Browsing by Author "Kwesiga, Brendan"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    The association between depression, Quality of life, and the Health care expenditure of patients with diabetes mellitus in Uganda
    (Journal of Affective Disorders, 2015) Akena, Dickens; Kadama, Philippa; Ashaba, Scholastic; Akello, Carolyne; Kwesiga, Brendan; Rejania, Lalitha; Okello, James; Mwesiga, Emmanuel. K.; Obuku, Ekwaro. A.
    Background—Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa. Methods—We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures. Results—The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87–5.04)], younger [OR=3.98 CI (1.20–13.23)], un-employed [OR=1.99(CI 1.04–3.81)], and having lost a spouse [OR=2.36 (CI 1.29–4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47–0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95–0.99)], psychological [OR=1.05 (CI 1.03–1.07)], and environmental [OR=0.97, (CI 0.95–0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03–2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01–2.28)]. Limitation—The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes. Conclusions—Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
  • Thumbnail Image
    Item
    The Association Between Depression,Quality Of Life,And The Health Care Expenditure Of Patients With Diabetes Mellitus In Uganda
    (Journal of Affective Disorders, 2015) Akena, Dickens; Kadama, Philippa; Ashaba, Scholastic; Akello, Carolyne; Kwesiga, Brendan; Rejani, Lalitha; Okello, James; Mwesiga, Emmanuel.K.; Obuku, Ekwaro.A.
    Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa.We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures.The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87–5.04)], younger [OR=3.98 CI (1.20–13.23)], un-employed [OR=1.99(CI 1.04–3.81)], and having lost a spouse [OR=2.36 (CI 1.29–4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47–0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95–0.99)], psychological [OR=1.05 (CI 1.03–1.07)], and environmental [OR=0.97, (CI 0.95–0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03–2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01–2.28)].The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes.Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
  • Thumbnail Image
    Item
    Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda
    (BMC Health Services Research, 2016) Walusimbi, Simon; Kwesiga, Brendan; Rodrigues, Rashmi; Haile, Melles; de Costa, Ayesha; Bogg, Lennart; Katamba, Achilles
    Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. Methods: A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. Results: The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. Conclusions: MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.