Browsing by Author "Abila, Derrick Bary"

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    Burden of Risk Factors for Cervical Cancer Among Women Living in East Africa: An Analysis of the Latest Demographic Health Surveys Conducted Between 2014 and 2017
    (JCO Global Oncology, 2021-07-15) Abila, Derrick Bary; Wasukira, Sulaiman Bugosera; Ainembabazi, Provia; Wabinga, Henry
    In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries. For each country, using STATA13 software and sampling weights, we analyzed the latest Demographic and Health Survey data sets conducted between 2014 and 2017 in Burundi, Kenya, Rwanda, Tanzania, and Uganda. We included women age 15-49 years and considered six risk factors (tobacco use, body mass index, age at first sexual intercourse, age at first birth, number of children, and hormonal contraceptive use). Of the 93,616 women from the five countries, each country had more than half of the women younger than 30 years and lived in rural areas. Pooled proportion of women with at least one risk factor was 89% (95% CI, 87 to 91). Living in a rural area in Burundi (adjusted incidence rate ration 0.94; 95% CI, 0.9 to 0.99; P = .019) and Rwanda (adjusted incidence rate Ration 0.92; 95% CI, 0.88 to 0.96; P < .001) was associated with a lower number of risk factors compared with living in an urban area. In all the countries, women with complete secondary education were associated with a lower number of risk factors compared with those with no education. This study reveals a high burden of risk factors for cervical cancer in East Africa, with a high proportion of women exposed to at least one risk factor. There is a need for interventions to reduce the exposure of women to these risk factors.
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    Coverage and Socio-Economic Inequalities in Breast Cancer Screening in Lowand Middle-Income Countries: Analysis of Demographic and Health Surveys Between 2010 and 2019
    (JCO Global, 2022-05-05) Abila, Derrick Bary; Kangoma, Grace; Kisuza, Ruth Ketty; Wasukira, Sulaiman Bugosera; Ainembabazi, Provia; Wabinga, Henry
    The World Health Organisation (WHO) launched the Global Breast Cancer Initiative (GBCI) in 2020 intending to reduce global breast cancer mortality by 2.5% per year until 2040, thereby averting an estimated 2.5 million deaths. In this study, we aimed to determine the coverage and socio-economic inequalities in the screening for breast cancer over one decade before the establishment of the GBCI.
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    Evaluation of the Initial 12months of a Routine Cryptococcal Antigen Screening Program in Reduction of HIV-Associated Cryptococcal Meningitis in Uganda
    (BMC Health Services Research, 2022) Enock, Kagimu; Kiwanuka, Julius; Abila, Derrick Bary; Rutakingirwa, Morris K.; Kasibante, John; Kiiza, Tadeo Kandole; Kwizera, Richard; Semeere, Aggrey; Meya, David B.
    Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. We conducted a retrospective, cross-sectional survey of patients with CD4 < 100 at seven urban and seven rural facilities after 1 year of program implementation. We quantified the number of patients who transitioned through the steps of the CrAg screening cascade over six-months follow-up. We defined cascade completion as a pre-emptive fluconazole prescription for the first 10 weeks. We conducted semi-structured interviews with lab personnel and clinic staff to assess functionality of the CrAg screening program. Data was collected using REDCap. We evaluated 359 patient records between April 2016 to March 2017; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of < 50 cell/μL. Overall, CrAg screening had been performed in 255/359 (71.0, 95% CI, 66.0–75.7) of patients’ records reviewed, with a higher proportion among urban facilities (170/209 (81.3, 95% CI, 75.4–86.4)) than rural facilities (85/150 (56.7, 95% CI, 48.3–64.7)). Among those who were CrAg screened, 56/255 (22.0, 95% CI, 17.0–27.5%) had cryptococcal antigenemia, of whom 47/56 (83.9, 95% CI, 71.7–92.4%) were initiated on pre-emptive therapy with fluconazole and 8/47 (17.0, 95% CI, 7.6–30.8%) of these were still receiving antifungal therapy at 6 months follow up. At least one CNS symptom was present in 70% (39/56) of those with antigenemia. In patients who had started ART, almost 40% initiated ART prior to CrAg screening. Inadequacy of equipment/supplies was reported by 15/26 (58%) of personnel as a program barrier, while 13/26 (50%) reported a need for training about CM and CrAg screening. There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening.. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.
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    Exposure to household air pollution from cooking fuel in Ugandan households and associated household factors: a retrospective analysis of demographic and health survey data
    (The Lancet Global Health, 2022-03-07) Abila, Derrick Bary; Nalunkuma, Racheal; Wasukira, Sulaiman Bugosera; Ainembabazi, Provia; Nakiyingi, Elizabeth Kiyingi; Lucero-Prisno III, Don Eliseo
    Household air pollution is mostly caused by cooking fuel. We describe the trend in household air pollution (HAP) caused by several types of cooking fuel used in Ugandan households from 2001 to 2016 and explore the household factors associated with it. We did a retrospective analysis of data from four Ugandan demographic and health surveys (UDHS) that were conducted from 2000–01 to 2016, with the household as the unit of analysis. We included all households that were in the UDHS dataset. We included variables that described the households, the type of cooking fuel, and where the food was cooked. A household was considered to have exposure to HAP if they used cooking fuels such as coal; charcoal; wood; straw, shrubs, or grass; crops; or animal dung. Bivariate and multivariate logistic regression was used to determine the association between household characteristics and exposure to household air pollution (HAP) from the most recent UDHS of 2016. The DHS programme obtained relevant ethics approval within Uganda and informed consent was provided by the participants. In this study, 45 376 households were included and surveyed. In all the surveys, most households were in rural areas (from 74·3% to 85·1%) and had a male as a head of household (from 69·0% to 72·5%. Wood was the most used household cooking fuel (from 71·7% to 82·1%). Other cooking fuels used were charcoal (from 15·3% to 26·3%), kerosene (from 0·7% to 2·5%) and electricity (0·1% to 0·8%). Exposure to HAP remained high in all the surveys ranging from 96·7% to 99·8%. From the multivariate logistic regression analysis, households with a household head having attained either complete secondary education (adjusted odds ratio 0·13, 95% CI 0·03–0·58; p=0·008) or higher education (0·11, 0·03 – 0·48; p=0·003) were less likely to be exposed to HAP than households with a household head having no education.
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    Post-Artesunate Delayed Hemolysis: Anything That Can Go Wrong Will Go Wrong—Murphy's Law
    (2025-01-16) Chemutai, Beliza; Ali, Muhammed Omar; Abila, Derrick Bary; Odonga, Denis Can; Apiyo, Paska; Bongomin, Felix
    In patients presenting with post-malarial anemia following intravenous artesunate treatment, post-artesunate delayed hemolysis should be considered in the differential diagnosis, even in endemic settings. Close monitoring for signs of delayed hemolysis in patients previously treated with intravenous artesunate for severe malaria, regardless of their malaria exposure history or geographic location is crucial.