Browsing by Author "Chiunda, Allan"

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    Body composition among HIV-Seropositive and HIV-Seronegative adult patients with Pulmonary Tuberculosis in Uganda
    (Elsevier Inc, 2009) Mupere, Ezekiel; Zalwango, Sarah; Chiunda, Allan; Okwera, Alphonse; Mugerwa, Roy; Whalen, Christopher
    Body wasting is a prominent and cardinal feature of tuberculosis (TB) (1, 2) and is a marker of disease severity and outcome. In sub-Saharan Africa, a large proportion of patients with TB also have coinfection with human immunodeficiency virus (HIV) (3). Coinfection may worsen the wasting seen in either TB or HIV infection alone (4, 5). Wasting in TB is associated with reduced caloric intake due to anorexia or loss of appetite and increase in consumption of calories due to altered metabolism induced by inflammation and immune response (6–8). Several studies (9–15) in sub-Saharan Africa have shown the impact of dual infection with HIV and TB on nutritional
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    Finding the best examples of healthcare quality improvement in Sub-Saharan Africa
    (BMJ Quality & Safety, 2010) Liu, Constance; Babigumira, Joseph; Chiunda, Allan; Katamba, Achilles; Litvak, Ilya; Miller, Lakisha; Namagembe, Imelda; Sekandi, Juliet; Seicean, Andrea; Seicean, Sinziana; Neuhauser, Duncan
    The purpose of this study was to summarise the current state of healthcare quality improvement literature focusing on sub-Saharan Africa. Methods Conventional methods of searching the literature were quickly found to be inadequate or inappropriate, given the different needs of practitioners in sub-Saharan Africa, and the inaccessibility of the literature. Results The group derived a core list of what were deemed exemplary quality improvement articles, based on consensus and a search into the “grey” literature of quality improvement. Conclusions Quality improvment articles from sub- Saharan Africa are difficult to find, and suffer from a lack of centrality and organisation of literature. Efforts to address this are critical to fostering the growth of quality improvement literature in developing country settings.
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    Lean Tissue Mass Wasting is Associated With Increased Risk of Mortality Among Women With Pulmonary Tuberculosis in Urban Uganda
    (Elsevier Inc., 2012) Mupere, Ezekiel; Malone, Lashaunda; Zalwango, Sarah; Chiunda, Allan; Okwera, Alphonse; Parraga, Isabel; Stein, Catherine M.; Tisch, Daniel J.; Mugerwa, Roy; Boom, W. Henry; Mayanja, Harriet; Whalen, Christopher C.
    OBJECTIVES: We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI). METHODS: In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival. RESULTS: Of 747 patients, 310 had baseline wasting by BMI (kg/m2) and 103 by LMI (kg/m2). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03–2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5–2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9–3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6–15.9) for women with low LMI compared with women with normal LMI. CONCLUSIONS: Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.
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    Secondary Attack Rate of Tuberculosis in Urban Households in Kampala, Uganda
    (PLoS ONE, 2011) Whalen, Christopher C.; Zalwango, Sarah; Chiunda, Allan; Malone, LaShaunda; Eisenach, Kathleen; Joloba, Moses; Boom, W. Henry; Mugerwa, Roy
    Tuberculosis is an ancient disease that continues to threaten individual and public health today, especially in sub-Saharan Africa. Current surveillance systems describe general risk of tuberculosis in a population but do not characterize the risk to an individual following exposure to an infectious case. Methods: In a study of household contacts of infectious tuberculosis cases (n = 1918) and a community survey of tuberculosis infection (N = 1179) in Kampala, Uganda, we estimated the secondary attack rate for tuberculosis disease and tuberculosis infection. The ratio of these rates is the likelihood of progressive primary disease after recent household infection. Results: The secondary attack rate for tuberculosis disease was 3.0% (95% confidence interval: 2.2, 3.8). The overall secondary attack rate for tuberculosis infection was 47.4 (95% confidence interval: 44.3, 50.6) and did not vary widely with age, HIV status or BCG vaccination. The risk for progressive primary disease was highest among the young or HIV infected and was reduced by BCG vaccination. Conclusions: Early case detection and treatment may limit household transmission of M. tuberculosis. Household members at high risk for disease should be protected through vaccination or treatment of latent tuberculosis infection.