Browsing by Author "Munabi, Ian"
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Item Adipose-derived stromal vascular fraction (SVF) in scar treatment: a systematic review protocol(American Journal of Stem Cells, 2022) Mbiine, Ronald; Wayengera, Misaki; Ocan, Moses; Kiwanuka, Noah; Munabi, Ian; Muwonge, Haruna; Lekuya, Hervé Monka; Kawooya2, Ismael Cephas Nakanwagi3,4, Alison Annet Kinengyere; Joloba, Moses; Galukande, MosesAutologous adipose-derived stromal vascular fraction (SVF) is an emerging therapy that is being pioneered as a potential treatment for keloids and hypertrophic scars. Up to this point, there isn’t a cure for keloids and hypertrophic scars yet they comprise the commonest benign skin disorders. Despite published studies reporting potential therapeutic benefits of SVF, their use and efficacy on scar improvement are not clearly described. The aim of this review is to describe the clinical practice involved in harvesting, processing, utilization of SVF, and associated efficacy in scar treatment. Methods: We shall include published clinical articles evaluating the efficacy of SVF on improving scar characteristics and assessment scores among adults with keloids or hypertrophic scars. Article search of Medline/PubMed, Cochrane Library and Embase using Mesh terms of “scars” and “stromal vascular fraction” combined with the Boolean operators (“AND”, “OR”) will be performed by two independent researchers following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. The primary outcome measure will be the mean difference in the Scar characteristics including Scar assessment scores, scar thickness among others. Data synthesis: Descriptive data synthesis and mean differences between treatment arms will be calculated for the primary outcome of the scar assessment scores. In case more than three studies provide consistent characteristics of the scar assessment scores, a meta-analysis will be conducted. Discussion: Evidence obtained from the systematic review will form the foundation upon which further clinical trials research will be conducted in evaluating the efficacy of autologous adipose-derived stromal vascular fraction in keloid and hypertrophic scar. The systematic review has been submitted to the PROSPERO database and is currently under review.Item Death after cure: Mortality among pulmonary tuberculosis survivors in rural Uganda Joseph Baruch Baluku Brenda Namanda Sharon Namiiro Aggrey Byaruhang(Elsevier Ltd, 2024-07) Baluku, Joseph Baruch; Namanda, Brenda; Namiiro, Sharon; Rwabwera, Diana Karungi; Mwesigwa, Gloria; Namaara, Catherine; Twinomugisha, Bright; Nyirazihawe, Isabella; Nuwagira, Edwin; Kansiime, Grace; Kizito, Enock; Nabukenya-Mudiope, Mary G; Sekadde, Moorine Penninah; Bongomin, Felix; Senfuka, Joshua; Olum, Ronald; Byaruhanga, Aggrey; Munabi, Ian; Kiguli, SarahObjectives: To determine the incidence of mortality and its predictors among pulmonary tuberculosis (PTB) survivors treated at a rural Ugandan tertiary hospital. Methods: We conducted a retrospective chart review of data between 2013 and 2023. We included all people that met the World Health Organisation's definition of tuberculosis cure and traced them or their next of kin to determine vital status (alive/deceased). We estimated the cumulative incidence of mortality per 1000 population, crude all-cause mortality rate per 1000 person-years, and median years of potential life lost for deceased individuals. Using Cox proportional hazard models, we investigated predictors of mortality. Results: Of 334 PTB survivors enrolled, 38 (11.4%) had died. The cumulative incidence of all-cause mortality was 113.7 per 1000 population, and the crude all-cause mortality rate was 28.5 per 1000 person-years. The median years of potential life lost for deceased individuals was 23.8 years (IQR: 9.6-32.8). Hospitalization (adjusted hazard ratio (aHR): 4.3, 95% CI: 1.1-16.6) and unemployment (aHR: 7.04, 95% CI: 1.5-31.6) at TB treatment initiation predicted mortality. Conclusion: PTB survivors experience post high mortality rates after TB cure. Survivors who were hospitalized and unemployed at treatment initiation were more likely to die after cure. Social protection measures and long-term follow-up of previously hospitalized patients could improve the long-term survival of TB survivors.Item Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study(Research Ethics, 2022) Ochieng, Joseph; Kaawa-Mafigiri, David; Munabi, Ian; Nakigudde, Janet; Nabukenya, Sylvia; Nakwagala, Frederick N.; Barugahare, John; Kwagala, Betty; Ibingira, Charles; Twimwijukye, Adelline; Sewankambo, Nelson; Mwaka Sabakaki, ErisaThis study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.Item Factors associated with prolonged hospitalization of patients with corona virus disease (COVID‑19) in Uganda: a retrospective cohort study(Tropical Medicine and Health, 2022) Ingabire, Prossie M.; Nantale, Ritah; Sserwanja, Quraish; Nakireka, Susan; Musaba, Milton W.; Muyinda, Asad; Tumuhaise, Criscent; Namulema, Edith; Bongomin, Felix; Napyo, Agnes; Ainembabazi, Rozen; Olum, Ronald; Munabi, Ian; Kiguli, Sarah; Mukunya, DavidIdentification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. Methods: We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. Results: Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1–89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9–16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65–3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01–10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55–0.83) were associated with prolonged hospitalization. Conclusion: One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.Item Informed consent in clinical practice: patients’ experiences and perspectives following surgery(BMC research notes, 2015) Ochieng, Joseph; Buwembo, William; Munabi, Ian; Ibingira, Charles; Kiryowa, Haruna; Nzarubara, Gabriel; Mwaka, ErisaInformed consent during medical practice is an essential component of comprehensive medical care and is a requirement that should be sought all the time the doctor interacts with the patients, though very challenging when it comes to implementation. Since the magnitude and frequency of surgery related risk are higher in a resource limited setting, informed consent for surgery in such settings should be more comprehensive. This study set out to evaluate patients’ experiences and perspectives of informed consent for surgery. Methods: This was a survey of post-operative patients at three university teaching hospitals in Uganda. The participants were interviewed using guided, semi-structured questionnaires. Patients from different surgical disciplines participated in the study.Item Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting(BMC research notes, 2015) Ochieng, Joseph; Ibingira, Charles; Buwembo, William; Munabi, Ian; Kiryowa, Haruna; Kitara, David; Bukuluki, Paul; Nzarubara, Gabriel; Mwaka, ErisaInformed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting.Item Outcomes of Periodontal Treatment in Diabetes Mellitus Patients at Kiruddu Referral Hospital in Uganda. A Prospective Cohort Study(Research Square, 2021) Kiryowa, Haruna; Mwaka, Erisa; Buwembo, William; Munabi, Ian; Rwenyonyi, Charles; Kaddumukasa, MarkPeriodontitis is a common complication of diabetes mellitus associated with poor glycemic control. The relationship between periodontal disease and glycemic control in patients with diabetes mellitus remains unclear. This study set out to determine the outcomes of periodontal treatment in diabetic patients in Uganda.Using a cohort study design, 41 adult diabetic patients with periodontal disease were enrolled and followed up for 3 months. Fasting blood sugar, glycated hemoglobin levels, pocketprobing depth, bleeding and clinical attachment loss at baseline and 3 months after periodontal treatment were determined. Gingival crevicular fluid was assessed to detect presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Bacteroides forsythus and Fusobacterium nucleatum. Data were analyzed using R version 4.10. Mean differences were calculated to determine effect of treatment and multiple logistic regressions was used to determine association between Hba1c and the different variables.Of the41 participants, 61% were females while 39% were males. The average age was 49.2 years (S.D = 11.2)while the mean BM1 was 27.8 (S.D = 4.8). Overall, there was a reduction in the average number of teeth with bleeding sites, those with pockets and the frequencies of selected bacteria except Fusobacterium nucleatum at 3 months after periodontal treatment. Following periodontal treatment, 39% of the participants had an improvement in their glycemic control (mean HbA1c reduction of 1.86) with age < 47.1 years, diabetic duration less than 1.6 years, BM1< 27.7 and HBA1c >8.9 at baseline being positively associated with this improvement. Treating periodontal disease in diabetic patients especially those with HBA1c <9.0 can improve glycemic control. However, larger studies need to be conducted to ascertain why some patients fail to attain an improved metabolic control following this intervention.Item Survival analysis of patients with COVID‑19 admitted at six hospitals in Uganda in 2021: a cohort study(Archives of Public Health, 2022) Muyinda, Asad; Ingabire, Prossie M.; Nakireka, Susan; Tumuhaise, Criscent; Namulema, Edith; Bongomin, Felix; Napyo, Agnes; Sserwanja, Quraish; Ainembabazi, Rozen; Olum, Ronald; Nantale, Ritah; Akunguru, Phillip; Nomujuni, Derrick; Olwit, William; Musaba, Milton W.; Namubiru, Bridget; Aol, Pamela; Babigumira, Peter A.; Munabi, Ian; Kiguli, Sarah; Mukunya, DavidAssessing factors associated with mortality among COVID-19 patients could guide in developing context relevant interventions to mitigate the risk. The study aimed to describe mortality and associated factors among COVID-19 patients admitted at six health facilities in Uganda. Methods: We reviewed medical records of patients admitted with COVID-19 between January 1st 2021 and December 31st 2021 in six hospitals in Uganda. Using Stata version 17.0, Kaplan Meier and Cox regression analyses were performed to describe the time to death and estimate associations between various exposures and time to death. Finally, accelerated failure time (AFT) models with a lognormal distribution were used to estimate corresponding survival time ratios. Results: Out of the 1040 study participants, 234 (22.5%: 95%CI 12.9 to 36.2%) died. The mortality rate was 30.7 deaths per 1000 person days, 95% CI (26.9 to 35.0). The median survival time was 33 days, IQR (9–82). Factors associated with time to COVID-19 death included; age ≥ 60 years [adjusted hazard ratio (aHR) = 2.4, 95% CI: [1.7, 3.4]], having malaria test at admission [aHR = 2.0, 95% CI:[1.0, 3.9]], a COVID-19 severity score of severe/critical [aHR = 6.7, 95% CI:[1.5, 29.1]] and admission to a public hospital [aHR = 0.4, 95% CI:[0.3, 0.6]]. The survival time of patients aged 60 years or more is estimated to be 63% shorter than that of patients aged less than 60 years [adjusted time ratio (aTR) 0.37, 95% CI 0.24, 0.56]. The survival time of patients admitted in public hospitals was 2.5 times that of patients admitted in private hospitals [aTR 2.5 to 95%CI 1.6, 3.9]. Finally, patients with a severe or critical COVID-19 severity score had 87% shorter survival time than those with a mild score [aTR 0.13, 95% CI 0.03, 0.56]. Conclusion: In-hospital mortality among COVID-19 patients was high. Factors associated with shorter survival; age ≥ 60 years, a COVID-19 severity score of severe or critical, and having malaria at admission. We therefore recommend close monitoring of COVID-19 patients that are elderly and also screening for malaria in COVID-19 admitted patients.Item Ugandan optometry students’ experiences of their clinical training: a qualitative study(BioMed Central Ltd, 2024-10) Mucunguzi, Boaz; Guti, Walker; Tumwine, Moreen; Mubuuke, Aloysius G; Munabi, Ian; Raaheim, Arild; Kiguli, SarahThere is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students' experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students' experiences of their clinical learning environment at a national referral and teaching hospital in Uganda. Between April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students' clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach. Two themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants' experiences. Each theme had three sub themes. Training optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students' experiences in lower-level health units to those in national referral hospitals. MEDLINEItem Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda(MC health services research, 2013) Galukande, Moses; Kaggwa, Sam; Sekimpi, Patrick; Kakaire, Othman; Katamba, Achilles; Munabi, Ian; Mwesigye Runumi, Francis; Hagopian, Amy; Blair, Geoffrey; Barnhart, Scott; Luboga, Sam; Mills, Ed.The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.