Browsing by Author "Amanya, Geofrey"
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Item Comparative epidemiologic analysis of COVID-19 patients during the first and second waves of COVID-19 in Uganda(IJID Regions, 2022) Elayeete, Sarah; Nampeera, Rose; Nsubuga, Edirisa J.; Nansikombi, Hildah T.; Kwesiga, Benon; Kadobera, Daniel; Amanya, Geofrey; Ajambo, Miriam; Mwanje, Wilbrod; Riolexus, Alex A.; Harris, Julie R.Introduction: Uganda was affected by two major waves of coronavirus disease 2019 (COVID-19). The first wave during late 2020 and the second wave in late April 2021. This study compared epidemiologic characteristics of hospitalized (HP) and non-hospitalized patients (NHP) with COVID-19 during the two waves of COVID-19 in Uganda. Methods: Wave 1 was defined as November–December 2020, and Wave 2 was defined as April–June 2021. In total, 800 patients were included in this study. Medical record data were collected for HP (200 for each wave). Contact information was retrieved for NHP who had polymerase-chain-reaction-confirmed COVID-19 (200 for each wave) from laboratory records; these patients were interviewed by telephone. Findings: A higher proportion of HP were male in Wave 1 compared with Wave 2 (73% vs 54%; P = 0.0001). More HP had severe disease or died in Wave 2 compared with Wave 1 (65% vs 31%; P < 0.0001). NHP in Wave 2 were younger than those in Wave 1, but this difference was not significant (mean age 29 vs 36 years; P = 0.13). HP were significantly older than NHP in Wave 2 (mean age 48 vs 29 years; P < 0.0001), but not Wave 1 (mean age 48 vs 43 years; P = 0.31). Interpretation: Demographic and epidemiologic characteristics of HP and NHP differed between and within Waves 1 and 2 of COVID-19 in Uganda.Item Cost effectiveness and decision analysis for evaluation of the national airport screening options in COVID-19 surveillance in Uganda, 2020(UNIPH, 2020) Amanya, GeofreyEarly during the COVID-19 outbreak, various approaches were utilized around the world to preventing introduction of COVID-19 from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions had not been evaluated. We evaluated different policy options for COVID-19-specific interventions at Entebbe International Airport to inform decision-making in future similar situations. Screening all incoming travellers for symptoms, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option for airport interventions against COVID-19. Higher prevalence of infection among incoming travellers increased cost-effectiveness of airport-specific interventions. This model may be used to evaluate prevention options at the airport for COVID-19 and other diseases with similar requirements for control.Item Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches – March-April 2020(Globalization and Health, 2020) Migisha, Richard; Kwesiga, Benon; Mirembe, Bernadette B.; Amanya, Geofrey; Kabwama, Steven N.; Kadobera, Daniel; Bulage, Lilian; Nsereko, Godfrey; Wadunde, Ignatius; Tindyebwa, Tonny; Lubwama, Bernard; Kagirita, Atek A.; Kayiwa, John T.; Lutwama, Julius J.; Boore, Amy L.; Harris, Julie R.; Kyobe Bosa, HenryOn March 13, 2020, Uganda instituted COVID-19 symptom screening at its international airport, isolation and SARS-CoV-2 testing for symptomatic persons, and mandatory 14-day quarantine and testing of persons traveling through or from high-risk countries. On March 21, 2020, Uganda reported its first SARS-CoV-2 infection in a symptomatic traveler from Dubai. By April 12, 2020, 54 cases and 1257 contacts were identified. We describe the epidemiological, clinical, and transmission characteristics of these cases. Methods: A confirmed case was laboratory-confirmed SARS-CoV-2 infection during March 21–April 12, 2020 in a resident of or traveler to Uganda. We reviewed case-person files and interviewed case-persons at isolation centers. We identified infected contacts from contact tracing records. Results: Mean case-person age was 35 (±16) years; 34 (63%) were male. Forty-five (83%) had recently traveled internationally (‘imported cases’), five (9.3%) were known contacts of travelers, and four (7.4%) were community cases. Of the 45 imported cases, only one (2.2%) was symptomatic at entry. Among all case-persons, 29 (54%) were symptomatic at testing and five (9.3%) were pre-symptomatic. Among the 34 (63%) case-persons who were ever symptomatic, all had mild disease: 16 (47%) had fever, 13 (38%) reported headache, and 10 (29%) reported cough. Fifteen (28%) case-persons had underlying conditions, including three persons with HIV. An average of 31 contacts (range, 4–130) were identified per case-person. Five (10%) case-persons, all symptomatic, infected one contact each. Conclusion: The first 54 case-persons with SARS-CoV-2 infection in Uganda primarily comprised incoming air travelers with asymptomatic or mild disease. Disease would likely not have been detected in these persons without the targeted testing interventions implemented in Uganda. Transmission was low among symptomatic persons and nonexistent from asymptomatic persons. Routine, systematic screening of travelers and at-risk persons, and thorough contact tracing will be needed for Uganda to maintain epidemic controlItem Health Education is a Key Pillar in Reducing Prevalence of Typhoid among Febrile Patients in Peri-Urban Western Uganda: A Cross-Sectional Study(International Journal of Scientific Study, 2017) Kiwungulo, Benard; Pius, Theophillus; Nabaasa, Saphurah; Kiconco, Ritah; Amanya, Geofrey; Amongi, Christine; Tamale, Andrew; Ruhinda, Nathan; Blessing, Yashim J. S.; Atuheire, CollinsTyphoid has remained a public health burden leading to several morbidities and despite many attempts. Health education targeted to patients receiving care in health centers may significantly reduce burden of typhoid among febrile patients in Uganda. Material and Methods: We consecutively sampled 283 participants presenting with febrile symptoms. Consent/assent was administered and after fully understanding the study, blood samples were collected using a 2 ml syringe and transferred into red top vacutainer before laboratory tests. We carried out centrifugation at 1000 rpm for 15 min. We performed slide agglutination test to identify presence of Salmonella typhi antibodies followed by tube agglutination for quantification. Titers of <1:160 were considered positive for typhoid. Data were analyzed descriptively as medians and proportions using STATA 14. Robust Poisson regression was carried out to obtain both crude and adjusted prevalence ratios (aPR) for bivariate and multivariate analysis, respectively. Results: The median age for participants was 25 years. The seroprevalence of typhoid was 26.5% (95%, confidence interval [CI]: 21.7-32.0). Teenagers were 3 times more likely to be tested positive for typhoid compared to those below 13 years; (crude prevalence ratio = 2.76, 95%, CI: 1.11-6.83). Participants who reported to have received health education over past 2 months were 58% less likely to suffer from typhoid compared to those that reported no recent health education (aPR = 0.42; 95%, CI: 0.26-0.69). Having history of typhoid over the past 2 months was positively associated with reoccurrence of typhoid (aPR = 1.75, 95%, CI: 1.12-2.72). Conclusion: Burden of typhoid still persists in rural communities especially among teenagers. Lack of health education predisposes communities. People who have had typhoid in the past 2 months are mostly likely to have a reoccurrence of the disease.Item Individual and household risk factors for COVID-19 infection among household members of COVID-19 patients in home-based care in western Uganda, 2020(IJID Regions, 2022) Amanya, Geofrey; Elyanu, Peter; Kadobera, Daniel; Riolexus, Alex A.; Harris, Julie R.; Mugisha, RichardTo investigate factors associated with COVID-19 among household members of patients in home-based care (HBC) in western Uganda. Methods: We conducted a case-control and cohort study. Cases were RT-PCR-confirmed SARS-CoV-2 diagnosed 1-30 November 2020 among persons in HBC in Kasese or Kabarole Districts. We compared 78 case-households (≥1 secondary case) to 59 control-households (no secondary cases). The cohort included all case-household members. Data were captured by in-person questionnaire. We regressed to calculate odds and risk ratios. Results: Case-households were larger than control-households (mean 5.8 vs 4.3 members, p<0.0001). Having ≥1 household member per room (aOR=4.5, 95%CI 2.0-9.9) or symptom development (aOR=2.3, 95%CI 1.1-5.0), interaction (aOR=4.6, 95%CI 1.4-14.7) with primary case-patient increased odds of case-household status. Households assessed for suitability for HBC reduced odds of case-household status (aOR=0.4, 95%CI=0.2-0.8). Interacting with primary case-patient (aRR=1.7, 95%CI 1.1-2.8) increased the risk of individual infection among household members. Conclusion: Household and individual factors influence secondary infection risk in HBC. Decisions about HBC should be made with these in mindItem Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: a New Challenge for Public Health in Low and Middle-Income Countries(Public Health, 2021) Alkhatib, Ahmad; Nnyanzi, Lawrence Achilles; Mujuni, Brian; Amanya, Geofrey; Ibingira, CharlesLow and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub- Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.Item Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries(Int. J. Environ. Res. Public Health, 2021) Alkhatib, Ahmad; Nnyanzi, Lawrence A.; Mujuni, Brian; Amanya, Geofrey; Ibingira, CharlesObjectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub- Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.Item Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda(BMC infectious diseases, 2017) Amanya, Geofrey; Kizito, Samuel; Nabukenya, Immaculate; Kalyango, Joan; Atuheire, Collins; Nansumba, Hellen; Akena Abwoye, Stephen; Opio, Denis Nixon; Kibuuka, Edrisa; Karamagi, CharlesHepatitis E is self-limiting, but can cause death in most at risk groups like pregnant women and those with preexisting acute liver disease. In developing countries it presents as epidemic, in 2014 Hepatitis E Virus (HEV) outbreak was reported in Napak district Uganda. The role of factors in this setting that might have propagated this HEV epidemic, including host, agent, and environmental characteristics, were still not clear. This study was therefore conducted to investigate the risk factors, person, place and time characteristics, associated with the hepatitis E virus (HEV) epidemic in Napak district. Methods: Review of line lists data for epidemiological description and matched case control study on neighborhood and age in the ratio of 1:2 were used to assess risk factors for HEV outbreak in Napak. Cluster and random sampling were used to obtain a sample size of 332, (111 cases, 221 controls). Possible interaction and confounding was assessed using conditional logistic regression. Results: Over 1359 cases and 30 deaths were reported during 2013/2014 HEV outbreak. The mean age of patients was 29 ± years, 57.9% of cases were females. Overall case Fatality Ratio was 2.2% in general population but 65.2% in pregnant women. More than 94% of the cases were reported in the sub counties of Napak, 5.7% of cases were reported in the outside neighboring districts. The epidemic peaked in January 2014 and gradually subsided by December 2014. Risk factors found to be associated with HEV included drinking untreated water (OR 6.69, 95% CI 3.15–14.16), eating roadside food (OR 6.11, 95% CI 2.85–13.09), reported not cleaning utensils (OR 3.24, 95% CI 1.55–1.76), and being a hunter (OR 1.14, 95% CI 1.03–12.66). Conclusion: The results of this study suggest that the virus is transmitted by the feco-oral route through contaminated water. They also suggest that active surveillance and appropriate measures targeting community and routine individual health actions are important to prevent transmission and decrease the deaths.Item Risk perception and psychological state of healthcare workers in referral hospitals during the early phase of the COVID‑19 pandemic, Uganda(BMC psychology, 2021) Migisha, Richard; Riolexus, Alex A.; Kwesiga, Benon; Bulage, Lilian; Kadobera, Daniel; Kabwama, Steven N.; Katana, Elizabeth; Ndyabakira, Alex; Wadunde, Ignatius; Byaruhanga, Aggrey; Amanya, Geofrey; Harris, Julie R.; Fitzmaurice, Arthur G.Safeguarding the psychological well-being of healthcare workers (HCWs) is crucial to ensuring sustainability and quality of healthcare services. During the COVID-19 pandemic, HCWs may be subject to excessive mental stress. We assessed the risk perception and immediate psychological state of HCWs early in the pandemic in referral hospitals involved in the management of COVID-19 patients in Uganda. Methods: We conducted a cross-sectional survey in five referral hospitals from April 20–May 22, 2020. During this time, we distributed paper-based, self-administered questionnaires to all consenting HCWs on day shifts. The questionnaire included questions on socio-demographics, occupational behaviors, potential perceived risks, and psychological distress. We assessed risk perception towards COVID-19 using 27 concern statements with a four-point Likert scale. We defined psychological distress as a total score > 12 from the 12-item Goldberg’s General Health Questionnaire (GHQ-12). We used modified Poisson regression to identify factors associated with psychological distress. Results: Among 335 HCWs who received questionnaires, 328 (98%) responded. Respondents’ mean age was 36 (range 18–59) years; 172 (52%) were male. The median duration of professional experience was eight (range 1–35) years; 208 (63%) worked more than 40 h per week; 116 (35%) were nurses, 52 (14%) doctors, 30 (9%) clinical officers, and 86 (26%) support staff. One hundred and forty-four (44%) had a GHQ-12 score > 12. The most common concerns reported included fear of infection at the workplace (81%), stigma from colleagues (79%), lack of workplace support (63%), and inadequate availability of personal protective equipment (PPE) (56%). In multivariable analysis, moderate (adjusted prevalence ratio, [aPR] = 2.2, 95% confidence interval [CI] 1.2–4.0) and high (aPR = 3.8, 95% CI 2.0–7.0) risk perception towards COVID-19 (compared with low-risk perception) were associated with psychological distress. Conclusions: Forty-four percent of HCWs surveyed in hospitals treating COVID-19 patients during the early COVID- 19 epidemic in Uganda reported psychological distress related to fear of infection, stigma, and inadequate PPE. Higher perceived personal risk towards COVID-19 was associated with increased psychological distress. To optimizeItem Stigma mastery in people living with HIV: gender similarities and theory(Journal of Public Health, 2022) Namisi, Charles P.; Munene, John C.; Wanyenze, Rhoda K.; Katahoire, Anne R.; Parkes-Ratanshi, Rosalinda M.; Kentutsi, Stella; Nannyonga, Maria M.; Ssentongo, Robina N.; Ogola, Mabel K.; Nabaggala, Maria S.; Amanya, Geofrey; Kiragga, Agnes N.; Batamwita, Richard; Tumwesigye, Nazarius M.Aims This study aimed to determine the prevalence of, factors associated with, and to build a theoretical framework for understanding Internalsed HIV-related Stigma Mastery (IHSM). Methods A cross-sectional study nested within a 2014 Stigma Reduction Cohort in Uganda was used. The PLHIV Stigma Index version 2008, was used to collect data from a random sample of 666 people living with HIV (PLHIV) stratified by gender and age. SPSS24 with Amos27 softwares were used to build a sequential-mediation model. Results The majority of participants were women (65%), aged ≥ 40 years (57%). Overall, IHSM was 45.5% among PLHIV, that increased with age. Specifically, higher IHSM correlated with men and older women “masculine identities” self-disclosure of HIV-diagnosis to family, sharing experiences with peers. However, lower IHSM correlated with feminine gender, the experience of social exclusion stress, fear of future rejection, and fear of social intimacy. Thus, IHSMsocial exclusion with its negative effects and age-related cognition are integrated into a multidimensional IHSM theoretical framework with a good model-to-data fit. Conclusion Internalised HIV-related Stigma Mastery is common among men and older women. Specificially, “masculine identities” self-disclose their own HIV-positive diagnosis to their family, share experiences with peers to create good relationships for actualising or empowerment in stigma mastery. However, social exclusion exacerbates series of negative effects that finally undermine stigma mastery by young feminine identities. Thus, stigma mastery is best explained by an integrated empowerment framework, that has implications for future practice, policy, and stigma-related research that we discuss.