Browsing by Author "Makumbi, Frederick"

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    Efficacy of Knowledge and Competence-Based Training of Non-Physicians in the Provision of Early Infant Male Circumcision using the Mogen Clamp in Rakai, Uganda
    (BJU international, 2017) Kankaka, Edward Nelson; Kigozi, Godfrey; Kayiwa, Daniel; Kighoma, Nehemiah; Makumbi, Frederick; Murungi, Teddy; Nabukalu, Dorean; Nampijja, Resty; Watya, Stephen; Namuguzi, Daniel; Nalugoda, Fred; Nakigozi, Gertrude; Serwadda, David; Wawer, Maria; Gray, Ronald H.
    To assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum.Training in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events.Despite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10-47) min for the COs, and 15 (10-50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity.Competence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
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    Evaluation of the Safety and Efficiency of the Dorsal Slit and Sleeve Methods of Male Circumcision Provided by Physicians and Clinical Officers in Rakai, Uganda
    (BJU international, 2012) Buwembo, Dennis; Musoke, Richard; Kigozi, Godfrey; Sempijja, Victor; Serwadda, David; Makumbi, Frederick; Watya, Stephen; Namuguzi, Dan; Nalugoda, Fred; Kiwanuka, Noah; Sewankambo, Nelson K.; Mangen, Fred Wabwire; Lutalo, Tom; Kiggundu, Valerian; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemia; Wawer, Maria J.; Gray, Ronald H.
    To assess safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers.We evaluated the time required for surgery and moderate / severe adverse events (AEs), among circumcisions by trained physicians and clinical officers using sleeve and dorsal slit methods. Univariate and multivariate regression with robust variance was used to assess factors associated with time for surgery (linear regression) and adverse events (logistic regression). Six physicians and 8 clinical officers conducted 1934 and 3218 MCs, respectively. There were 2471 dorsal slit and 2681 sleeve procedures. The mean duration of surgery was 33 minutes for newly trained providers and decreased to ~20 minutes after ~100 circumcisions. The adjusted mean duration of surgery for dorsal slit was significantly shorter than that for sleeve method (Δ −2.8 minutes, p- <0.001). The duration of surgery was longer for clinical officers than physicians performing the sleeve procedure, but not the dorsal slit procedure. Crude AEs rates were 0.6% for dorsal slit and 1.4% with the sleeve method (p=0.006). However, there were no significant differences after multivariate adjustment. Use of cautery significantly reduced time needed for surgery (Δ − 4.0 minutes, p =0.008), but was associated with higher rates of AEs (adjusted odds ratio 2.13, 95%CI 1.26–3.61, p=0.005).The dorsal slit resection method of male circumcision is faster and safer than sleeve resection, and can be safely performed by non-physicians. However, use of cautery may be inadvisable in this setting.
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    Impact Of An Integrated Community Case Management Programme On Uptake Of Appropriate Diarrhoea And Pneumonia Treatments In Uganda: A Propensity Score Matching And Equity Analysis Study
    (International journal for equity in health, 2015) Nanyonjo, Agnes; Ssekitooleko, James; Counihan, Helen; Makumbi, Frederick; Tomson, Göran; Källander, Karin
    Pneumonia and diarrhoea disproportionately affect children in resource-poor settings. Integrated community case management (iCCM) involves community health workers treating diarrhoea, pneumonia and malaria. Studies on impact of iCCM on appropriate treatment and its effects on equity in access to the same are limited. The objective of this study was to measure the impact of integrated community case management (iCCM) as the first point of care on uptake of appropriate treatment for children with a classification of pneumonia (cough and fast breathing) and/or diarrhoea and to measure the magnitude and distribution of socioeconomic status related inequality in use of iCCM.Following introduction of iCCM, data from cross-sectional household surveys were examined for socioeconomic inequalities in uptake of treatment and use of iCCM among children with a classification of pneumonia or diarrhoea using the Erreygers’ corrected concentration index (CCI). Propensity score matching methods were used to estimate the average treatment effects on the treated (ATT) for children treated under the iCCM programme with recommended antibiotics for pneumonia, and ORS plus or minus zinc for diarrhoea.Overall, more children treated under iCCM received appropriate antibiotics for pneumonia (ATT = 34.7 %, p < 0.001) and ORS for diarrhoea (ATT = 41.2 %, p < 0.001) compared to children not attending iCCM. No such increase was observed for children receiving ORS-zinc combination (ATT = -0.145, p < 0.05).There were no obvious inequalities in the uptake of appropriate treatment for pneumonia among the poorest and least poor (CCI = -0.070; SE = 0.083). Receiving ORS for diarrhoea was more prevalent among the least poor groups (CCI = 0.199; SE = 0.118). The use of iCCM for pneumonia was more prevalent among the poorest groups (CCI = -0.099; SE = 0.073). The use of iCCM for diarrhoea was not significantly different among the poorest and least poor (CCI = -0.073; SE = 0.085).iCCM is a potentially equitable strategy that significantly increased the uptake of appropriate antibiotic treatment for pneumonia and ORS for diarrhoea, but not the uptake of zinc for diarrhoea. For maximum impact, interventions increasing zinc uptake should be considered when scaling up iCCM programmes.
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    Pregnancy Incidence and Fertility Desires Among Couples by HIV Status in Rakai, Uganda
    (JAIDS Journal of Acquired Immune Deficiency Syndromes, 2019) Brahmbhatt, Heena; Santelli, John; Kaagayi, Joseph; Lutalo, Tom; Serwadda, David; Makumbi, Frederick
    The desire for more children and pregnancy rates are influenced by many relationship dynamics and HIV serostatus of couples.Rakai Community Cohort Study in Uganda.Couple data were retrospectively linked from survey rounds between 2007 and 2015 to assess drivers of fertility desire and pregnancy incidence by HIV status (M−F−; M+F+; M−F+; and M+F−). Multivariable modified Poisson regression was used to estimate prevalence ratios of fertility desire, whereas multivariable Poisson regression was used to estimate incidence rate ratios of pregnancy associated with couple characteristics.Six thousand six hundred forty-seven couples contributed to 7656 person-years. Approximately 40% of couples (where at least 1 HIV+) desired more children. Unmet need for family planning was evident; couples of mediumor low Socioeconomic status and with coresident children had lower fertility desires but higher pregnancy rates. Older age, being in a polygamous union, and having a HIV+ spouse in care were associated with lower fertility desire while having an older male partner was associated with higher fertility desire. Pregnancy incidence was lower with older age, among women using hormonal contraception and condoms, HIV+ concordant couples and couples where the HIV+ spouse was in care while pregnancy incidence were higher among women who desired more children, and serodiscordant couples (M−F+).There are many drivers of fertility desires and pregnancy rates, and HIV does not diminish the desire for more children. Unmet need for family planning was evident and highlighted the need to understand and meet the contraceptive needs of couples.
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    Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda
    (BJU international, 2012) Kigozi, Godfrey; Musoke, Richard; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemiah; Ssebanenya, William; Mwinike, Joshua; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Nalwoga, Grace; Nakigozi, Gertrude; Kiwanuka, Noah; Makumbi, Frederick; Lutalo, Tom; Serwadda, David; Wawer, Maria; Gray, Ronald
    Male circumcision (MC) has been shown to reduce the risk of HIV acquisition by 50 – 60% [ 1 – 3 ] and the WHO now recommends it as one of the proven methods for HIV prevention [ 4 ] . Several programmes in sub-Saharan Africa have initiated MC implementation. For MC to be effective at a community level there is need to achieve high MC coverage, and modelling suggests that the higher the prevalence of MC the greater the impact on HIV incidence [ 5 ] . One reason consistently cited by men for not accepting MC is fear of pain during surgery [ 6 – 10 ] . Our experience in Rakai is that when men are offered MC, only a few men initially come for surgery, and the majority, fearing pain, wait to hear the experiences of men who have had surgery.