Browsing by Author "Makumbi, Fred"

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    Age of male circumcision and risk of prevalent HIV infection in rural Uganda
    (Aids, 1999) Kelly, Robert; Kiwanuka, Noah; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson; Wabwire-Mangen, Fred; Li, Chuanjun; Konde-Lule, Joseph K.; Lutalo, Tom; Makumbi, Fred; Gray, Ronald H.
    Epidemiological evidence suggests that male circumcision may reduce the risk of sexually transmitted diseases (STD) and possibly HIV infection. Studies of STD clinic attenders have found that circumcised men are less likely to have gonorrhea, syphilis, herpes, candidiasis, and genital ulcer disease (GUD) [1–3]. Age at circumcision has also been reported as a risk factor in penile cancer [4]. Ecological studies report geographic correlations between HIV seroprevalence and the proportion of uncircumcised men in African populations [5,6], but subsequent cross-sectional and prospective studies found an inconsistent association between male circumcision and HIV-1 and HIV-2 infection in men and women [7–9].
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    The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project
    (Elsevier Inc, 2024-01-09) Kirenga, Bruce J; Chakaya, Jeremiah; Yimer, Getnet; Nyale, George; Haile, Tewodros; Muttamba, Winters; Mugenyi, Levicatus; Katagira, Winceslaus; Worodria, William; Aanyu-Tukamuhebwa, Hellen; Lugogo, Njira; Joloba, Moses; Mersha, Tesfaye B.; Bekele, Amsalu; Makumbi, Fred; Mekasha, Amha; Green, Cynthia L.; de Jong, Corina; Kamya, Moses; van der Molen, Thys
    Background: Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. Objective: We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Methods: Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Results: Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. Conclusion: The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.
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    CD4-T-Lymphocyte Reference Ranges in Uganda and Its Influencing Factors
    (Laboratory Medicine, 2011) Nanzigu, Sarah; Waako, Paul; Petzold, Max; Kiwanuka, Gertrude; Dungu, Henry; Makumbi, Fred; Gustafsson, Lars L.; Eriksen, Jaran
    Given the importance of CD4-T-lymphocyte monitoring in HIV/ART management, we established CD4/CD8 reference ranges in Uganda and studied factors associated with CD4/CD8 in a normal population. Blood samples for 206 HIV seronegative healthy volunteers from the Mbarara and Kampala districts in Uganda were analyzed using the PanLeucogating protocol.
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    Characterization of Asthma and Its Determinants in Ethiopia: Part of the African Severe Asthma Project (ASAP)
    (Ethiopian Medical Journal, 2021) Bekel, Amsalu; Haile, Tewodros; Mekekasha, Amha; Fuad, Oumer; Muttamba, Winters; Mugenyi, Levi; Katagira, Wincey; Nyale, George; Lugogo, Njira; Worodria, William; Aanyu, Hellen T.; Joloba, Moses; Jong, Corina de; Makumbi, Fred; Molen, Thys van der; Chakaya, Jeremiah; Kirenga, Bruce J; Yimer, Getenet
    Asthma is a major public health problem globally affecting 339 million people with 300,000 annual death. African Severe Asthma Program was a multi-country prospective cohort study designed to characterize severe asthma in three African countries, Ethiopia, Uganda and Kenya. In this study, we describe the baseline characteristics and disease severity among asthmatics enrolled in the Ethiopia site of African Severe Asthma Program. Asthmatics seen at Tikur Anbessa Specialized Hospital from August 2016 to May 2018 were studied. Asthma was diagnosed based on symptoms and spirometry. Baseline demographic and clinical data were collected using a structured questionnaire. Standardized research tools were used to assess asthma severity, asthma control and asthma quality of life. A total of 419 asthmatic patients were enrolled in the study; the mean age for the group was 52 ± 8 years and 58.2 % were female. The majority of the participants, 365 (87.2%), had a prior diagnosis of asthma with a median (IQR) age at first diagnosis of 29 (IQR: 22 - 36) years. A family history of asthma was present in 149 (35.6%) subjects. Current or previous cigarette smoking was reported in 8.6% of the participants. Overall, 93.8% of the participants reported uncontrolled asthma symptoms (ACQ >1.5). More than half of the patients, had severe persistent asthma and 35% presented with one or more comorbidities. Conclusions: In Ethiopia, asthmatics presenting to a tertiary care hospital were characterized as predominantly female with late onset disease, poor control, and associated comorbidities. Key Words: Asthma, Characteristics, determinants and Severe
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    Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts
    (Global Health Action, 2017) Ekirapa-Kiracho, Elizabeth; Muhumuza Kananura, Rornald; Tetui, Moses; Namazzi, Gertrude; Mutebi, Aloysius; George, Asha; Paina, Ligia; Waiswa, Peter; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Lyagoba, Moses; Naiga, Harriet; Putan, Mary; Kulwenza, Agatha; Ajeani, Judith; Kakaire- Kirunda, Ayub; Makumbi, Fred; Atuyambe, Lynn; Okui, Olico; Namusoke Kiwanuka, Suzanne
    The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17– 1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.
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    Effect of changing antiretroviral treatment eligibility criteria on patient load in Kampala, Uganda
    (AIDS care, 2011) Konde-Lule, Joseph; Makumbi, Fred; Pakker, Nadine; Muyinda, Asad; Mubiru, Mesach; Cobelens, Frank G.J.
    In many resource-poor countries, CD4 count thresholds of eligibility for antiretroviral treatment (ART) were initially low (<200 cells/mm3) but are now being increased to improve patient survival and to reduce HIV transmission. There are few quantitative data on the effect of such increases on the demand for ART. The objective of this study was to measure HIV prevalence and the proportion of HIV-positives eligible for antiretroviral therapy at different CD4 cut-off levels among users of public health care services in Kampala, Uganda. We recruited 1200 adults from three primary care clinics in Kampala, including equal numbers of family planning (FP) clients, pregnant women, adult patients with any complaint, and persons seeking HIV counseling and testing. All participants were screened for HIV and those positive had a CD4 count done. HIV prevalence in all patients was 16.9% (203/1200). ART eligibility based on CD4 counts significantly increased from 36% at a 200 cells/mm3 cut-off to 44% at 250 cells and to 57% at 350 cells cut-off (p for χ2 trend<0.001). We concluded that changing cut-off levels to higher CD4 counts will significantly increase patient load in Kampala's primary care clinics, but a phased implementation should minimize negative effects on quality of care.
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    Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study
    (BMC pregnancy and childbirth, 2017) Buregyeya, Esther; Naigino, Rose; Mukose, Aggrey; Makumbi, Fred; Esiru, Godfrey; Arinaitwe, Jim; Musinguzi, Joshua; Wanyenze, Rhoda K.
    In 2012, Uganda started implementing lifelong antiretroviral therapy (ART) for prevention of mother to child transmission (PMTCT) in line with the WHO 2012 guidelines. This study explored experiences of HIV infected pregnant and breastfeeding women regarding barriers and facilitators to uptake and adherence to lifelong ART. Methods: This was a cross-sectional qualitative study conducted in three districts (Masaka, Mityana and Luwero) in Uganda, between February and May 2014. We conducted in-depth interviews with 57 pregnant and breastfeeding women receiving care in six health facilities, who had been on lifelong ART for at least 6 months. Data analysis was done using a content thematic approach with Atlas-ti software. Results: Initiation of lifelong ART was done the same day the mother tested HIV positive. Several women felt the counselling was inadequate and had reservations about taking ART for life. The main motivation to initiate and adhere to ART was the desire to have an HIV-free baby. Adherence was a challenge, ranging from not taking the drugs at the right time, to completely missing doses and clinic appointments. Support from their male partners and peer family support groups enhanced good adherence. Fear to disclose HIV status to partners, drug related factors (side effects and the big size of the tablet), and HIV stigma were major barriers to ART initiation and adherence. Transition from antenatal care to HIV chronic care clinics was a challenge due to fear of stigma and discrimination. Conclusions: In order to maximize the benefits of lifelong ART, adequate preparation of women before ART initiation and on-going support through family support groups and male partner engagement are critical, particularly after birth and cessation of breastfeeding.
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    Hormonal contraceptive use and HIV-1 infection in a population-based cohort in Rakai, Uganda
    (Aids, 2003) Kiddugavu, Mohammed; Makumbi, Fred; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson K.; Wabwire-Mangen, Fred; Lutalo, Tom; Meehan, Mary; Gray, Ronald H.
    Hormonal contraceptives have been associated with increased risk of HIV acquisition. Methods: The association between hormonal contraception use and HIV acquisition was assessed in a rural community-based cohort in Rakai District, Uganda. A group of 5117 sexually active HIV-negative women were surveyed at 10 month intervals between 1994 and 1999. Information on demographic and sociobehavioral characteristics, use of hormonal contraception (pill and injectable methods), condoms and the number of sexual partners was obtained by home-based interview. HIV incidence rate ratios (IRR) and 95% confidence intervals (CI) associated with hormonal contraception were estimated by multivariate Poisson regression after adjustment for age, condom use, number of sexual partners, marital status, education and history of genital ulcer disease. Results: At one or more interviews, 16.6% of women reported use of hormonal contraceptives and 23.0% reported condom use. HIV incidence was 2.3/100 personyears in hormonal contraceptive users compared with 1.5/100 person-years in non-hormonal contraceptive users (unadjusted IRR, 1.56; 95% CI, 1.00–2.33). After multivariate adjustment, the IRR associated with hormonal contraceptives was reduced to 0.94 (95% CI, 0.53–1.64). The adjusted IRR was 1.12 (95% CI, 0.48–2.56) with oral contraceptive use and 0.84 (95%CI, 0.41–1.72) with injectable methods. Conclusion: Use of hormonal contraception is not associated with HIV acquisition after adjustment for behavioral confounding
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    Maternal and neonatal implementation for equitable systems. A study design paper
    (Global Health Action, 2017) Ekirapa-Kiracho, Elizabeth; Tetui, Moses; Bua, John; Muhumuza Kananura, Rornald; Waiswa, Peter; Makumbi, Fred; Atuyambe, Lynn; Ajeani, Judith; George, Asha; Mutebi, Aloysuis; Kakaire, Ayub; Namazzi, Gertrude; Paina, Ligia; Namusoke Kiwanuka, Suzanne
    Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacitybuilding. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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    Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans
    (HIV/AIDS – Research and Palliative Care, 2013) Nanzigu, Sarah; Kiguba, Ronald; Kabanda, Joseph; Mukonzo, Jackson K .; Waako, Paul; Kityo, Cissy; Makumbi, Fred
    With access to antiretroviral therapy (ART) expanding in resource-limited settings, assessing factors related to clinical, immunological, and virological outcomes of ART is of great importance. Even though ART is loosely referred to as a lifelong treatment, clinical, immunological and virological outcome measures differ among patients on highly active ART (HAART), with differences reported within and across cohorts.1–6 Mortality is among the ART-outcome variables that have been studied extensively, and rates of up to 30% have been reported during the first year of treatment in some sub-Saharan settings