of multimorbidity in sub-saharan africa: Preliminary findings from three community studies

Context: Multimorbidity (MM) (co-occurrence of ≥2 chronic conditions (CCs)) is a global health ch... more Context: Multimorbidity (MM) (co-occurrence of ≥2 chronic conditions (CCs)) is a global health challenge. Most evidence from MM research comes from studies in high-income countries. In many low and middle-income countries (LMIC), including low-income sub-Saharan Africa (SSA), the burden of CC is rising, however, the epidemiology of MM remains relatively unknown.

Research paper thumbnail of Islet autoantibody positivity in an adult population with recently diagnosed diabetes in Uganda

PLOS ONE, May 23, 2022

This study aimed to investigate the frequency of islet autoantibody positivity in adult patients ... more This study aimed to investigate the frequency of islet autoantibody positivity in adult patients with recently diagnosed diabetes in Uganda and its associated characteristics. Methods Autoantibodies to glutamic acid decarboxylase-65 (GADA), zinc transporter 8 (ZnT8-A), and tyrosine phosphatase (IA-2A) were measured in 534 adult patients with recently diagnosed diabetes. Islet autoantibody positivity was defined based on diagnostic thresholds derived from a local adult population without diabetes. The socio-demographic, clinical, and metabolic characteristics of islet autoantibody-positive and negative participants were then compared. The differences in these characteristics were analysed using the x 2 test for categorical data and the Kruskal Wallis test for continuous data. Multivariate analysis was performed to identify predictors of islet autoantibody positivity. Results Thirty four (6.4%) participants were positive for �1 islet autoantibody. GADA, IA-2A and ZnT8-A positivity was detected in 17 (3.2%), 10 (1.9%), and 7 (1.3%) participants, respectively. Compared with those negative for islet autoantibodies, participants positive for islet autoantibodies were more likely to live in a rural area (n = 18, 52.9% Vs n = 127, 25.5%, p = 0.005), to be initiated on insulin therapy (n = 19, 55.9% Vs n = 134, 26.8%, p<0.001), to have a lower median waist circumference (90 [80-99] cm Vs 96 [87-104.8], p = 0.04), waist circumference: height ratio (0.

Research paper thumbnail of Sputum smear-positive, culture-negative state during anti-tuberculosis treatment in the MGIT liquid culture era

International Journal of Tuberculosis and Lung Disease, Mar 1, 2018

Research paper thumbnail of Barriers to TB Care During the COVID19 Pandemic: A Comparison Between Urban and Rural Populations in Uganda

Research paper thumbnail of Technology in Survey Data Collection: Cost-Effective Advances from Limited-Resource Settings

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 18, 2014

Research paper thumbnail of Medium-to-long term sustainability of a health systems intervention to improve service readiness and quality of non-communicable disease (NCD) patient care and experience at primary care settings in Uganda

BMC Health Services Research

Background With the double burden of rising chronic non-communicable diseases (NCDs) and persiste... more Background With the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed. Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services. In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial’s original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received. Methods Cross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical ...

Research paper thumbnail of Identification and characterisation of diabetes in Uganda: protocol for the nested, population-based ‘Diabetes in low-resource Populations’ (DOP) Study

BMJ Open

IntroductionSub-Saharan Africa is experiencing an increasing burden of diabetes, but there are li... more IntroductionSub-Saharan Africa is experiencing an increasing burden of diabetes, but there are little reliable data, particularly at the community level, on the true prevalence or why this condition affects young and relatively lean individuals. Moreover, the detection of diabetes in Africa remains poor, not only due to a lack of resources but because the performance of available diagnostic tests is unclear.MethodsThis research aims to (1) determine the prevalence and risk factors of diabetes in a rural Ugandan population, (2) use clinical and biochemical markers to define different diabetes phenotypes and (3) study the progression of diabetes in this population. We will also assess the utility of the widely used tests (glycated haemoglobin (HbA1c), oral glucose tolerance test (OGTT) and fasting glucose) in diagnosing diabetes.DesignThis is a population-based study nested within the longstanding general population cohort in southwestern Uganda. We will undertake a population survey ...

Research paper thumbnail of 1296-P: Comparison of Fingerstick and Venous Plasma Glucose in the Ugandan Diabetes in Low-Resource Populations Study

Diabetes

As Africa is experiencing the most rapid rise in the world of type 2 diabetes (T2D), identifying ... more As Africa is experiencing the most rapid rise in the world of type 2 diabetes (T2D), identifying feasible, accurate ways to measure glucose is imperative. While venous glucose (ven-glucose) is recommended, cost and lack of access to pre-analytical processing often rules out this option. Fingerstick measurement of capillary glucose (fs-glucose) is a potential alternative. But data on the correlation between fs-glucose and ven-glucose are scant. Hence OGTT were performed in 512 Ugandans (Male: 46% (234/512), age: 43±17y (mean±SD) enrolled in the Diabetes in Low Resource Populations Study with fs-glucose (Contour Plus Glucometer) and ven-glucose (Glucokinase Method, Roche Cobas 6000) obtained at 0h and 2h. To determine correlation, bias and levels of agreement, Pearson’s correlations and Bland Altman analyses were performed. T2D, preT2D and normal glucose tolerance occurred in 2% (9/512), 18% (92/512) and 80% (411/512), resp. At 0h, fs-glucose and ven-glucose were modestly correlated (...

Research paper thumbnail of Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic

PLOS Global Public Health

Background: During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likel... more Background: During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda—a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/6...

Research paper thumbnail of Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda

BMC Public Health

Background A shortage of healthcare workers in low- and middle-income countries (LMICs) combined ... more Background A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. Methods This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All in...

Research paper thumbnail of Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis

BMJ Open

ObjectiveContemporary data on the attainment of optimal diabetes treatment goals and the burden o... more ObjectiveContemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes.MethodsWe systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the...

Research paper thumbnail of The influence of fasting and post-load glucose levels on maternal and neonatal outcomes in women with hyperglycaemia in pregnancy in Uganda: A prospective observational cohort study

Diabetes Research and Clinical Practice

Research paper thumbnail of Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: Findings from four population cohorts

PLOS global public health, Dec 5, 2023

We investigated prevalence and demographic characteristics of adults living with multimorbidity (... more We investigated prevalence and demographic characteristics of adults living with multimorbidity (�2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling. Median participant age was 29 (Inter quartile range-IQR 22-38), 34 (IQR25-48), 32 (IQR 22-53) and 37 (IQR 26-51) in urban Malawi, rural Malawi, The Gambia, and Uganda, respectively. Age standardised multimorbidity prevalence was higher in urban and rural Malawi (22.5%;95% Confidence intervals-CI 21.6-23.4%) and 11.7%; 95%CI 11.1-12.3, respectively) than in The Gambia (2.9%; 95%CI 2.5-3.4%) and Uganda (8.2%; 95%CI 7.5-9%) cohorts. In multivariate models, females were at greater risk of multimorbidity than males in Malawi (Incidence rate ratio-IRR 1.97, 95% CI 1.79-2.16 urban and IRR 2.10; 95% CI 1.86-2.37 rural) and Uganda (IRR-1.60, 95% CI 1.32-1.95), with no evidence of difference between the sexes in The Gambia (IRR 1.16, 95% CI 0.86-1.55). There was strong evidence of greater multimorbidity risk with increasing age in all populations (p-value <0.001). Higher educational attainment was associated with increased multimorbidity risk in Malawi (IRR 1.78; 95% CI 1.60-1.98 urban and IRR 2.37; 95% CI 1.74-3.23 rural) and Uganda (IRR 2.40, 95% CI 1.76-3.26), but not in The Gambia (IRR 1.48; 95% CI 0.56-3.87). Further research is needed to study multimorbidity epidemiology in sub-Saharan Africa with an emphasis on robust population-level data collection for a wide variety of longterm conditions and ensuring proportionate representation from men and women, and urban and rural areas.

Research paper thumbnail of Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question

BMC Health Services Research

Background Interventions for non-communicable diseases are increasingly implemented and evaluated... more Background Interventions for non-communicable diseases are increasingly implemented and evaluated in sub-Saharan Africa, but little is known about their medium- to long-term sustainability beyond the end of research funding. A cluster randomised trial conducted between 2013 and 2016 in Uganda and Tanzania showed that an intervention package to improve hypertension (HT) and type-2 diabetes mellitus (DM) care was highly effective in increasing service readiness and quality of care. The present study assesses the sustainability of the intervention 4 years after the trial in Uganda. Methods The study was conducted in 2020 in 22 primary care health facilities (HFs) (3 referrals and 19 lower-level units) that had received the intervention package until trial end (2016), to assess their current capacity and practice to sustain ongoing intervention activities for HT and DM care. Through a cross-sectional survey, 4 pre-defined domains (i.e., cognitive participation, coherence, collective act...

Research paper thumbnail of Growth Profiles of Children and Adolescents Living with and without Perinatal HIV Infection in Southern Africa: A Secondary Analysis of Cohort Data

Nutrients

Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection.... more Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection. We characterised growth relative to population norms, among the full adolescent period in southern Africa to better understand processes leading to morbidity in adulthood. We conducted a secondary analysis of 945 adolescents aged 8–20 years from urban Malawi and Zimbabwe; we included children with HIV (CWH), an uninfected comparison group from a cohort study, and CWH with co-morbid chronic lung disease (CLD) from a randomised controlled trial. We used latent class analysis of anthropometric Z-scores generated from British 1990 reference equations at two annual time-points, to identify growth trajectory profiles and used multinomial logistic regression to identify factors associated with growth profiles. Growth faltering (one or more of weight-for-age, height-for-age, or BMI-for-age Z-scores < −2) occurred in 38% (116/303) of CWH from the cohort study, 62% (209/336) of CWH with CLD, a...

Research paper thumbnail of Mortality Among Smokers and Non-Smokers with COPD

Research paper thumbnail of Role of Health-Focused Economic Empowerment Programs Aimed at Increasing ART Adherence Among Adolescents Living with HIV in Uganda: A Randomized Controlled Trial

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 18, 2014

Research paper thumbnail of Understanding the pathogenesis of lean non-autoimmune diabetes in an African population with newly diagnosed diabetes

Diabetologia, Feb 9, 2022

Aims/hypothesis Apparent type 2 diabetes is increasingly reported in lean adult individuals in su... more Aims/hypothesis Apparent type 2 diabetes is increasingly reported in lean adult individuals in sub-Saharan Africa. However, studies undertaking robust clinical and metabolic characterisation of lean individuals with new-onset type 2 diabetes are limited in this population. This cross-sectional study aimed to perform a detailed clinical and metabolic characterisation of newly diagnosed adult patients with diabetes in Uganda, in order to compare features between lean and non-lean individuals. Methods Socio-demographic, clinical, biophysical and metabolic (including oral glucose tolerance test) data were collected on 568 adult patients with newly diagnosed diabetes. Participants were screened for islet autoantibodies to exclude those with autoimmune diabetes. The remaining participants (with type 2 diabetes) were then classified as lean (BMI <25 kg/m 2) or non-lean (BMI ≥25 kg/m 2), and their socio-demographic, clinical, biophysical and metabolic characteristics were compared. Results Thirty-four participants (6.4%) were excluded from analyses because they were positive for pancreatic autoantibodies, and a further 34 participants because they had incomplete data. For the remaining 500 participants, the median (IQR) age, BMI and HbA 1c were 48 years (39-58), 27.5 kg/m 2 (23.6-31.4) and 90 mmol/mol (61-113) (10.3% [7.7-12.5]), respectively, with a female predominance (approximately 57%). Of the 500 participants, 160 (32%) and 340 (68%) were lean and non-lean, respectively. Compared with non-lean participants, lean participants were mainly male (60.6% vs 35.3%, p<0.001) and had lower visceral adiposity level (5 [4-7] vs 11 [9-13], p<0.001) and features of the metabolic syndrome (uric acid, 246.5 [205.0-290.6] vs 289 [234-347] μmol/l, p<0.001; leptin, 660.9 [174.5-1993.1] vs 3988.0 [1336.0-6595.0] pg/ml, p<0.001). In addition, they displayed markedly reduced markers of beta cell function (oral insulinogenic index 0.

Research paper thumbnail of Influence of Lung Function and Cardiovascular Disease on Mortality

Research paper thumbnail of Level of education and preferred language of informed consent for clinical research in a multi-lingual community

African Health Sciences, Jul 22, 2020

Background: Low education levels and language barriers present challenges in obtaining informed c... more Background: Low education levels and language barriers present challenges in obtaining informed consent for clinical research. Objective: To describe and correlate the association between the level of education and the participant's preferred language of consent. Design: Descriptive-analytical cross-sectional study. Participants: Adults being consented for participation in tuberculosis(TB) research studies in an East African community with varying levels of education. Procedures: We analyzed data on demographic and educational characteristics collected from adults being consented for participation in TB studies .Only participants who could understand and speak Luganda (the main local language) or English (the official language of Uganda) were included in this analysis. Results: A total of 523 participants were consented between April 2015 and December 2017 and included in this analysis; 250 below Senior four (< 11yrs of education), 114 senior four (at 11yrs of education),73 senior five-senior six (12-13yrs of education) and 86 beyond senior six (> 13yrs of education). We noted that the preference for English rises with the rising levels of education and peaked at beyond senior six (83%Vs17%,OR=49,95%CI:22.8-106.3,p<0.001).Participants below senior four preferred Luganda Vs senior four and above(OR=16.9,95%CI:9.9-28.8,p<0.001) Conclusion: Rising education levels of participants were associated with preference for English language usage during initial consent for clinical research studies.

Research paper thumbnail of Burden of multimorbidity in sub-saharan africa: Preliminary findings from three community studies

Context: Multimorbidity (MM) (co-occurrence of ≥2 chronic conditions (CCs)) is a global health ch... more Context: Multimorbidity (MM) (co-occurrence of ≥2 chronic conditions (CCs)) is a global health challenge. Most evidence from MM research comes from studies in high-income countries. In many low and middle-income countries (LMIC), including low-income sub-Saharan Africa (SSA), the burden of CC is rising, however, the epidemiology of MM remains relatively unknown.

Research paper thumbnail of Islet autoantibody positivity in an adult population with recently diagnosed diabetes in Uganda

PLOS ONE, May 23, 2022

This study aimed to investigate the frequency of islet autoantibody positivity in adult patients ... more This study aimed to investigate the frequency of islet autoantibody positivity in adult patients with recently diagnosed diabetes in Uganda and its associated characteristics. Methods Autoantibodies to glutamic acid decarboxylase-65 (GADA), zinc transporter 8 (ZnT8-A), and tyrosine phosphatase (IA-2A) were measured in 534 adult patients with recently diagnosed diabetes. Islet autoantibody positivity was defined based on diagnostic thresholds derived from a local adult population without diabetes. The socio-demographic, clinical, and metabolic characteristics of islet autoantibody-positive and negative participants were then compared. The differences in these characteristics were analysed using the x 2 test for categorical data and the Kruskal Wallis test for continuous data. Multivariate analysis was performed to identify predictors of islet autoantibody positivity. Results Thirty four (6.4%) participants were positive for �1 islet autoantibody. GADA, IA-2A and ZnT8-A positivity was detected in 17 (3.2%), 10 (1.9%), and 7 (1.3%) participants, respectively. Compared with those negative for islet autoantibodies, participants positive for islet autoantibodies were more likely to live in a rural area (n = 18, 52.9% Vs n = 127, 25.5%, p = 0.005), to be initiated on insulin therapy (n = 19, 55.9% Vs n = 134, 26.8%, p<0.001), to have a lower median waist circumference (90 [80-99] cm Vs 96 [87-104.8], p = 0.04), waist circumference: height ratio (0.

Research paper thumbnail of Sputum smear-positive, culture-negative state during anti-tuberculosis treatment in the MGIT liquid culture era

International Journal of Tuberculosis and Lung Disease, Mar 1, 2018

Research paper thumbnail of Barriers to TB Care During the COVID19 Pandemic: A Comparison Between Urban and Rural Populations in Uganda

Research paper thumbnail of Technology in Survey Data Collection: Cost-Effective Advances from Limited-Resource Settings

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 18, 2014

Research paper thumbnail of Medium-to-long term sustainability of a health systems intervention to improve service readiness and quality of non-communicable disease (NCD) patient care and experience at primary care settings in Uganda

BMC Health Services Research

Background With the double burden of rising chronic non-communicable diseases (NCDs) and persiste... more Background With the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed. Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services. In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial’s original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received. Methods Cross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical ...

Research paper thumbnail of Identification and characterisation of diabetes in Uganda: protocol for the nested, population-based ‘Diabetes in low-resource Populations’ (DOP) Study

BMJ Open

IntroductionSub-Saharan Africa is experiencing an increasing burden of diabetes, but there are li... more IntroductionSub-Saharan Africa is experiencing an increasing burden of diabetes, but there are little reliable data, particularly at the community level, on the true prevalence or why this condition affects young and relatively lean individuals. Moreover, the detection of diabetes in Africa remains poor, not only due to a lack of resources but because the performance of available diagnostic tests is unclear.MethodsThis research aims to (1) determine the prevalence and risk factors of diabetes in a rural Ugandan population, (2) use clinical and biochemical markers to define different diabetes phenotypes and (3) study the progression of diabetes in this population. We will also assess the utility of the widely used tests (glycated haemoglobin (HbA1c), oral glucose tolerance test (OGTT) and fasting glucose) in diagnosing diabetes.DesignThis is a population-based study nested within the longstanding general population cohort in southwestern Uganda. We will undertake a population survey ...

Research paper thumbnail of 1296-P: Comparison of Fingerstick and Venous Plasma Glucose in the Ugandan Diabetes in Low-Resource Populations Study

Diabetes

As Africa is experiencing the most rapid rise in the world of type 2 diabetes (T2D), identifying ... more As Africa is experiencing the most rapid rise in the world of type 2 diabetes (T2D), identifying feasible, accurate ways to measure glucose is imperative. While venous glucose (ven-glucose) is recommended, cost and lack of access to pre-analytical processing often rules out this option. Fingerstick measurement of capillary glucose (fs-glucose) is a potential alternative. But data on the correlation between fs-glucose and ven-glucose are scant. Hence OGTT were performed in 512 Ugandans (Male: 46% (234/512), age: 43±17y (mean±SD) enrolled in the Diabetes in Low Resource Populations Study with fs-glucose (Contour Plus Glucometer) and ven-glucose (Glucokinase Method, Roche Cobas 6000) obtained at 0h and 2h. To determine correlation, bias and levels of agreement, Pearson’s correlations and Bland Altman analyses were performed. T2D, preT2D and normal glucose tolerance occurred in 2% (9/512), 18% (92/512) and 80% (411/512), resp. At 0h, fs-glucose and ven-glucose were modestly correlated (...

Research paper thumbnail of Risk factors for disruptions in tuberculosis care in Uganda during the COVID-19 pandemic

PLOS Global Public Health

Background: During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likel... more Background: During the COVID-19 pandemic, TB mortality increased while diagnoses decreased, likely due to care disruption. In March, 2020, Uganda—a country with high TB burden, implemented a COVID-19 lockdown with associated decrease in TB diagnoses. This study aims to examine patient level risk factors for disruption in TB care during the COVID-19 pandemic in Uganda. This retrospective cross-sectional cohort study included six TB clinics in Uganda. Clustered sampling included phases of TB care and three time-periods: pre-lockdown, lockdown and post-lockdown. Characteristics of patients with TB care disruption (TBCD), defined as those with > 2 months of symptoms prior to diagnosis or who missed a TB clinic, and those without TB care disruption (non-TBCD) were analyzed between time-periods. 1,624 charts were reviewed; 1322 were contacted, 672 consented and completed phone interview; pre-lockdown (n = 213), lockdown (n = 189) and post-lockdown (n = 270). TBCD occurred in 57% (385/6...

Research paper thumbnail of Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda

BMC Public Health

Background A shortage of healthcare workers in low- and middle-income countries (LMICs) combined ... more Background A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. Methods This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All in...

Research paper thumbnail of Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis

BMJ Open

ObjectiveContemporary data on the attainment of optimal diabetes treatment goals and the burden o... more ObjectiveContemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes.MethodsWe systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the...

Research paper thumbnail of The influence of fasting and post-load glucose levels on maternal and neonatal outcomes in women with hyperglycaemia in pregnancy in Uganda: A prospective observational cohort study

Diabetes Research and Clinical Practice