Browsing by Author "Nakitto, Miriam"

Now showing 1 - 6 of 6
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    Comparison of approaches to determine echocardiographic outcomes for children with latent rheumatic heart disease
    (Open Heart, 2022) Rwebembera, Joselyn; Beaton, Andrea; Okello, Emmy; Nakitto, Miriam; Pulle, Jafesi; Scheel, Amy; Grobler, Anneke; Steer, Andrew Craig; Sable, Craig
    Screening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review.
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    Household Economic Consequences of Rheumatic Heart Disease in Uganda
    (Frontiers in Cardiovascular Medicine, 2021) Opara, Chinonso C.; Atala, Jenifer; Kansiime, Rosemary; Nakitto, Miriam; Ndagire, Emma; Nalubwama, Haddy; Okello, Emmy; Watkins, David A.; Su, Yanfang
    Rheumatic heart disease (RHD) has declined dramatically in wealthier countries in the past three decades, but it remains endemic in many lower-resourced regions and can have significant costs to households. The objective of this study was to quantify the economic burden of RHD among Ugandans affected by RHD.
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    Mobility study of young women who exchange sex for money or commodities using Google Maps and qualitative methods in Kampala, Uganda
    (BMJ open, 2021) King, Rachel; Muhanguzi, Eva; Nakitto, Miriam; Mirembe, Miriam; Kasujja, Francis Xavier; Bagiire, Daniel; Seeley, Janet
    We aimed to assess mobility patterns and reasons for high mobility among young women engaged in sex work within a randomised controlled trial to gauge how mobility may hinder access to health services and enhance HIV risk in a highly vulnerable population.
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    A Qualitative Study of Patients’ Experiences, Enablers and Barriers of Rheumatic Heart Disease Care in Uganda
    (Global Heart, 2023) Nalubwama, Hadija; Pulle, Jafesi; Atala, Jenifer; Nakitto, Miriam; Namara, Rebecca; Beaton, Andrea; Kansiime, Rosemary; Mwima, Rachel; Ndagire, Emma; Okello, Emmy; Watkins, David
    Rheumatic heart disease (RHD) remains a significant public health problem in countries with limited health resources. People living with RHD face numerous social challenges and have difficulty navigating ill-equipped health systems. This study sought to understand the impact of RHD on PLWRHD and their households and families in Uganda. In this qualitative study, we conducted in-depth interviews with 36 people living with RHD sampled purposively from Uganda’s national RHD research registry, stratifying the sample by geography and severity of disease. Our interview guides and data analysis used a combination of inductive and deductive methods, with the latter informed by the socio-ecological model. We ran thematic content analysis to identify codes that were then collapsed into themes. Coding was done independently by three analysts, who compared their results and iteratively updated the codebook. The inductive portion of our analysis, which focused on the patient experience, revealed a significant impact of RHD on work and school. Participants often lived in fear of the future, faced limited childbirth choices, experienced domestic conflict, and suffered stigmatization and low self-esteem. The deductive portion of our analysis focused on barriers and enablers to care. Major barriers included the high out-of-pocket cost of medicines and travel to health facilities, as well as poor access to RHD diagnostics and medications. Major enablers included family and social support, financial support within the community, and good relationships with health workers, though this varied considerably by location. Despite several personal and community factors that support resilience, PLWRHD in Uganda experience a range of negative physical, emotional, and social consequences from their condition. Greater investment is needed in primary healthcare systems to support decentralized, patient-centered care for RHD. Implementing evidence-based interventions that prevent RHD at district level could greatly reduce the scale of human suffering. There is need to increase investment in primary prevention and tackling social determinants, to reduce the incidence of RHD in communities where the condition remains endemic.
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    Quality of Life in Ugandan Children and Young Adults After Surgery for Congenital Heart Disease: Mixed Methods Approach
    (Public Library of Science, 2024-04) Searchinger, Chloe; Nalubwama, Hadija; Pulle, Jafesi; Mehta, Rittal; Tumwbaze, Hilda; Kyarimpa, Rachel; Mwima, Rachel; Atukunda, Emily; Bua, Bobson; Sarnacki, Rachel; Sherman, Meredith G; Oketcho, Michael; Zimmerman, Meghan; Nakitto, Miriam; Longenecker, Chris T; Webel, Allison; Scheel, Amy; Lwabi, Peter S; Sable, Craig A
    Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute. One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings. Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization. Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions.
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    Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease
    (New England Journal of Medicine, 2022) Beaton, Andrea; Okello, Emmy; Rwebembera, Joselyn; Alepere, Juliet; Lwabi, Peter; Nakitto, Miriam; Ndagire, Emma; Omara, Isaac O.; Karthikeyan, Ganesan; Steer, Andrew C.
    Rheumatic heart disease affects more than 40.5 million people worldwide and results in 306,000 deaths annually. Echocardiographic screening detects rheumatic heart disease at an early, latent stage. Whether secondary antibiotic prophylaxis is effective in preventing progression of latent rheumatic heart disease is unknown.