Browsing by Author "Guwatudde, David"
Now showing 1 - 20 of 93
Results Per Page
Sort Options
Item Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda(PLoS ONE, 2016) Mayanja, Yunia; Mukose, Aggrey David; Nakubulwa, Susan; Omosa-Manyonyi, Gloria; Kamali, Anatoli; Guwatudde, DavidThe prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance. Methods We enrolled 241 FSWs in a cross sectional study; they were aged 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. MantelHaenszel tests for interaction were performed. Results Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education. Conclusion Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.Item Alcohol consumption, hypertension and obesity: Relationship patterns along different age groups in Uganda(Preventive Medicine Reports, 2020) Mbona Tumwesigye, Nazarius; Mutungi, Gerald; Bahendeka, Silver; Wesonga, Ronald; Katureebe, Agaba; Biribawa, Claire; Guwatudde, DavidThe prevalence of non-communicable diseases including hypertension and obesity is rising and alcohol consumption is a predisposing factor. This study explored the effect of alcohol consumption patterns on the hypertension-age group and obesity-age group relationships. The data were extracted from the 2014 National NCD Survey of adults aged 18–69 years. Hypertension was defined as a condition of having systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg while obesity was defined as having a body mass index ≥30 kg/m2 . Frequent alcohol consumption was measured as alcohol use ≥3 times a week. Multivariable log binomial regression analysis was used to assess independent relationship between the outcomes and alcohol consumption. The prevalences of hypertension, frequent alcohol consumption and obesity increased across age groups but were divergent towards last age group. Hypertension prevalence ratios were higher with higher age groups among moderate and nondrinkers but not among frequent drinkers. Alcohol drinking pattern modified the age hypertension relationship in a model with ungrouped age. The drinking pattern did not modify obesity-age relationship. Alcohol consumption pattern appeared to modify the hypertension-age group relationship. However, more research is needed to explain why prevalence ratios are higher with higher age groups among moderate drinkers and abstainers while they stagnate among the frequent drinkers. There was no evidence to show the effect of alcohol consumption on obesity-age group relationshipItem Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey(Global Health Action, 2016) Ndugwa Kabwama, Steven; Ndyanabangi, Sheila; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidThere are limited data on levels of alcohol use in most sub-Saharan African countries. Objective: We analyzed data from Uganda’s non-communicable diseases risk factor survey conducted in 2014, to identify alcohol use prevalence and associated factors. Design: The survey used the World Health Organization STEPS tool to collect data, including the history of alcohol use. Alcohol users were categorized into low-, medium-, and high-end users. Participants were also classified as having an alcohol-use-related disorder if, over the past 12 months, they were unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session the night before. Weighted logistic regression analysis was used to identify factors associated with medium- to high-end alcohol use. Results: Of the 3,956 participants, 1,062 (26.8%) were current alcohol users, including 314 (7.9%) low-end, 246 (6.2%) medium-end, and 502 (12.7%) high-end users. A total of 386 (9.8%) were classified as having an alcohol-use-related disorder. Male participants were more likely to be medium- to high-end alcohol users compared to females; adjusted odds ratio (AOR)2.34 [95% confidence interval (CI)1.882.91]. Compared to residents in eastern Uganda, participants in central and western Uganda were more likely to be mediumto high-end users; AOR1.47 (95% CI1.012.12) and AOR1.89 (95% CI1.312.72), respectively. Participants aged 3049 years and those aged 5069 years were more likely to be medium- to high-end alcohol users, compared to those aged 1829 years, AOR1.49 (95% CI1.161.91) and AOR2.08 (95% CI1.522.84), respectively. Conclusions: The level of alcohol use among adults in Uganda is high, and 9.8% of the adult population has an alcohol-use-related disorder.Item Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle Income Countries(2020-10) Teufel, Felix; Geldsetzer, Pascal; Manne-Goehler, Jennifer; Karlsson, Omar; Koncz, Viola; Deckert, Andreas; Theilmann, Michaela; Marcus, Maja-Emilia; Ebert, Cara; A. Seiglie, Jacqueline; Agoudavi, Kokou; Andall-Brereton, Glennis; Gathecha, Gladwell; Gurung, Mongal S; Guwatudde, David; Houehanou, Corine; Hwalla, Nahla; Kagaruki, Gibson B.; Karki, Khem B.; Labadarios, Demetre; Martins, Joao S; Msaidie, Mohamed; Norov, Bolormaa; Sibai, Abla M.; Sturua, Lela; Tsabedze, Lindiwe; Wesseh, Chea S.; Davies, Justine; Atun, Rifat; Vollmer, Sebastian; Subramanian, S.V.; Barnighausen, Till; Jaacks, Lindsay M.; Barnighausen, JTill; Jaacks, Lindsay M.; De Neve, Jan-WalterObjective: The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent. Research design and methods: We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics. Results: Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2-162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9-8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications. Conclusions: Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.Item Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle Income Countries(Diabetes Care, 2020) Teufel, Felix; Geldsetzer, Pascal; Manne-Goehler, Jennifer; Karlsson, Omar; Koncz, Viola; Deckert, Andreas; Theilmann, Michaela; Marcus, Maja-Emilia; Ebert, Cara; Seiglie, Jacqueline A.; Agoudavi, Kokou; Andall-Brereton, Glennis; Gathecha, Gladwell; Gurung, Mongal S.; Guwatudde, David; Houehanou, Corine; Hwalla, Nahla; Kagaruki, Gibson B.; Karki, Khem B.; Labadarios, Demetre; Martins, Joao S.; Msaidie, Mohamed; Norov, Bolormaa; Sibai, Abla M.; Sturua, Lela; Tsabedze, Lindiwe; Wesseh, Chea S.; Davies, Justine; Atun, Rifat; Vollmer, Sebastian; Subramanian, S.V.; Barnighausen, Till; Jaacks, Lindsay M.; Neve, Jan-Walter DeThe prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are notwell understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent. RESEARCH DESIGN AND METHODS We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample,major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics. RESULTS Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2–162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9–8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications. CONCLUSIONS Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.Item ‘As soon as the umbilical cord gets off, the child ceases to be called a newborn’: sociocultural beliefs and newborn referral in rural Uganda(Global Health Action, 2015) Nalwadda, Christine K.; Waiswa, Peter; Guwatudde, David; Kerber, Kate; Peterson, Stefan; Kiguli, JulietThe first week of life is the time of greatest risk of death and disability, and is also associated with many traditional beliefs and practices. Identifying sick newborns in the community and referring them to health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa and the extent to which these norms can be modified. Objective: This study aimed to understand the community’s perspective of potential sociocultural barriers and facilitators to compliance with newborn referral. Method: In this qualitative study, focus group discussions (n12) were conducted with mothers and fathers of babies aged less than 3 months. In addition, in-depth interviews (n11) were also held with traditional birth attendants and mothers who had been referred by community health workers to seek health-facilitybased care. Participants were purposively selected from peri-urban and rural communities in two districts in eastern Uganda. Data were analysed using latent content analysis. Results: The community definition of a newborn varied, but this was most commonly defined by the period between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care emerged along three sub-themes: community understanding of the newborn period and cultural expectations; the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy. Conclusion: In this setting, there is discrepancy between biomedical and community definitions of the newborn period. There were a number of sociocultural factors that could potentially affect compliance to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness, individual experiences in households, perceived health system gaps, and decision-making processes were facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to address locally existing cultural beliefs at the same time as they strengthen facility careItem Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data(PLoS Med, 2020) Davies, Justine I.; Krishnamurthy Reddiar, Sumithra; Hirschhorn, Lisa R.; Ebert, Cara; Marcus, Maja-Emilia; Seiglie, Jacqueline A.; Zhumadilov, Zhaxybay; Supiyev, Adil; Sturua, Lela; Silver, Bahendeka K.; Sibai, Abla M.; Quesnel-Crooks, Sarah; Norov, Bolormaa; Mwangi, Joseph K.; Mwalim Omar, Omar; Wong-McClure, Roy; Mayige, Mary T.; Martins, Joao S.; Lunet, Nuno; Labadarios, Demetre; Karki, Khem B.; Kagaruki, Gibson B.; Jorgensen, Jutta M. A.; Hwalla, Nahla C.; Houinato, Dismand; Houehanou, Corine; Guwatudde, David; Gurung, Mongal S.; Bovet, Pascal; Bicaba, Brice W.; Aryal, Krishna K.; Msaidie, Mohamed; Andall-Brereton, Glennis; Brian, Garry; Stokes, Andrew; Vollmer, Sebastian; Ba¨rnighausen, Till; Atun, Rifat; Geldsetzer, Pascal; Manne-Goehler, Jennifer; Jaacks, Lindsay M.Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases (‘NCD readiness indicators’ from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08–3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09–4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02–1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06– 1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11–1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01–1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12–2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01–1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09– 1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01–1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. Conclusion In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries’ preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care.Item Bacteriological and Physical Quality of Locally Packaged Drinking Water in Kampala, Uganda(Journal of environmental and public health, 2015) Halage, Abdullah Ali; Ssemugabo, Charles; Ssemwanga, David K.; Musoke, David; Mugambe, Richard K.; Guwatudde, David; Ssempebwa, John C.To assess the bacteriological and physical quality of locally packaged drinking water sold for public consumption. Methods. This was cross-sectional study where a total of 60 samples of bottled water from 10 brands and 30 samples of sachet water from 15 brands purchased randomly were analyzed for bacteriological contamination (total coliform and faecal coliform per 100 mL) usingmembrane filtrate method and reported in terms of cfu/100 mL. Results. Both bottled water and sachet water were not contaminated with faecal coliform.Majority (70%, 21/30) of the sachetwater analyzed exceeded acceptable limits of 0 total coliforms per 100mL set byWHOand the national drinking water standards.The physical quality (turbidity and pH) of all the packaged water brands analyzed was within the acceptable limits.There was statistically significant difference between the median count of total coliform in both sachet water and bottled water brands (𝑈(24) = 37.0, 𝑝 = 0.027). Conclusion. Both bottled water and sachet water were not contaminated with faecal coliforms; majority of sachet waterwas contaminated with total coliformabove acceptable limits. Government and other stakeholders should consider intensifying surveillance activities and enforcing strict hygienic measures in this rapidly expanding industry to improve packaged water quality.Item Barriers to antiretroviral adherence in HIV-positive patients receiving free medication in Kayunga, Uganda(AIDS care, 2011) Senkomago, Virginia; Guwatudde, David; Breda, Mark; Khoshnood, KavehGlobal and local efforts have been devoted to increase the supply of antiretroviral therapy (ART) in sub-Saharan Africa. Recent qualitative studies suggest that even with free ART, patients may fail to adhere to medication because of socioeconomic barriers such as transportation costs to clinics. The aim of this study was to measure adherence in a population of patients receiving free ART and to examine barriers to adherence. Adherence was measured using the pill count and self-report methods among 140 HIV-positive patients at four PEPFARfacilitated ART clinics in Kayunga, a rural district in Uganda. Self-report was also used to examine reasons for non-adherence. Pill count adherence estimates revealed that 86.4% of the patients were adherent (]95%) in the past six months. Self-report estimates showed that all the patients were adherent in the past six months with average adherence of 99.7%90.6. The main reasons for non-adherence were being away from medication at dose time (29.4%) and forgetting to take pills (27.5%). Lack of access to food and transportation costs accounted for 11.7% and 7.8% of non-adherence, respectively. Patients with 100% adherence reported lack of access to food as the main challenge they had to overcome to stay adherent. Patients attending the rural clinic were significantly less adherent to ART than patients at the Kayunga district capital [OR 0.046 (0.008 0.269)]. The study revealed that the greatest patient-perceived challenge to adherence in this population is the lack of access to food; however, the immediate reasons for non-adherence were found to be forgetfulness and being away from medication at dose’s time. These results suggest that interventions tackling lack of access to food are necessary, but interventions addressing forgetfulness and being away from medication at dose’s time would be the most effective in enhancing adherence inpatients receiving free ART.Item Building capacity for injury research: A case study from Uganda(Abstracts, 2016) Hyder, Adnan A.; Kobusingye, Olive; Bachani, Abdulgafoor M.; Paichadze, Nino; Bishai, David; Wegener, Stephen; Mbona Tumwesigye, Nazarius; Guwatudde, David; Atuyambe, Lynn; Stevens, Kent A.Despite the high burden of injuries, they have largely been overlooked in global health research. One of the reasons for this is that in many developing countries there is limited supply of trained human resources for addressing injury research. Uganda is one such country where two critical gaps in addressing the lifelong consequences of trauma, injuries and disability are the lack of trained human resources and the lack of data. Objectives Through innovative model of sustainable development, the Johns Hopkins University-Makerere University Chronic Consequences of Trauma, Injuries and Disability in Uganda (JHU-MU Chronic TRIAD) program aims to strengthen research capacity on the long-term health and economic consequences of trauma, injuries and disability across the lifespan in Uganda.Item Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey(International Journal for Equity in Health, 2016) Wesonga, Ronald; Guwatudde, David; Bahendeka, Silver K.; Mutungi, Gerald; Nabugoomu, Fabian; Muwonge, JamesModification of known risk factors has been the most tested strategy for dealing with noncommunicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well. Methods: Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed. Results: A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55.Item The burden of hypertension in sub-Saharan Africa: a four-country cross sectional study(BMC public health, 2015) Guwatudde, David; Nankya-Mutyoba, Joan; Kalyesubula, Robert; Laurence, Carien; Adebamowo, Clement; Ajayi, IkeOluwapo; Bajunirwe, Francis; Njelekela, Marina; Chiwanga, Faraja S.; Reid, Todd; Volmink, Jimmy; Adami, Hans-Olov; Holmes, Michelle D.; Dalal, ShonaHypertension, the leading single cause of morbidity and mortality worldwide, is a growing public health problem in sub-Saharan Africa (SSA). Few studies have estimated and compared the burden of hypertension across different SSA populations. We conducted a cross-sectional analysis of blood pressure data collected through a cohort study in four SSA countries, to estimate the prevalence of pre-hypertension, the prevalence of hypertension, and to identify the factors associated with hypertension. Methods: Participants were from five different population groups defined by occupation and degree of urbanization, including rural and peri-urban residents in Uganda, school teachers in South Africa and Tanzania, and nurses in Nigeria. We used a standardized questionnaire to collect data on demographic and behavioral characteristics, injuries, and history of diagnoses of chronic diseases and mental health. We also made physical measurements (weight, height and blood pressure), as well as biochemical measurements; which followed standardized protocols across the country sites. Modified Poison regression modelling was used to estimate prevalence ratios (PR) as measures of association between potential risk factors and hypertension. Results: The overall age-standardized prevalence of hypertension among the 1216 participants was 25.9 %. Prevalence was highest among nurses with an age-standardized prevalence (ASP) of 25.8 %, followed by school teachers (ASP = 23.2 %), peri-urban residents (ASP = 20.5 %) and lowest among rural residents (ASP = 8.7 %). Only 50.0 % of participants with hypertension were aware of their raised blood pressure. The overall age-standardized prevalence of pre-hypertension was 21.0 %. Factors found to be associated with hypertension were: population group, older age, higher body mass index, higher fasting plasma glucose level, lower level of education, and tobacco use.Item Burden of tuberculosis in Kampala, Uganda(World Health Organization, 2003) Guwatudde, David; Zalwango, Sarah; Kamya, Moses; Debanne, Sara; Mireya, Diaz; Okwera, Alphonse; Mugerwa, Roy; King, Charles; Christopher, WhalenOver the past two decades, the number of tuberculosis cases has risen worldwide, especially in the developing countries of southeast Asia and sub-Saharan Africa, where co-infection with human immunodeficiency virus (HIV) and tuberculosis is common (1, 2). Case notification data often are used to assess the burden of tuberculosis. The wide belief, however, is that a substantial number of cases of tuberculosis are not detected by the health care systems in most of these countries (3, 4), and surveys of the prevalence of tuberculosis in some of these countries support this belief (5, 6). Furthermore, the poor peri-urban areas of developing countries, where living conditions are unsatisfactory with overcrowding, poor hygiene and inadequate sanitation, are usually most affected by tuberculosis (7, 8). Such living conditions, coupled with high prevalence of HIV infection and lack of access to health care and/or poor health-seeking behavior (8, 9), may lead to a vicious circle of transmission of diseases, including tuberculosis. National average notification data often do not reveal the overwhelming burden of tuberculosis in these settings.Item Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm(Nutrients, 2020) Oumrait, Nuria Güil; Daivadanam, Meena; Absetz, Pilvikki; Guwatudde, David; Berggreen-Clausen, Aravinda; Alvesson, Helle Mölsted; De Man, Jeroen; Annerstedt, Kristi SidneyType 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants’ main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the e ect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence.Item Cohort Profile: The Iganga-Mayuge Health and Demographic Surveillance Site, Uganda (IMHDSS, Uganda)(International journal of epidemiology, 2020) Kajungu, Dan; Hirose, Atsumi; Rutebemberwa, Elizeus; Pariyo, George W; Peterson, Stefan; Guwatudde, David; Galiwango, Edward; Tusubira, Valerie; Kaija, Judith; Nareeba, Tryphena; Hanson, ClaudiaThe Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) was set up in 2004 to provide a platform for community-based epidemiological research and research training. Seed funding was provided by the Swedish International Development Agency (SIDA) as part of the Karolinska Institutet, Sweden and Makerere University– Sweden bilateral research collaboration. The specific objectives at inception were to (i) register and monitor health and demographic events (births, deaths, migration) and dynamics in a population and serve as a resource of information for decision making, providing an environment for several community-based projects in single-/multi-disciplinary research and research training; (ii) provide unique, essential, household-level information individually tailored for policy, planning and research needs; (iii) provide a platform for training in applied field research and practical health, socioeconomic and demographic survey methods to students, staff and researchers; and (iv) provide a platform for high-quality household survey data for operational field trials that measures interventions including but not limited to, monitoring trends in communicable and noncommunicable diseases (NCDs), clinical and vaccine trials and other surveillance activities.Item Community health workers – a resource for identification and referral of sick newborns in rural Uganda(Tropical medicine & international health, 2013) Kayemba Nalwadda, Christine; Guwatudde, David; Waiswa, Peter; Kiguli, Juliet; Namazzi, Gertrude; Namutumba, Sarah; Tomson, Goran; Peterson, StefanTo determine community health workers’ (CHWs) competence in identifying and referring sick newborns in Uganda. methods Case-vignettes, observations of role-plays and interviews were employed to collect data using checklists and semistructured questionnaires, from 57 trained CHWs participating in a community health facility–linked cluster randomised trial. Competence to identify and refer sick newborns was measured by knowledge of newborn danger signs, skills to identify sick newborns and effective communication to mothers. Proportions and median scores were computed for each attribute with a pre-defined pass mark of 100% for knowledge and 90% for skill and communication. results For knowledge, 68% of the CHWs attained the pass mark. The median percentage score was 100 (IQR 94 100). 74% mentioned the required five newborn danger signs unprompted. ‘Red umbilicus/cord with pus’ was mentioned by all CHWs (100%), but none mentioned chest in-drawing and grunting as newborn danger signs. 63% attained the pass mark for both skill and communication. The median percentage scores were 91 (IQR 82 100) for skills and 94 (IQR 89, 94) for effective communication. 98% correctly identified the four case-vignettes as sick or not sick newborn. ‘Preterm birth’ was the least identified danger sign from the case-vignettes, by 51% of the CHWs. conclusion CHWs trained for a short period but effectively supervised are competent in identifying and referring sick newborns in a poor resource setting.Item Comparison of fasting plasma glucose and haemoglobin A1c point-of-care tests in screening for diabetes and abnormal glucose regulation in a rural low income setting(Diabetes Research and Clinical Practice, 2014) Mayega, Roy William; Guwatudde, David; Makumbi, Fredrick Edward; Nakwagala, Frederick Nelson; Peterson, Stefan; Tomson, Goran; Ostenson, Claes-GoranGlycated haemoglobin (HbA1C) has been suggested to replace glucose tests in identifying diabetes and pre-diabetes. We assessed agreement between fasting plasma glucose (FPG) and HbA1C rapid tests in classifying abnormal glucose regulation (AGR), and their utility for preventive screening in rural Africa. Methods: A population-based survey of 795 people aged 35–60 years was conducted in a mainly rural district in Uganda. FPG was measured using On-Call1 Plus glucometers, and classified using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. HbA1C was measured using A1cNow1 kits and classified using ADA criteria. Body mass index and blood pressure were measured. Percentage agreement between the two tests was computed. Results: Using HbA1C, 11.3% of participants had diabetes compared with 4.8% for FPG. Prevalence of HbA1C-defined pre-diabetes (26.4%) was 1.2 times and 2.5 times higher than FPG-defined pre-diabetes using ADA (21.8%) and WHO (10.1%) criteria, respectively. With FPG as the reference, agreement between FPG and HbA1C in classifying diabetes status was moderate (Kappa = 22.9; Area Under the Curve (AUC) = 75%), while that for AGR was low (Kappa = 11.0; AUC = 59%). However, agreement was high (over 90%) among negative tests and among participants with risk factors for type 2 diabetes (obesity, overweight or hypertension). HbA1C had more procedural challenges than FPG.Item Computerized Cognitive Rehabilitation Training for Ugandan Seniors Living with HIV: A Validation Study(Journal of Clinical Medicine, 2020) Ezeamama, Amara E.; Sikorskii, Alla; Sankar, Parvathy R.; Nakasujja, Noeline; Ssonko, Michael; Kaminski, Norbert E.; Guwatudde, David; Boivin, Michael J.; Giordani, BrunoThe feasibility, acceptability and preliminary efficacy of computerized cognitive rehabilitation therapy (CCRT) for mitigating neurocognitive decline was evaluated in African adults 50 years old. Eighty-one Ugandans with (n = 40) and without (n = 41) chronic human immunodeficiency viruses (HIV) were allocated CCRT—i.e., 20–45-min cognitive training sessions with culturally adapted video games delivered via Captain’s Log Software, or standard of care (SOC). Pre and post (i.e., 8-weeks later) intervention performance based neurocognitive tests, quality of life (QOL) and frailty related phenotype (FRP) were determined in all respondents. Multivariable linear regression estimated CCRT- vs. SOC-related di erences ( ) in neurocognitive batteries, QOL and FRP. E ect sizes (ES) for estimated were calculated. CCRT protocol was completed by 92.8% of persons allocated to it. Regardless of HIV status, CCRT was associated with higher performance in learning tests than SOC—interference list ( = 1.00, 95%CI: (0.02, 1.98); ES = 0.43) and delayed recall ( = 1.04, 95%CI: (0.06, 2.02); ES = 0.47). CCRT e ect on verbal fluency was clinically important (ES = 0.38), but statistical significance was not reached ( = 1.25, 95%CI: (0.09, 2.58)). Among HIV-positive adults, clinically important post-CCRT improvements were noted for immediate recall (ES = 0.69), working memory (ES = 0.51), verbal fluency (ES = 0.51), and timed gait (ES = 0.44) tasks. Among HIV-negative adults, CCRT resulted in moderate post-intervention improvement in learning tests (ES = 0.45) and large decline in FRP (ES = 0.71), without a positive e ect on simple attention and visuomotor coordination tasks. CCRT intervention is feasible among older Ugandan adults with potential benefit for learning and verbal fluency tests regardless of HIV status and lowering FRP in HIV-negative older adults.Item Consumption of processed food dietary patterns in four African populations(Public Health Nutrition, 2018) Holmes, Michelle D.; Dalal, Shona; Sewram, Vikash; Diamond, Megan B.; Adebamowo, Sally N.; Ajayi, Ikeoluwapo O.; Adebamowo, Clement; Chiwanga, Faraja S.; Njelekela, Marina; Laurence, Carien; Volmink, Jimmy; Bajunirwe, Francis; Nankya-Mutyoba, Joan; Guwatudde, David; Reid, Todd G.; Willett, Walter C.; Adami, Hans-Olov; Fung, Teresa T.To identify predominant dietary patterns in four African populations and examine their association with obesity. Design: Cross-sectional study. Setting/Subjects: We used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of noncommunicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men. Results: We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity. Conclusions: We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.Item Contraceptive Use in Women Enrolled into Preventive HIV Vaccine Trials: Experience from a Phase I/II Trial in East Africa(PLoS ONE, 2009) Kibuuka, Hannah; Guwatudde, David; Kimutai, Robert; Maganga, Lucas; Maboko, Leonard; Watyema, Cecilia; Sawe, Fredrick; Shaffer, Douglas; Matsiko, Dickson; Millard, Monica; Michael, Nelson; Wabwire-Mangen, Fred; Robb, MerlinHIV vaccine trials generally require that pregnant women are excluded from participation, and contraceptive methods must be used to prevent pregnancy during the trial. However, access to quality services and misconceptions associated with contraceptive methods may impact on their effective use in developing countries. We describe the pattern of contraceptive use in a multi-site phase I/IIa HIV Vaccine trial in East Africa (Uganda, Kenya and Tanzania) and factors that may have influenced their use during the trial. Methods: Pregnancy prevention counseling was provided to female participants during informed consent process and at each study visit. Participants’ methods of contraception used were documented. Methods of contraceptives were provided on site. Pregnancy testing was done at designated visits during the trial. Obstacles to contraceptive use were identified and addressed at each visit. Results: Overall, 103 (31.8%) of a total of 324 enrolled volunteers were females. Female participants were generally young with a mean age of 29(67.2), married (49.5%) and had less than high school education (62.1%). Hormonal contraceptives were the most common method of contraception (58.3%) followed by condom use (22.3%). The distribution of methods of contraception among the three sites was similar except for more condom use and less abstinence in Uganda. The majority of women (85.4%) reported to contraceptive use prior to screening. The reasons for not using contraception included access to quality services, insufficient knowledge of certain methods, and misconceptions. Conclusion: Although hormonal contraceptives were frequently used by females participating in the vaccine trial, misconceptions and their incorrect use might have led to inconsistent use resulting in undesired pregnancies. The study underscores the need for an integrated approach to pregnancy prevention counseling during HIV vaccine trials.