Browsing by Author "Katamba, Godfrey"
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Item A 10-Year Risk of Cardiovascular Disease among Patients with Severe Mental Illness at Mbarara Regional Referral Hospital, Southwestern Uganda(BioMed Research International, 2020) Agaba, David Collins; Migisha, Richard; Lugobe, Henry Mark; Katamba, Godfrey; Ashaba, ScholasticCardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Patients with severe mental illness (SMI) are at a higher risk for developing CVD and have a higher risk for harboring factors related to CVD. In addition to the effects of antipsychotic medications, unhealthy lifestyle factors, such as poor diet, inadequate physical activity, cigarette smoking, and sedentary behaviors, are known to be risk factors that may contribute to poor cardiovascular health in patients with SMI. Early identification of individuals at elevated risk of CVD is essential so that dietary and lifestyle modifications or pharmacological interventions can be prescribed to alleviate the risk of cardiovascular disease. The objective of the study was to determine the 10-year risk of cardiovascular disease among patients with severe mental illness at Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a cross-sectional study at the outpatient mental health clinic of Mbarara Regional Referral Hospital, between October 2018 and March 2019. We used the Globorisk CVD risk score to estimate the 10-year risk of CVD among patients with SMI, using the online Globorisk calculator. Participants were then assigned to one of three categories depending on their 10-year CVD risk score: <3% (low), 3–10% (intermediate), and >10% (high). We calculated the risk scores of 125 participants aged 40-74 years. Most of the participants were female 75 (60%), had a diagnosis of bipolar disorder 75 (60%), and had mental illness for ≥10 years 57 (46%). Eighty five percent (85%) of the participants had intermediate to high 10-year risk of CVD (64% with intermediate and 21% with high risk). The average risk score was significantly higher in males compared to females, 8.82% versus 6.43%, p = 0:016. We detected a high 10-year risk of CVD in a significant proportion of patients with SMI in southwestern Uganda. We recommend lifestyle modifications and pharmacological interventions to reverse risk or delay progression to CVD in this patient population.Item Abnormal obstetric shock index and associated factors among immediate postpartum women following vaginal delivery at a tertiary hospital in Southwestern Uganda(Research Square, 2022) Agaba, David Collins; Lugobe, Henry Mark; Migisha, Richard; Jjuuko, Mark; Saturday, Pascal; Kisombo, Dean; Mlangwa Atupele, Subira; Kirabira, Justus; Tumusiime, Matthew; Katamba, Godfrey; Mugyenyi, Godfrey; Masembe, Sezalio; Kayondo, Musa; Ngonzi, JosephEarly recognition of haemodynamic instability after birth and prompt interventions are necessary to reduce adverse maternal outcomes due to postpartum haemorrhage. Obstetric shock Index (OSI) has been recommended as a simple, accurate, reliable, and low-cost early diagnostic measure that identifies hemodynamically unstable women. Objectives We determined the prevalence of abnormal obstetric shock index and associated factors among women in the immediate postpartum period following vaginal delivery at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods We conducted a cross-sectional study at the labour suite and postnatal ward of MRRH from January 2022 to April 2022. We systematically sampled women who had delivered vaginally, and measured their blood pressures and pulse rates at 1 hour postpartum. We excluded mothers with hypertensive disorders of pregnancy. Sociodemographic, medical and obstetric data were obtained through intervieweradministered questionnaires. The prevalence of abnormal OSI was the proportion of participants with an OSI ≥ 0.9 (calculated as the pulse rate divided by the systolic BP). Logistic regression analysis was used to determine associations between abnormal OSI and independent variables. Results We enrolled 427 women with a mean age of 25.66 ± 5.30 years. Of these, 83 (19.44%), 95% CI (15.79– 23.52) had an abnormal obstetric shock index. Being referred [aOR 2.34, 95% CI (1.41–3.89), p = 0.001], having had an episiotomy/perineal laceration [aOR 1.90, 95% CI (1.15–3.13), p = 0.012] and having a visually estimated blood loss > 200 mls [aOR 1.78, 95% CI (1.06–3.01), p = 0.028] were significantly associated with abnormal OSI. Conclusion Approximately one in every five women who delivered vaginally at MRRH during the study period had an abnormal OSI. We recommend that clinicians have a high index of suspicion for haemodynamic instability among women in the immediate postpartum period. Mothers who are referred in from other facilities, those that get episiotomies/perineal lacerations and those with estimated blood loss > 200mls should be prioritized for close monitoring.Item Cardio-metabolic abnormalities among patients with severe mental illness at a Regional Referral Hospital in southwestern Uganda(2020) Agaba, David Collins; Migisha, Richard; Katamba, Godfrey; Ashaba, ScholasticPatients with severe mental illness (SMI) have a higher burden of premature cardio-metabolic abnormalities, including diabetes mellitus, hypertension, hyperlipidemia, and obesity resulting into a 3-fold increase in mortality, and up to 20% reduction in life expectancy compared to the general population. Although over 30% of Ugandans have some form of mental illness, there are no national or hospital-based screening guidelines for cardio-metabolic abnormalities among these patients a general trend in most low-income countries. The screening rates for cardio-metabolic abnormalities in most low-income countries are at only 0.6%. The objective of this study was to describe the cardio-metabolic abnormalities among patients with SMI at Mbarara Regional Referral Hospital. Through a cross-sectional study, we recruited 304 patients with SMI and evaluated them for cardio-metabolic abnormalities using the National Cholesterol Education Programme Adult Treatment Panel III criteria for dyslipidemias, World Health Organisation criteria for diabetes mellitus, obesity, and the Joint national committee criteria for hypertension. We then determined the proportion of participants who met the criteria for each of the individual cardio-metabolic abnormalities. Of the 304 participants, 44.41% were male and 55.59% female with a mean age of 38.56 ±13.66 years. Almost half (46.38%) of the participants were either overweight or obese, 33.22% had abdominal obesity, 40.46% were hypertensive, 34.11% had low high-density lipoproteins, 37.42% had hypertriglyceridemia and 34.77% had hypercholesterolemia. Based on fasting blood sugar, 11.18% and 9.87% had pre-diabetes and diabetes respectively. There is a high level of cardio-metabolic abnormalities among patients with psychiatric disorders and thus metabolic screening for these abnormalities should be done routinely during psychiatric reviews. There is a need for national guidelines for screening of metabolic abnormalities among patients with SMI so that these abnormalities can be detected early enough at stages where they can be either reversed or delayed to progress to cardiovascular disease.Item High prevalence of prolonged QTc interval among individuals in ambulatory diabetic care in southwestern Uganda(International journal of diabetes in developing countries, 2021) Migisha, Richard; Agaba, David Collins; Katamba, Godfrey; Miranda, Silvia Lopez; Muyingo, Anthony; Siedner, Mark J.Heart rate-corrected QT (QTc) interval is associated with increased risk for cardiovascular events and mortality among individuals with diabetes mellitus (DM). Little is known about the epidemiology of prolonged QTc among people with DM in resource-limited settings. Methods We conducted a cross-sectional study among adults with diabetes in ambulatory care at the Mbarara Regional Referral Hospital, from November 2018 to April 2019. Twelve-lead ECG recordings were performed on all participants. We collected clinical and laboratory data related to diabetes disease status and treatment control.We estimated QTc using Bazett’s formula and categorized it according to standardized sex-adjusted thresholds. Linear regression analysis was performed to identify correlates of QTc. Results We recruited 299 participants with a mean age of 50.1 years (SD±9.8) and mean HbA1c of 9.7 % (SD±2.6), and 69.6% were female. We detected prolonged and borderline QTc in 6.4% (19/299, 95% CI: 3.9–9.7%) and 23.4% (70/299, 95% CI: 18.7–28.6%) of participants, respectively. In multivariate models, factors associated with increasing QTc interval were mean arterial pressure (β=0.34; 95% CI: 0.07–0.63, p=0.019) and female sex (β=15.26; 95% CI: 7.58–22.94, p<0.001). Conclusions The prevalence of abnormal QTc among individuals in routine diabetes care in southwestern Uganda was high. Female sex and mean arterial pressure were correlated with QTc interval. Given these findings, future studies should explore the clinical impact of abnormal QTc in this patient population.Item Neck circumference as marker of overweight and obesity among secondary adolescents aged 12-19 years in southwestern Uganda: a cross-sectional survey(Research Square, 2021) Katamba, Godfrey; Agaba, David; Namaganda, Agnes; Musasizi, Abdul; Kinene, Mivule; Migisha, RichardOverweight and obesity have become more common among adolescents. Various indicators have been used to assess this burden across populations. Recent findings elsewhere have found neck circumference to be useful in defining overweight and obesity. However, the use of neck circumference as marker of overweight and obesity needs to be further explored among adolescents in Uganda. Objective: To assess the usefulness of neck circumference as a marker of overweight and obesity. Methods: A cross sectional study was conducted among secondary adolescents aged 12-19 years from May to August in 2018, Height was measured using a wall mount height board and weight using a standard weighing scale. Neck circumference was measured using an inelastic measuring tape. We defined overweight as BMI =25.0-29.9kg/m2 while obesity as BMI ≥30.0kg/m2 among the study participants. Pearson correlation coefficient was used to determine the correlation between neck circumference, height, weight and body mass index. Receiver operating characteristic (ROC) curve analysis was used to determine the suitable cutoff of neck circumference for overweight and obesity. Results: We enrolled 616 adolescents aged 12-19 years, with mean age of 15.6±2.0 years. Most (65.6%) were female. The overall prevalence of overweight was 30.5% while that of obesity was 3.4%. Neck circumference was significantly correlated with height (r = 0.561, p<0.001), weight (r = 0.547, p<0.001) and body mass index (r = 0.193, p<0.001). The best cutoff of neck circumference to identify participants with obesity were ≥ 31.0 cm with AUC of 0.83 and ≥ 32.0cm with an AUC of 0.59 among the females and males respectively. Conclusion: Neck circumference was useful in defining and hence classifying for overweight or obesity among the female adolescents in our study population. It could useful for screening for overweight and obesity among the female adolescents.Item Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross‑sectional study(BMC Cardiovascular Disorders, 2021) Migisha, Richard; Agaba, David Collins; Katamba, Godfrey; Manne‑Goehler, Jennifer; Muyingo, Anthony; Siedner, Mark J.Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are often unrecognized in clinical care for diabetic individuals, yet they are associated with increased risk for adverse cardiovascular outcomes. We aimed to determine the prevalence of the abnormal orthostatic blood pressure (BP) responses, and associated factors among diabetic individuals in ambulatory care for diabetes in southwestern Uganda. Methods: We conducted a cross-sectional study among diabetic individuals aged 18–65 years at Mbarara Regional Referral Hospital, southwestern Uganda from November 2018 to April 2019. We obtained demographic and clinical data including a detailed medical history, and glycemic profile. BP measurements were taken in supine position and within 3 min of standing. We defined OH in participants with either ≥ 20 mmHg drop in systolic BP (SBP) or ≥ 10 mmHg drop in diastolic BP (DBP) after assuming an upright position. OHT was defined in participants with either a ≥ 20 mmHg rise in SBP, or ≥ 10 mmHg rise in DBP after assuming an upright position. Multivariate logistic regression was used to identify factors associated with OH and OHT. Results: We enrolled 299 participants, with a mean age of 50 years (SD ± 9.8), and mean HbA1c of 9.7% (SD ± 2.6); 70% were female. Of the 299 participants, 52 (17.4%; 95% CI 13.3–22.2%) met the definition of OH and 43 (14.4%; 95% CI 10.6–18.9%) were classified as having OHT. In multivariable models, factors associated with diabetic OH were older age (OR = 2.40 for 51–65 years vs 18–50 years, 95% CI 1.02–5.67, P = 0.046), diabetic retinopathy (OR = 2.51; 95% CI 1.14–5.53, P = 0.022), higher resting SBP ≥ 140 mmHg (OR = 3.14; 95% CI 1.31–8.7.56, P = 0.011), and history of palpitations (OR = 2.31; 95% CI 1.08–4.92, P = 0.031). Self-report of palpitations (OR = 3.14; 95% CI 1.42–6.95, P = 0.005), and higher resting SBP ≥ 140 mmHg (OR = 22.01; 95% CI 1.10–4.42, P = 0.043) were associated with OHT. Conclusion: OH and OHT are common among diabetic individuals in ambulatory diabetes care in southwestern Uganda. Orthostatic BP measurements should be considered as part of routine physical examination to improve detection of OH and OHT, especially among older diabetics with complications of the disease. Future studies to assess the health and prognostic implications of OH and OHT among diabetics in the region are warranted.Item Prevalence and Correlates of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes in Uganda: A Hospital-Based Cross-sectional Study(Global Heart, 2020) Migisha, Richard; Agaba, David Collins; Katamba, Godfrey; Kwaga, Teddy; Tumwesigye, Raymond; Miranda, Silvia Lopez; Muyingo, Anthony; Siedner, Mark J.Cardiovascular autonomic neuropathy (CAN) is a common complication in individuals with diabetes mellitus (DM) but often overlooked in clinical practice. The burden and correlates of CAN have not been extensively studied in low-income countries, particularly in sub-Saharan Africa. Objectives: To determine the prevalence and correlates of CAN among adults in ambulatory diabetes care in southwestern Uganda. Method: We conducted a cross-sectional study among adults with diabetes from November 2018 to April 2019. CAN was assessed using the five autonomic function tests: deep breathing, Valsalva maneuver, postural index on standing, change in blood pressure during standing and diastolic blood pressure response to isometric exercise. We estimated the prevalence of CAN and fit regression models to identify its demographic and clinical correlates. Results: We enrolled 299 individuals. The mean age was 50.1 years (SD ± 9.8), mean HbA1c was 9.7 (SD ± 2.6) and 69.6% were female. CAN was detected in 156/299 (52.2%) of the participants on the basis of one or more abnormal cardiovascular autonomic reflex tests. Out of 299 participants, 88 (29.4%) were classified as early CAN while 61/299 (20.4%) and 7/299 (2.3%) were classified as definite and severe (advanced) CAN respectively. In multivariable regression models, age over 50 years (aOR 3.48, 95%CI 1.35 –8.99, p = 0.010), duration of diabetes over 10 years (aOR 4.09, 95%CI 1.78 –9.38, p = 0.001), and presence of diabetic retinopathy (aOR 2.25, 95%CI 1.16 –4.34, p = 0.016) were correlated with CAN. Conclusions: Our findings reveal a high prevalence of CAN among individuals in routine outpatient care for diabetes mellitus in Uganda. Older age, longer duration of diabetes and coexistence of retinopathy are associated with CAN. Future work should explore the clinical significance and long term outcomes associated with CAN in this region.Item Prevalence of hypertension in relation to anthropometric indices among secondary adolescents in Mbarara, Southwestern Uganda(Italian Journal of Pediatrics, 2020) Katamba, Godfrey; Agaba, David C.; Migisha, Richard; Namaganda, Agnes; Namayanja, Rosemary; Turyakira, EleanorStudies investigating the prevalence of hypertension and its correlation with anthropometric indices among adolescents are still scarce compared to those conducted in adults of greater than 40 years. So far, no other study estimating the prevalence and correlates of hypertension among adolescents in Uganda has been found. Objective: The purpose of this study, therefore, was to asses the prevalence of hypertension and its correlation with anthropometric indices among adolescents in Mbarara Municipality, southwestern Uganda. Methods: A cross-sectional study was carried out among 616 secondary school adolescents aged 12–19 years in Mbarara Municipality, Uganda. Blood pressure and anthropometric indices were determined by standard methods. In the statistical analysis, linear regression analysis was done to assess the relationship between blood pressure and anthropometric indices. Results: Overall prevalence of hypertension among adolescents was at 3.1% (n = 19) while prehypertension was 7.1% (n = 44). There was a statistically significant correlation between blood pressure, neck circumference, waist to hip ratio and body mass index at bivariate analysis. In multivariate analysis for anthropometric indices and sex, only neck circumference remained significantly correlated with blood pressure (p < 0.05). Conclusion: The prevalence of hypertension among adolescents in the study setting was low. An increase in neck circumference results in an increase in blood pressure among adolescents.Item Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda(Journal of Human Hypertension, 2020) Katamba, Godfrey; Agaba, David C.; Migisha, Richard; Namaganda, Agnes; Namayanja, Rosemary; Turyakira, EleanorHypertension is the number one risk factor for cardiovascular diseases worldwide and yet its diagnosis among adolescents, based on blood pressure percentiles which are age, height, and sex-specific, is complex. Our study intended to determine the suitability of blood pressure height index in defining adolescent hypertension among secondary school adolescents aged 12–17 years in Mbarara municipality, southwestern Uganda. Our study used data of 485 secondary school adolescents of which 173 were boys. Receiver operating characteristic curve analysis was performed to assess the performance of systolic blood pressure height index (SBPHI) and diastolic blood pressure height index (DBPHI) for screening for adolescent prehypertension and hypertension. The optimal systolic/diastolic thresholds for defining prehypertension were 0.70/0.43 mmHg/cm in boys and 0.76/0.43 in girls. The corresponding values for hypertension were 0.78/0.43 and 0.77/0.48 mmHg/cm, respectively. The negative predictive values were much higher (all ≥ 95%) for prehypertension and hypertension, while the positive predictive value was 100% for hypertension in both sexes. In conclusion, Blood pressure height index is simple and accurate for screening for prehypertension and hypertension in adolescents aged 12–17 years hence can be used for early screening of adolescents at high risk of hypertension but not its diagnosis.Item The utility of Resting Pulse Rate in Defining High Blood Pressure among Adolescents in Mbarara Municipality, 3 Uganda(Journal of Human Hypertension, 2021) Katamba, Godfrey; Agaba, David Collins; Namayanja, Rosemary; Namaganda, Agnes; Musasizi, Abdul; Kinene, Mivule Abdul; Migisha, RichardHigh resting pulse rate (RPR) is associated with adverse cardiovascular events, and could be used as a marker of cardiovascular health. We determined the correlation between RPR and blood pressure (BP); and its accuracy in defining high blood pressure among adolescents attending secondary schools in Mbarara municipality, south-western Uganda. We conducted a cross-sectional study among secondary school adolescents aged 12-19 years in Mbarara municipality, Uganda. We captured demographic characteristics using a structured questionnaire; and measured anthropometric indices and BP. We performed a linear regression analysis to determine the relationship between RPR and blood pressure and plotted receiver operating characteristics curves (ROC) to assess the accuracy of RPR in defining high BP. We enrolled 616 adolescents with a mean age of 15.6±2.0 years and 65.6% (404/616) were female. The RPR was significantly correlated with diastolic blood pressure (DBP) in both boys (Beta = 0.22 [95%CI: 0.10; 0.36]), p<0.001 and girls (Beta = 0.51 [95%CI: 0.43; 0.60]), p<0.001. RPR was significantly correlated with systolic blood pressure (SBP) only in the girls (Beta = 0.23 [95%CI: 30 0.15; 0.30]), p<0.001. The optimal threshold for RPR in defining prehypertension was RPR≥76bpm with an area under the curve (AUC) of 0.653[95%CI: 0.583-0.722], the sensitivity of 0.737 and specificity of 0.577. In defining hypertension, the optimal threshold was RPR ≥ 79bpm at a sensitivity of 0.737 and specificity of 0.719, with an AUC of 0.728[95%CI: 0.624-34 0.831]. Resting pulse rate was positively correlated with BP and was more accurate in defining hypertension compared to prehypertension in the study.