NRU :: Browsing by Author "Kibirige, Davis"

Browsing by Author "Kibirige, Davis"

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Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective
(BMC pulmonary medicine, 2017) Kibirige, Davis; Kampiire, Leaticia; Atuhe, David; Mwebaze, Raymond; Katagira, Winceslaus; Muttamba, Winters; Nantanda, Rebecca; Worodria, William; Kirenga, Bruce
Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management.
Access to medicines and diagnostic tests integral in the management of diabetes mellitus and cardiovascular diseases in Uganda: insights from the ACCODAD study
(International journal for equity in health, 2017) Kibirige, Davis; Atuhe, David; Kampiire, Leaticia; Kiggundu, Daniel Ssekikubo; Nabbaale, Juliet; Mwebaze, Raymond Mbayo; Kalyesubula, Robert; Lumu, William
Despite the burgeoning burden of diabetes mellitus (DM) and cardiovascular diseases (CVD) in low and middle income countries (LMIC), access to affordable essential medicines and diagnostic tests for DM and CVD still remain a challenge in clinical practice. The Access to Cardiovascular diseases, Chronic Obstructive pulmonary disease, Diabetes mellitus and Asthma Drugs and diagnostics (ACCODAD) study aimed at providing contemporary information about the availability, cost and affordability of medicines and diagnostic tests integral in the management of DM and CVD in Uganda.
Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study
(Tropical medicine and health, 2021) Bongomin, Felix; Olum, Ronald; Kyazze, Andrew Peter; Ninsiima, Sandra; Nattabi, Gloria; Nakyagaba, Lourita; Nabakka, Winnie; Kukunda, Rebecca; Ssekamatte, Phillip; Kibirige, Davis; Cose, Stephen; Nakimuli, Annettee
Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda. Methods: We conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda. Results: The prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37). Conclusions: Despite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.
Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa
(Tropical Medicine & International Health, 2022) Kibirige, Davis; Olum, Ronald; Kyazze, Andrew Peter; Bongomin, Felix; Sanya, Richard E.
To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. Methods: Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model metaanalysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. Results: A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8% - 49.2%, I2=95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3% - 39.9%, I2=91.6%), premixed insulin 49.4% (95% CI: 24.9% - 73.9%, I2=90.57%), glibenclamide 55.9% (95% CI: 43.8% - 68.0%, I2=96.7%), and metformin 47.0% (95% CI: 34.6% - 59.4, I2=97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9% - 61.1%, I2=97.43%), for HbA1c 24.6% (95% CI: 3.1% - 46.1%, I2=91.64), and for lipid profile tests 35.7% (95% CI: 19.4% - 51.9%, I2=83.77%). The median (IQR) affordability in days’ wages was 7 (4.7- 7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7- 0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin. Conclusion: The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.
Cryptococcosis complicating diabetes mellitus: a scoping review
(Therapeutic advances in infectious disease, 2021) Nsenga, Lauryn; Kajjimu, Jonathan; Olum, Ronald; Ninsiima, Sandra; Kyazze, Andrew Peter; Ssekamatte, Phillip; Kibirige, Davis; Baruch Baluku, Joseph; Andia-Biraro, Irene; Bongomin, Felix
A better understanding of the epidemiology of cryptococcal infection in HIVnegative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to Cryptococcus neoformans. Risk factors and outcomes of cryptococcosis in DM are not well documented. Objective: The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM. Methods: MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded. Results: A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% (n = 18) of the cases. Median age was 60.5 (range: 27–79) years. The majority of the patients had cryptococcal meningitis (68.1%, n = 32) followed by disseminated cryptococcosis (6.4%, n = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% (n = 18). Among those with meningitis mortality was 36.2%. Conclusion: A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.
Dyslipidaemia in a Black African Diabetic Population: Burden, Pattern and Predictors
(BMC research notes, 2017) Lumu, William; Kampiire, Leaticia; Akabwai, George Patrick; Ssekitoleko, Richard; Kiggundu, Daniel Ssekikubo; Kibirige, Davis
This study sought to assess the burden, pattern and predictors of dyslipidaemia in 425 adult diabetic patients in Uganda. The median (IQR) age of the study participants was 53 (43.5–62) years with a female majority (283, 66.9%). Dyslipidaemia defined as presence of ≥ 1 lipid abnormalities was observed in 374 (88%) study participants. Collectively, the predictors of dyslipidaemia were: female gender, study site (private hospitals), type of diabetes (type 2 diabetes mellitus), statin therapy, increased body mass index and diastolic blood pressure. Proactive screening of dyslipidaemia and its optimal management using lipid lowering therapy should be emphasised among adult diabetic patients in Uganda.
Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial
(BioMed Central Ltd, 2024-05) Lumu, William; Bahendeka, Silver; Kibirige, Davis; Wesonga, Ronald; Mutebi, Ronald Kasoma
Abstract Hypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in people living with type 2 diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes, partly due to the scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known. We evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda. A two-armed cluster randomized controlled trial compared the nurse-led management intervention with usual doctor-led care. The intervention involved training nurses to provide structured health education, protocol-based HT/CVD management, 24-h phone calls, and 2-monthly text messages for 6 months. The primary outcome was the mean difference in SBP change among patients with T2D with a high ASCVD risk in the intervention and control groups after 6 months. The secondary outcome was the absolute difference in the number of patients at target for SBP, total cholesterol (TC), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) after the intervention. The study was analyzed according to the intention-to-treat principle. Generalized estimating equations were used to assess intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses. Eight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192; control 4 clinics; n = 196). A nurse-led intervention reduced SBP by -11.21 [+ or -] 16.02 mmHg with a mean difference between the groups of -13.75 mmHg (95% CI -16.48 to -11.02, p < 0.001). An increase in SBP of 2.54 [+ or -] 10.95 mmHg was observed in the control group. Diastolic blood pressure was reduced by -6.80 [+ or -] 9.48 mmHg with a mean difference between groups of -7.20 mmHg (95% C1 -8.87 to -5.48, p < 0.001). The mean differences in the change in ASCVD score and glycated hemoglobin were -4.73% (95% CI -5.95 to -3.51, p = 0.006) and -0.82% (95% CI -1.30 to -0.35, p = 0.001), respectively. There were significant absolute differences in the number of patients at target in SBP (p = 0.001), DBP (p = 0.003), and TC (p = 0.008). A nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D. Such an intervention may be pragmatic in the screening and management of HT/ASCVD in Uganda.
Frequency and predictors of suboptimal glycemic control in an African diabetic population
(International journal of general medicine, 2017) Kibirige, Davis; Akabwai, George Patrick; Kampiire, Leaticia; Kiggundu, Daniel Ssekikubo; Lumu, William
Persistent suboptimal glycemic control is invariably associated with onset and progression of acute and chronic diabetic complications in diabetic patients. In Uganda, studies documenting the magnitude and predictors of suboptimal glycemic control in adult ambulatory diabetic patients are limited. This study aimed at determining the frequency and predictors of suboptimal glycemic control in adult diabetic patients attending three urban outpatient diabetic clinics in Uganda.
HIV, Tuberculosis, Diabetes Mellitus and Hypertension Admissions and Premature Mortality among Adults in Uganda from 2011 to 2019: is the Tide Turning?
(Tropical Medicine and Health, 2022) Kazibwe, Andrew; Bisaso, Kuteesa Ronald; Kyazze, Andrew Peter; Ninsiima, Sandra; Ssekamatte, Phillip; Bongomin, Felix; Baluku, Joseph Baruch; Kibirige, Davis; Akabwai, George Patrick; Kamya, Moses R.; Mayanja‑Kizza, Harriet; Kagimu, Magid; Kalyesubula, Robert; Andia‑Biraro, Irene
The growing burden of diabetes mellitus (DM) and hypertension (HTN) on the background of endemic Human Immuno-deficiency Virus (HIV) and tuberculosis (TB) is a concern in low- and middle-income countries. We aimed to describe annual trends in admissions, mortality rates and premature mortality (years of potential life lost—YPLLs) due to HIV, tuberculosis (TB), diabetes mellitus (DM) and hypertension (HTN) in Uganda. We conducted a retrospective cohort study, retrieving electronic records of adults admitted to Mulago and Kiruddu national referral hospitals medical wards between 1st January 2011 and 31st December 2019. We used STATA BE 17.0 and GraphPad Prism 8.0.2 to compute total admissions, inpatient crude mortality rates, and YPLLs; and demonstrate trends using Mann–Kendall test. Of 108,357 admissions, 55,620 (51.3%) were female, 15,300 (14.1%) were recorded in 2012, and 22,997 (21.2%) were aged 21–30 years. HIV, TB, DM and HTN accounted for 26,021 (24.0%); 9537 (8.8%); 13,708 (12.7) and 13,252 (12.2%) of all admissions, respectively. Overall inpatient mortality was 16.7% (18,099/108,357), 53.5% (9674/18,099) were male, 21.5% (3898) were aged 31–40 years and 2597 (14.4%) were registered in 2013. HIV, TB, DM and HTN accounted for 35.6% (6444), 14.6% (2646), 9.1% (1648) and 11.8% (2142) of all deaths, respectively. Total admissions (Kendall’s tau-B = − 0.833, p < 0.001) and deaths declined (Kendall’s tau-B = − 0.611, p = 0.029). A total of 355,514 (mean = 20.8 years, SD 30.0) YPLLs were recorded, of which 54.6% (191,869) were in males; 36.2% (128,755) were among those aged 21–30 years and were recorded in 2012 (54,717; 15.4%). HIV, TB, DM and HTN accounted for 46.5% (165,352); 19.5% (69,347); 4.8% (16,991) and 4.5% (16,167) of YPLLs, respectively. Proportionate contribution of HIV to deaths and YPLLs declined, remained stagnant for TB; and increased for both DM and HTN. TB and HIV account for higher though declining, while DM and HTN account for lower albeit rising morbidity and premature mortality among adult medical patients in Uganda. TB prevention and treatment; and DM/HTN service integration in HIV care should be optimized and scaled up.
Hyperglycemia in pregnancy diagnosed using glycated hemoglobin (HbA1c) in Uganda: a preliminary cross-sectional report [version 1; peer review: 1 approved]
(Emerald Open Research, 2020) Bongomin, Felix; Kyazze, Andrew P.; Ninsiima, Sandra; Olum, Ronald; Nattabi, Gloria; Nabakka, Winnie; Kukunda, Rebecca; Batte, Charles; Ssekamatte, Phillip; Baruch Baluku, Joseph; Kibirige, Davis; Cose, Stephen; Andia-Biraro, Irene
Hyperglycemia in pregnancy (HIP) is a common medical complication during pregnancy and is associated with several short and long-term maternal-fetal consequences. We aimed to determine the prevalence and factors associated with HIP among Ugandan women. Methods: We consecutively enrolled eligible pregnant women attending antenatal care at Kawempe National Referral Hospital, Kampala, Uganda in September 2020. Mothers known to be living with diabetes mellitus or haemoglobinopathies and those with anemia (hemoglobin <11g/dl) were excluded. Random blood sugar (RBS) and glycated hemoglobin A1c (HbA1c) were measured on peripheral venous blood samples. HIP was defined as an HbA1c ≥5.7% with its subsets of diabetes in pregnancy (DIP) and prediabetes defined as HbA1c of ≥6.5% and 5.7-6.4% respectively. ROC curve analysis was performed to determine the optimum cutoff of RBS to screen for HIP. Results: A total of 224 mothers with a mean (± SD) age 26±5 years were enrolled, most of whom were in the 2nd or 3rd trimester (94.6%, n=212) with a mean gestation age of 26.6±7.3 weeks. Prevalence of 6HIP was 11.2% (n=25) (95% CI: 7.7-16.0). Among the mothers with HIP, 2.2% (n=5) had DIP and 8.9% (n=20) prediabetes. Patients with HIP were older (28 years vs. 26 years, p=0.027), had previous tuberculosis (TB) contact (24% vs. 6.5%, p=0.003) and had a bigger hip circumference (107.8 (±10.4) vs. 103.3 (±9.7) cm, p = 0.032). However only previous TB contact was predictive of HIP (odds ratio: 4.4, 95% CI: 1.2-14.0; p=0.022). Using HbA1c as a reference variable, we derived an optimum RBS cutoff of 4.75 mmol/L as predictive of HIP with a sensitivity and specificity of 90.7% and 56.4% (area under the curve = 0.75 (95% CI: 0.70-0.80, p<0.001)), respectively. Conclusions: HIP is common among young Ugandan women, the majority of whom are without identifiable risk factors.
Latent Tuberculosis Infection Status of Pregnant Women in Uganda Determined Using QuantiFERON TB Gold-Plus
(Oxford University Press, 2021) Bongomin, Felix; Ssekamatte, Phillip; Nattabi, Gloria; Olum, Ronald; Ninsiima, Sandra; Kyazze, Andrew Peter; Nabakka, Winnie; Kukunda, Rebecca; Cose, Stephen; Kibirige, Davis; Batte, Charles; Kaddumukasa, Mark; Kirenga, Bruce J.; Nakimuli, Annettee; Baruch Baluku, Joseph; ndia-Biraro, Irene A
The risk of progression of latent tuberculosis infection (LTBI) to active disease increases with pregnancy. This study determined the prevalence and risk factors associated with LTBI among pregnant women in Uganda. Methods. We enrolled 261 pregnant women, irrespective of gestational age. Participants who had known or suspected active tuberculosis (TB) on the basis of clinical evaluation or who had recently received treatment for TB were excluded. LTBI was defined as an interferon-γ concentration ≥0.35 IU/mL (calculated as either TB1 [eliciting CD4+ T-cell responses] or TB2 [eliciting CD8+ T-cell responses] antigen minus nil) using QuantiFERON TB Gold-Plus (QFT-plus) assay. Results. LTBI prevalence was 37.9% (n = 99) (95% confidence interval [CI], 32.3–44.0). However, 24 (9.2%) subjects had indeterminate QFT-plus results. Among participants with LTBI, TB1 and TB2 alone were positive in 11 (11.1%) and 18 (18.2%) participants, respectively. In multivariable analysis, human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR], 4.4 [95% confidence interval {CI}, 1.1–18.0]; P = .04) and age 30–39 years (aOR, 4.0 [95% CI, 1.2–12.7]; P = .02) were independently associated with LTBI. Meanwhile, smoking status, alcohol use, nature of residence, crowding index, and TB contact were not associated with LTBI. Conclusions. Our findings are in keeping with the evidence that HIV infection and advancing age are important risk factors for LTBI in pregnancy. In our setting, we recommend routine screening for LTBI and TB preventive therapy among eligible pregnant women.
Statin Therapy Reduces the Likelihood of Suboptimal Blood Pressure Control among Ugandan Adult Diabetic Patients
(Therapeutics and Clinical Risk Management, 2017) Lumu, William; Kampiire, Leaticia; Akabwai, George Patrick; Kiggundu, Daniel Ssekikubo; Kibirige, Davis
Hypertension is one of the recognized risk factors of cardiovascular diseases in adult diabetic patients. High prevalence of suboptimal blood pressure (BP) control has been well documented in the majority of studies assessing BP control in diabetic patients in sub-Saharan Africa. In Uganda, there is a dearth of similar studies. This study evaluated the prevalence and correlates of suboptimal BP control in an adult diabetic population in Uganda.
Suboptimal glycaemic and blood pressure control and screening for diabetic complications in adult ambulatory diabetic patients in Uganda: a retrospective study from a developing country
(Journal of Diabetes & Metabolic Disorders, 2014) Kibirige, Davis; Atuhe, David; Sebunya, Robert; Mwebaze, Raymond
Currently, Sub Saharan Africa is faced with a substantial burden from diabetes mellitus. In most of the African countries, screening for diabetes related complications and control of blood pressure and glycaemic levels is often suboptimal. The study aimed at assessing the extent of optimal glycaemic and blood pressure control and the frequency of screening for diabetic complications in adult ambulatory Ugandan diabetic patients.

Browsing by Author "Kibirige, Davis"

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