Browsing by Author "Mutungi, Gerald"
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Item Alcohol consumption, hypertension and obesity: Relationship patterns along different age groups in Uganda(Preventive Medicine Reports, 2020) Mbona Tumwesigye, Nazarius; Mutungi, Gerald; Bahendeka, Silver; Wesonga, Ronald; Katureebe, Agaba; Biribawa, Claire; Guwatudde, DavidThe prevalence of non-communicable diseases including hypertension and obesity is rising and alcohol consumption is a predisposing factor. This study explored the effect of alcohol consumption patterns on the hypertension-age group and obesity-age group relationships. The data were extracted from the 2014 National NCD Survey of adults aged 18–69 years. Hypertension was defined as a condition of having systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg while obesity was defined as having a body mass index ≥30 kg/m2 . Frequent alcohol consumption was measured as alcohol use ≥3 times a week. Multivariable log binomial regression analysis was used to assess independent relationship between the outcomes and alcohol consumption. The prevalences of hypertension, frequent alcohol consumption and obesity increased across age groups but were divergent towards last age group. Hypertension prevalence ratios were higher with higher age groups among moderate and nondrinkers but not among frequent drinkers. Alcohol drinking pattern modified the age hypertension relationship in a model with ungrouped age. The drinking pattern did not modify obesity-age relationship. Alcohol consumption pattern appeared to modify the hypertension-age group relationship. However, more research is needed to explain why prevalence ratios are higher with higher age groups among moderate drinkers and abstainers while they stagnate among the frequent drinkers. There was no evidence to show the effect of alcohol consumption on obesity-age group relationshipItem Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey(Global Health Action, 2016) Ndugwa Kabwama, Steven; Ndyanabangi, Sheila; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidThere are limited data on levels of alcohol use in most sub-Saharan African countries. Objective: We analyzed data from Uganda’s non-communicable diseases risk factor survey conducted in 2014, to identify alcohol use prevalence and associated factors. Design: The survey used the World Health Organization STEPS tool to collect data, including the history of alcohol use. Alcohol users were categorized into low-, medium-, and high-end users. Participants were also classified as having an alcohol-use-related disorder if, over the past 12 months, they were unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session the night before. Weighted logistic regression analysis was used to identify factors associated with medium- to high-end alcohol use. Results: Of the 3,956 participants, 1,062 (26.8%) were current alcohol users, including 314 (7.9%) low-end, 246 (6.2%) medium-end, and 502 (12.7%) high-end users. A total of 386 (9.8%) were classified as having an alcohol-use-related disorder. Male participants were more likely to be medium- to high-end alcohol users compared to females; adjusted odds ratio (AOR)2.34 [95% confidence interval (CI)1.882.91]. Compared to residents in eastern Uganda, participants in central and western Uganda were more likely to be mediumto high-end users; AOR1.47 (95% CI1.012.12) and AOR1.89 (95% CI1.312.72), respectively. Participants aged 3049 years and those aged 5069 years were more likely to be medium- to high-end alcohol users, compared to those aged 1829 years, AOR1.49 (95% CI1.161.91) and AOR2.08 (95% CI1.522.84), respectively. Conclusions: The level of alcohol use among adults in Uganda is high, and 9.8% of the adult population has an alcohol-use-related disorder.Item Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey(International Journal for Equity in Health, 2016) Wesonga, Ronald; Guwatudde, David; Bahendeka, Silver K.; Mutungi, Gerald; Nabugoomu, Fabian; Muwonge, JamesModification of known risk factors has been the most tested strategy for dealing with noncommunicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well. Methods: Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed. Results: A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55.Item Cost-effectiveness analysis of integrating screening and treatment of selected non-communicable diseases into HIV/AIDS treatment in Uganda(Journal of the International AIDS Society, 2020) Sando, David; Kintu, Alexander; Okello, Samson; Kawungezi, Peter Chris; Guwatudde, David; Mutungi, Gerald; Muyindike, Winnie; Menzies, Nicolas A.; Danaei, Goodarz; Verguet, StephaneDespite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost-effectiveness of basic NCD-HIV integration in a Ugandan setting. Methods: We developed an epidemiologic-cost model to analyze, from the provider perspective, the cost-effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization’s STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability-adjusted life years were estimated over 10 subsequent years along with incremental cost-effectiveness of the integration. Results: Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10-year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability-adjusted life year averted among older ART patients. Conclusions: Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost-effectiveness comparable to other standalone interventions to address NCDs in low- and middle-income country settings.Item Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries(The lancet Diabetes & endocrinology, 2016) Manne-Goehler, Jennifer; Atun, Rifat; Stokes, Andrew; Goehler, Alexander; Houinato, Dismand; Houehanou, Corine; Hambou, Mohamed Msaidie Salimani; Longo Mbenza, Benjamin; Sobngwi, Eugène; Balde, Naby; Kibachio Mwangi, Joseph; Gathecha, Gladwell; Ngugi, Paul Waweru; Wesseh, C. Stanford; Damasceno, Albertino; Lunet, Nuno; Bovet, Pascal; Labadarios, Demetre; Zuma, Khangelani; Mayige, Mary; Kagaruki, Gibson; Ramaiya, Kaushik; Agoudavi, Kokou; Guwatudde, David; Bahendeka, Silver K.; Mutungi, Gerald; Geldsetzer, Pascal; Levitt, Naomi S.; Geldsetzer, Joshua; Yudkin, John S.; Vollmer, Sebastian; Bärnighausen, TillDespite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care. Methods We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005–15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We fi rst quantifi ed the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantifi ed the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fi xed-eff ects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment. Findings We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2–14) and the median prevalence of overweight or obesity was 27% (range 16–68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11–37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27–63]); (3) had ever been told that they had diabetes (median 27% [IQR 22–51]); (4) had ever been counselled to lose weight (median 15% [IQR 13–23]); (5) had ever been counselled to exercise (median 15% [IQR 11–30]); (6) were using oral diabetes drugs (median 25% [IQR 18–42]); and (7) were using insulin (median 11% [IQR 6–13]). Compared with those aged 15–39 years, the adjusted odds of met need for diabetes diagnosis (measures 1–3) were 2·22 to 3·53 (40–54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was signifi cantly more likely to be met (measures 4–7) in the oldest age and highest educational groups. Interpretation Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment.Item The Epidemiology of Hypertension in Uganda: Findings from the National Non- Communicable Diseases Risk Factor Survey(PLoS ONE, 2015) Guwatudde, David; Mutungi, Gerald; Wesonga, Ronald; Kajjura, Richard; Kasule, Hafisa; Muwonge, James; Ssenono, Vincent; Bahendeka, Silver K.Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions.We analyzed blood pressure data from Uganda’s nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors.Item Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda.(https://doi.org/10.1080/17441692.2019.1611897, 2019-12) Bahendeka, Silver; Mutungi, Gerald; Tugumisirize, Florence; Kamugisha, Albert; Nyangabyaki, Catherine; Wesonga, Ronald; Sseguya, Wenceslaus; Mubangizi, Denis; Nalunkuma, Cissy; Were, Thereza PiloyaThe management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM.Item Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa(Journal of the International AIDS Society, 2020) Kintu, Alexander; Sando, David; Okello, Samson; Mutungi, Gerald; Guwatudde, David; Menzies, Nicolas A.; Danaei, Goodarz; Verguet, StephaneThere is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. Discussion: Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. Conclusions: An expanded agenda for addressing HIV-NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.Item Low consumption of fruits and vegetables among adults in Uganda: findings from a countrywide cross-sectional survey(Archives of Public Health, 2019) Ndugwa Kabwama, Steven; Bahendeka, Silver K.; Wesonga, Ronald; Mutungi, Gerald; Guwatudde, DavidAdequate consumption of fruits and vegetables has protective benefits against development of coronary heart disease, hypertension and chronic obstructive pulmonary disease. However, approximately 2.7 million deaths annually can be attributed to inadequate fruit and vegetable consumption. We analyzed data from a countrywide survey in Uganda, to estimate the prevalence of adequate fruit and/ or vegetable consumption, and identify associated factors. Methods: Data were collected using the World Health Organization STEPwise approach to surveillance, a standard approach to surveillance of risk factors for Non Communicable Diseases. Fruit and vegetable consumption was assessed by asking participants the number of days in a typical week they eat fruits or vegetables and the number of servings eaten in one of those days. Adequate fruit and/ or vegetable consumption was defined as consuming 5 or more servings of fruits and/ or vegetables per day in a typical week. We used modified Poisson regression analysis to estimate prevalence risk ratios (PRRs) and identify factors associated with eating 5 or more servings of fruits and/ or vegetables per day, per week. Results: Of 3962 participants, 484 (12.2%) consumed 5 or more servings of fruits and/ or vegetables per day in a typical week. Participants who were married or cohabiting were more likely to consume at least 5 servings of fruits and/ or vegetables per day in a typical week compared with those who had never been married PRR = 1.51 [95% CI 1.07–2.14]. Compared with participants from Western region, those from Central region were more likely to consume 5 or more servings of fruits and/ or vegetables per day in a typical week, PRR = 3.54 [95% CI 2.46–5.10] as were those from Northern, PRR = 2.90 [95% CI 2.00–4.23] and Eastern regions PRR = 1.60 [95% CI 1.04–2.47]. Conclusions: Fruit and vegetable consumption in Uganda is low and does not differ significantly across social and demographic characteristics, except marital status and geographical region of residence. There is a need to develop and strengthen policies that promote adequate consumption of fruits and vegetables in the Ugandan population.Item Physical Activity Levels Among Adults in Uganda: Findings From a Countrywide Cross-Sectional Survey(Journal of Physical Activity and Health, 2016) Guwatudde, David; Kirunda, Barbara E.; Wesonga, Ronald; Mutungi, Gerald; Kajjura, Richard; Kasule, Hafisa; Muwonge, James; Bahendeka, Silver K.Being physically active is associated with lower risk of many noncommunicable diseases (NCDs). We analyzed physical activity (PA) data collected as part of Uganda’s countrywide NCD risk factor survey conducted in 2014, to describe PA levels in Uganda. Methods: PA data were collected on the domains of work, travel and leisure. We calculated the percentage of participants meeting the World Health Organization (WHO) PA recommendations, and the types of intense-specific duration of PA. Prevalence ratios (PR) were used to identify factors associated with meeting WHO PA recommendations. Results: Of the 3987 participants, 3758 (94.3%) met the WHO PA recommendations. Work-related PA of moderate intensity, and travel-related PA contributed most to participants’ overall weekly duration of PA, each contributing 49.6% and 25.2% respectively. The median weekly duration of all moderate-intensity PA was 1470 minutes (interquartile range [IQR] = 540 to 2460). Weekly duration of all vigorous-intensity PA was low with a median of 0 minutes (IQR = 0 to 1080). The median daily sedentary time was 120 minutes (IQR = 60 to 240). Factors significantly associated with meeting WHO PA recommendations were body mass index and level of education. Conclusions: PA levels in Uganda are high, mostly achieved through travel and work-related activities of moderate intensity.Item Prevalence and correlates of abdominal obesity among adults in Uganda: findings from a national cross-sectional, population based survey 2014(BMC obesity, 2018) Ndugwa Kabwama, Steven; Kirunda, Barbara; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidOverweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda’s 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity. Methods: Data were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure mid-way between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors. Results: Of the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58–10.33]. Participants who were married or cohabiting APRR 1.82 [1. 29–2.57] and participants who were separated or divorced APRR 1.69 [1.17–2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09–1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57–2.14]. Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12–1.78]. Conclusions: There is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.Item Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey(Tropical Medicine & International Health, 2016) Bahendeka, Silver; Wesonga, Ronald; Mutungi, Gerald; Muwonge, James; Neema, Stella; Guwatudde, DavidWe analysed fasting blood glucose (FBG) and other data collected as part of a population-based nationwide non-communicable disease risk factor survey, to estimate the prevalence of impaired fasting glycaemia (IFG) and diabetes mellitus and to identify associated factors in Uganda. methods The nationwide cross-sectional survey was conducted between April and July 2014. Participants were adults aged 18–69 years. A multistage stratified sample design was used to produce a national representative sample. Fasting capillary glucose was measured to estimate glycaemia. Data were managed with WHO e-STEPs software and Epi Info. Stata survey procedures were used to account for the sampling design, and sampling weights were used to account for differential probability of selection between strata. results Of the 3689 participants, 1467 (39.8%) were males, and 2713 (73.5%) resided in the rural areas. The mean age was 35.1 years (standard deviation = 12.6) for males and 35.8 years (13.2) for females. The overall prevalence of IFG was 2.0% (95% confidence interval (CI) = 1.5–2.5%), whereas that of diabetes mellitus was 1.4% (95% CI 0.9–1.9%). The prevalence of IFG was 2.1% (95% CI 1.3–2.9%) among males and 1.9% (95% CI 1.3–2.6%) among females, whereas that of diabetes mellitus was 1.6% (95% CI 0.8–2.6%) and 1.1% (95% CI 0.6–1.7%), respectively. The prevalence of IFG was 2.6% (95% CI 1.4–3.8%) among urban and 1.9% (95% CI 1.3–2.4%) among rural residents, whereas that of diabetes mellitus was 2.7% (95% CI 1.4–4.1) and 1.0% (95% 0.5–1.6%), respectively. The majority of participants identified with hyperglycaemia (90.5% IFG and 48.9% diabetes) were not aware of their hyperglycaemic status. Factors associated with IFG were region of residence, body mass index and total cholesterol; factors associated with diabetes mellitus were age, sex, household floor finish and abdominal obesity. conclusion The prevalence of IFG and of diabetes mellitus is low in the Ugandan population, providing an opportunity for the prevention of diabetes. The majority of persons with hyperglycaemia were not aware of their hyperglycaemic status, which implies a likelihood of presenting late with complications.Item Prevalence and correlates of proteinuria in Kampala, Uganda: a cross‑sectional pilot study(BMC research notes, 2016-02-16) Lunyera, Joseph; Ingabire, Prossie; Bagasha, Peace; Egger, Joseph R.; Mutungi, Gerald; Kalyesubula, RobertDespite the increasing prevalence of chronic kidney disease (CKD) in sub-Saharan Africa, few community-based screenings have been conducted in Uganda. Opportunities to improve the management of CKD in sub-Saharan Africa are limited by low awareness, inadequate access, poor recognition, and delayed presentation for clinical care. Therefore, the Uganda Kidney Foundation engaged key stakeholders in performing a screening event on World Kidney Day.Item Quantifying the burden of cardiovascular diseases among people living with HIV in sub-Saharan Africa: findings from a modeling study for Uganda(Journal of Global Health Reports, 2020) Kintu, Alexander; Sando, David; Guwatudde, David; Bahendeka, Silver; Kawungezi, Peter C.; Mutungi, Gerald; Muyindike, Winnie; Menzies, Nicolas; Okello, Samson; Danaei, Goodarz; Verguet, StéphaneThe burden of non-communicable diseases (NCDs) is rapidly increasing in low- and middle-income countries, but remains largely unknown among people living with HIV (PLWH) in most sub-Saharan African countries. Methods We estimated the proportion of PLWH in Uganda with raised blood pressure and high total cholesterol, and used a modified cardiovascular disease (CVD) risk prediction model (Globorisk) to assess the 10-year risk of atherosclerotic cardiovascular disease using individual-level data on cardiometabolic risk factors, population-level data on HIV prevalence and ART coverage, and the impact of HIV on blood pressure and cholesterol. Results Among PLWH aged 30 to 69 years, the prevalence of raised blood pressure was 30% (95% uncertainty range, UR=27-33%) in women and 26% in men (95% UR=23-29%). The predicted mean 10-year CVD risk was 5% for HIV-infected women, and 6% for HIV-infected men. Five percent (n=41,000) of PLWH may experience a CVD event from 2016 to 2025 with an estimated 38% of these events being fatal. Full ART coverage would have little effect on the predicted number of CVD cases. Conclusions Despite having a high prevalence of raised blood pressure, the burden of atherosclerotic CVD among PLWH in Uganda remains low. ART programs should prioritize routine screening and treatment of raised blood pressure. An approach of using HIV treatment delivery platforms to deliver care for NCDs may miss the larger burden of disease among HIV-uninfected individuals that are not routinely seen at health facilities.Item Screening tuberculosis patients for diabetes mellitus in a routine program setting in Kampala, Uganda: a cross-sectional study(F1000Research, 2019) Nsonga, Joseph; Dongo, John Paul; Mugabe, Frank; Mutungi, Gerald; Walyomo, Richard; Oundo, Christopher; Zalwango, Sarah; Okello, Daniel; Muchuro, Simon; Dlodlo, Riitta A.; Lin, YanUganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. Health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times.Item Tobacco use and associated factors among Adults in Uganda: Findings from a nationwide survey(Tobacco induced diseases, 2016) Ndugwa Kabwama, Steven; Ndyanabangi, Sheila; Mutungi, Gerald; Wesonga, Ronald; Bahendeka, Silver K.; Guwatudde, DavidTobacco use and the exposure to tobacco smoke is one of the most preventable causes of death and disability globally. The risk is even higher among daily tobacco users. The World Health Organization (WHO) has recommended that surveillance of major risk factors for Non Communicable Diseases (NCDs) such as tobacco use is imperative to predict the future burden of NCDs, identify interventions to reduce future burden and monitor emerging patterns and trends. In 2014 the first Uganda nation-wide NCD risk factor survey was carried out to estimate the prevalence of major NCD risk factors. We analyzed data from this survey to estimate the prevalence of daily tobacco use and associated risk factors.