NRU :: Browsing by Author "Nakibuuka, Jane"

Browsing by Author "Nakibuuka, Jane"

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Acute Hypoxaemic Respiratory Failure In A Low-Income Country: A Prospective Observational Study Of Hospital Prevalence And Mortality
(BMJ Open Respiratory Research, 2020) Kwizera, Arthur; Nakibuuka, Jane; Nakiyingi, Lydia; Sendagire, Cornelius; Tumukunde, Janat; Katabira, Catherine; Ssenyonga, Ronald; Kiwanuka, Noah; Kateete, David Patrick; Joloba, Moses; Kabatoro, Daphne; Atwine, Diana; Summers, Charlotte
Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment characteristics as well as assess factors associated with mortality.We conducted a prospective observational study at the Mulago National Referral and Teaching Hospital in Uganda. Critically ill adults who were hospitalised at the emergency department and met the criteria for AHRF (acute shortness of breath for less than a week) were enrolled and followed up for 90 days. Multivariable analyses were conducted to determine the risk factors for death.A total of 7300 patients was screened. Of these, 327 (4.5%) presented with AHRF. The majority (60 %) was male and the median age was 38 years (IQR 27–52). The mean plethysmographic oxygen saturation (SpO2) was 77.6% (SD 12.7); mean SpO2/FiO2 ratio 194 (SD 32) and the mean Lung Injury Prediction Score (LIPS) 6.7 (SD 0.8). Pneumonia (80%) was the most common diagnosis. Only 6% of the patients received mechanical ventilatory support. In-hospital mortality was 77% with an average length of hospital stay of 9.2 days (SD 7). At 90 days after enrolment, the mortality increased to 85%. Factors associated with mortality were severity of hypoxaemia (risk ratio (RR) 1.29 (95% CI 1.15 to 1.54), p=0.01); a high LIPS (RR 1.79 (95% CI 1.79 1.14 to 2.83), p=0.01); thrombocytopenia (RR 1.23 (95% CI 1.11 to 1.38), p=0.01); anaemia (RR 1.15 (95% CI 1.01 to 1.31), p=0.03) ; HIV co-infection (RR 0.84 (95% CI 0.72 to 0.97), p=0.019) and male gender (RR 1.15 (95% CI 1.01 to 1.31) p=0.04).The prevalence of AHRF among emergency department patients in a tertiary hospital in an LIC was low but was associated with very high mortality. Pneumonia was the most common cause of AHRF. Mortality was associated with higher severity of hypoxaemia, high LIPS, anaemia, HIV co-infection, thrombocytopenia and being male.
Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit
(Critical care research and practice, 2016) Kwizera, Arthur; Nabukenya, Mary; Agaba, Peter; Semogerere, Lameck; Ayebale, Emmanuel; Katabira, Catherine; Kizito, Samuel; Nantume, Cecilia; Clarke, Ian; Nakibuuka, Jane
In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference to . Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4, )), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76, )), and ARDS (OR 4.5 (95% CI: 1.07–16.7, )) had a statistically significant association with mortality. Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.
A Descriptive Epidemiological Study on Stroke in Kampala, Uganda: A Hospital based Study
(African Journal of Neurological Sciences, 2012) Nakibuuka, Jane; Nyakoojo, Abwooli; Namale, Alice; Blondin, Nicholas A.; Ddumba, Edward
Basic stroke features are hardly known in sub-Saharan countries, and no data are available in Uganda. Objective To characterize patients presenting with clinical stroke to Mulago Hospital. Design Descriptive epidemiological study. Setting Mulago National referral Hospital in Kampala, Uganda. Participants Patients presenting with clinical stroke from 1st July to 30th November 2006. Patients with confirmed stroke had comprehensive assessments for stroke risk factors. Results Among 139 patients presenting with clinical stroke, 127 had a non-contrast head CT scan and 12 died prior to scan. Eighty five patients were confirmed to have stroke while 42 had non stroke lesions. Among patients with confirmed stroke, 77.6% had ischemic stroke while 22.4% had hemorrhagic stroke. The mean age for all stroke patients was 62.2 ± 16.2 yrs and 51.8% were men. The incidence of both ischemic and hemorrhagic stroke increased with age. Atherosclerotic stroke was the most common ischemic stroke etiology, observed in 43.5% patients with ischemic stroke, while intraparenchymal hemorrhage was the most common hemorrhagic stroke etiology, observed in 78.9% of patients with hemorrhagic stroke. Hypertension was the commonest risk factor with more than 50% of all stroke patients reporting a history of hypertension, and more than half found to have blood pressure greater than 140/90 mm Hg. Physical inactivity and hypercholesterolemia were encountered in more than 36% and 30% of patients with ischemic and haemorrhagic strokes respectively. Conclusions Hypertension was the main risk factor for both Ischemic and hemorrhagic strokes in this study. This study provides important primary data on stroke in an African population and emphasizes the relevance of CT scan in stroke diagnosis.
Determinants of hypertension in a young adult Ugandan population in epidemiological transition—the MEPI-CVD survey
(BMC public health, 2015) Kayima, James; Nankabirwa, Joaniter; Sinabulya, Isaac; Nakibuuka, Jane; Zhu, Xiaofeng; Rahman, Mahboob; Longenecker, Christopher T.; Katamba, Achilles; Mayanja-Kizza, Harriet; Kamya, Moses R.
High blood pressure is the principal risk factor for stroke, heart failure and kidney failure in the young population in Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality in younger populations compared with the elderly; however, blood pressure control efforts in the young are hampered by scarcity of data on prevalence and factors influencing awareness, treatment and control of hypertension. We aimed to describe the prevalence of prehypertension and hypertension among young adults in a peri-urban district of Uganda and the factors associated with occurrence of hypertension in this population. Methods: This cross-sectional study was conducted between August, 2012 and May 2013 in Wakiso district, a suburban district that that encircles Kampala, Uganda’s capital city. We collected data on socio-demographic characteristics and hypertension status using a modified STEPs questionnaire from 3685 subjects aged 18–40 years selected by multistage cluster sampling. Blood pressure and anthropometric measurements were performed using standardized protocols. Fasting blood sugar and HIV status were determined using a venous blood sample. Association between hypertension status and various biosocial factors was assessed using logistic regression. Results: The overall prevalence of hypertension was 15 % (95 % CI 14.2 – 19.6) and 40 % were pre-hypertensive. Among the 553 hypertensive participants, 76 (13.7 %) were aware of their diagnosis and all these participants had initiated therapy with target blood pressure control attained in 20 % of treated subjects. Hypertension was significantly associated with the older age-group, male sex and obesity. There was a significantly lower prevalence of hypertension among participants with HIV OR 0.6 (95 % CI 0.4–0.8, P = 0.007). Conclusion: There is a high prevalence of high blood pressure in this young periurban population of Uganda with sub-optimal diagnosis and control. There is previously undocumented high rate of treatment, a unique finding that may be exploited to drive efforts to control hypertension. Specific programs for early diagnosis and treatment of hypertension among the young should be developed to improve control of hypertension. The relationship between HIV infection and blood pressure requires further clarification by longitudinal studies.
Feasibility study of a Targeted Self-Management Intervention for Reducing Stroke Risk Factors in a High-risk Population in Uganda
(2018) Kaddumukasa, Mark; Nakibuuka, Jane; Mugenyi, Levicatus; Namusoke, Olivia; Kabaala, Bryan; Blixen, Carol; Katabira, Elly; Furlan, Anthony; Sajatovic, Martha
Introduction—Stroke remains a global concern due to increasing lifespan, patterns of industrialization, adoption of harmful western diets, and an increasing prevalence of risk factors such as hypertension, obesity, and diabetes. We investigated an adopted novel self-management intervention, TargetEd mAnageMent Intervention (TEAM) to reduce modifiable stroke risk factors in Uganda. A six-month, uncontrolled, prospective pilot study to establish feasibility, acceptability and preliminary efficacy of TEAM in Ugandans at high risk for stroke was conducted. The primary outcome was change in systolic BP from baseline to 24-week follow-up. Secondary outcomes included change in diastolic BP, serum cholesterol, high and low density lipoprotein (HDL, LDL) and triglycerides. Mean (SD) baseline systolic BP was 162.9 (±25.6) mmHg while mean (SD) baseline diastolic BP was 99.1 (±13.8) mmHg. There was a significant reduction in mean baseline blood pressure of 163/98.8mmHg to blood pressure of 147.8/88.0 mmHg at 24 weeks, p=0.023. There were also significant reductions in the serum total cholesterol levels at 24 weeks with p=0.001. Targeted training in self-management (TEAM) adapted to the Ugandan setting is feasible, highly acceptable to participants and appears to be associated with reduced blood pressure, improved lipid profiles and improved glucose control in diabetics.
Modified EarlyWarning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study
(PloS one, 2016) Kruisselbrink, Rebecca; Kwizera, Arthur; Crowther, Mark; Fox-Robichaud, Alison; O'Shea, Timothy; Nakibuuka, Jane; Ssinabulya, Isaac; Nalyazi, Joan; Bonner, Ashley
Providing optimal critical care in developing countries is limited by lack of recognition of critical illness and lack of essential resources. The Modified Early Warning Score (MEWS), based on physiological parameters, is validated in adult medical and surgical patients as a predictor of mortality. The objective of this study performed in Uganda was to determine the prevalence of critical illness on the wards as defined by the MEWS, to evaluate the MEWS as a predictor of death, and to describe additional risk factors for mortality
National intensive care unit bed capacity and ICU patient characteristics in a low income country
(BMC research notes, 2012) Kwizera, Arthur; Dünser, Martin; Nakibuuka, Jane
Primary health care delivery in the developing world faces many challenges. Priority setting favours HIV, TB and malaria interventions. Little is known about the challenges faced in this setting with regard to critical care medicine. The aim of this study was to analyse and categorise the diagnosis and outcomes of 1,774 patients admitted to a hospital intensive care unit (ICU) in a low-income country over a 7-year period. We also assessed the country’s ICU bed capacity and described the challenges faced in dealing with critically ill patients in this setting. Findings: A retrospective audit was conducted in a general ICU in a university hospital in Uganda. Demographic data, admission diagnosis, and ICU length of stay were recorded for the 1,774 patients who presented to the ICU in the period January 2003 to December 2009. Their mean age was 35.5 years. Males accounted for 56.5% of the study population; 92.8% were indigenous, and 42.9% were referrals from upcountry units. The average mortality rate over the study period was 40.1% (n = 715). The highest mortality rate (44%) was recorded in 2004 and the lowest (33.2%) in 2005. Children accounted for 11.6% of admissions (40.1% mortality). Sepsis, ARDS, traumatic brain injuries and HIV related conditions were the most frequent admission diagnoses. A telephonic survey determined that there are 33 adult ICU beds in the whole country. Conclusions: Mortality was 40.1%, with sepsis, head injury, acute lung injury and HIV/AIDS the most common admission diagnoses. The country has a very low ICU bed capacity. Prioritising infectious diseases poses a challenge to ensuring that critical care is an essential part of the health care package in Uganda
Safety and efficacy of hydroxychloroquine for treatment of non‑severe COVID‑19 among adults in Uganda: a randomized open label phase II clinical trial
(BMC Infectious Diseases, 2021) Byakika‑Kibwika, Pauline; Sekaggya‑Wiltshire, Christine; Semakula, Jerome Roy; Nakibuuka, Jane; Musaazi, Joseph; Kayima, James; Sendagire, Cornelius; Meya, David; Kirenga, Bruce; Nanzigu, Sarah; Kwizera, Arthur; Nakwagala, Fred; Kisuule, Ivan; Wayengera, Misaki; Mwebesa, Henry G.; Kamya, Moses R.; Bazeyo, William
Several repurposed drugs such as hydroxychloroquine (HCQ) have been investigated for treatment of COVID-19, but none was confirmed to be efficacious. While in vitro studies have demonstrated antiviral properties of HCQ, data from clinical trials were conflicting regarding its benefit for COVID-19 treatment. Drugs that limit viral replication may be beneficial in the earlier course of the disease thus slowing progression to severe and critical illness. Design: We conducted a randomized open label Phase II clinical trial from October–December 2020. Methods: Patients diagnosed with COVID-19 using RT-PCR were included in the study if they were 18 years and above and had a diagnosis of COVID-19 made in the last 3 days. Patients were randomized in blocks, to receive either HCQ 400 mg twice a day for the first day followed by 200 mg twice daily for the next 4 days plus standard of care (SOC) treatment or SOC treatment alone. SARS COV-2 viral load (CT values) from RT-PCR testing of samples collected using nasal/orapharyngeal swabs was performed at baseline, day 2, 4, 6, 8 and 10. The primary outcome was median time from randomization to SARS COV-2 viral clearance by day 6.

Browsing by Author "Nakibuuka, Jane"

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