Browsing by Author "Ntaro, Moses"

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    2353.Distance and Time to Clinic Are Associated with Increased Risk of Detectable HIV-1 Viral Load at a Peripheral Health Center in Rural Western Uganda
    (US: Oxford University Press., 2022) Hendren, Cate; Ndizeye, Ronnie; Mumbere, Nobert; Rubinstein, Rebecca J.; Baguma, Emma; Muhindo, Rabbison; Goel, Varun; Ntaro, Moses; Siedner, Mark; Mulogo, Edgar
    Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For example, a previous study at a large, urban referral center in Uganda showed GPS-measured distance was associated with clinic absenteeism. However, others suggest that PLHIV are willing to travel farther for HIV care because of stigma or for higher quality care. Less is known about the effect of travel burden in rural settings where transportation infrastructure is sparse, and there are few transportation options. Therefore, the objective of this study funded by the IDSA GERM Program was to explore potential associations between distance- and time-to-clinic in a highland area of rural western Uganda with HIV outcomes including viral suppression.
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    A cross-sectional study of point-of-care lactate testing in integrated community care management (ICCM) for children with acute respiratory illness in rural uganda
    (2024-11) Matte, Michael; Koyama, Natsumi; Giandomenico, Dana; Baguma, Emmanuel; Kibaba, Georget; Ntaro, Moses; Reyes, Raquel; Mulogo, Edgar M; Boyce, Ross M; Ciccone, Emily Jxx
    Abstract Background Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs’ ability to make timely and appropriate referrals. Methods The study was a cross-sectional evaluation of children aged <5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants. Results During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9–36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1 mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5 mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation. Conclusions Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.
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    Community health workers trained to conduct verbal autopsies provide better mortality measures than existing surveillance: Results from a cross-sectional study in rural western Uganda
    (PLoS ONE, 2019) Nabukalu, Doreen; Ntaro, Moses; Seviiri, Mathias; Reyes, Raquel; Wiens, Matthew; Sundararajan, Radhika; Mulogo, Edgar; Boyce, Ross M.
    In much of sub-Saharan Africa, health facilities serve as the primary source of routine vital statistics. These passive surveillance systems, however, are plagued by infrequent and unreliable reporting and do not capture events that occur outside of the formal health sector. Verbal autopsies (VA) have been utilized to estimate the burden and causes of mortality where civil registration and vital statistics systems are weak, but VAs have not been widely employed in national surveillance systems. In response, we trained lay community health workers (CHW) in a rural sub-county of western Uganda to conduct VA interviews in order to assess the feasibility of leveraging CHW to measure the burden of disease in resource limited settings. Methods and findings Trained CHWs conducted a cross-sectional survey of the 36 villages comprising the Bugoye sub-county to identify all deaths occurring in the prior year. The sub county has an estimated population of 50,249, approximately one-quarter of whom are children under 5 years of age (25.3%). When an eligible death was reported, CHWs administered a WHO 2014 VA questionnaire, the results of which were analyzed using the InterVA-4 tool. To compare the findings of the CHW survey to existing surveillance systems, study staff reviewed inpatient registers from neighboring referral health facilities in an attempt to match recorded deaths to those identified by the survey. Overall, CHWs conducted high quality VA interviews on direct observation, identifying 230 deaths that occurred within the sub-county, including 77 (33.5%) among children under five years of age. More than half of the deaths (123 of 230, 53.5%) were reported to have occurred outside a health facility and thus would not be captured by passive surveillance. More than two-thirds (73 of 107, 68.2%) of facility deaths took place in one of three nearby hospitals, yet only 35 (47.9%) were identified on our review of inpatient registers. Consistent with previous VA studies, the leading causes of death among children under five years of age were malaria (19.5%), prematurity (19.5%), and neonatal pneumonia (15.6%). while among adults, HIV/AIDS-related deaths illness (13.6%), pulmonary tuberculosis (11.4%) and malaria (8.6%) were the leading causes of death. No child deaths identified from inpatient registers listed HIV/AIDS as a cause of death despite 8 deaths (10.4%) attributed to HIV/AIDS as determined by VA. Conclusions Lay CHWs are able to conduct high quality VA interviews to capture critical information that can be analyzed using standard methodologies to provide a more complete estimate of the burden and causes of mortality. Similar approaches can be scaled to improve the measurement of vital statistics in order to facilitate appropriate public health interventions in rural areas of sub-Saharan Africa.
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    A Cross-Sectional Study Comparing Case Scenarios and Record Review to Measure Quality of Integrated Community Case Management Care in Western Uganda
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2021) Miller, James S.; Mbusa, Rapheal Kisolhu; Baguma, Stephen; Patel, Palka; Matte, Michael; Ntaro, Moses; Wesuta, Andrew Christopher; Mumbere, Nobert; Bwambale, Shem; McCarthy, Sara Mian; Kenney, Jessica; Guiles, Daniel; Mulogo, Edgar Mugema; Stone, Geren S.
    In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs’ performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period.In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education.The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.
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    Using verbal autopsies to estimate under-5 mortality at household level in a rural area of southwestern Uganda: a cross-sectional study
    (The Lancet Global Health, 2018) Nabukalu, Doreen; Ntaro, Moses; Seviiri, Mathias; Sundararajan, Radhika; Reyes, Raquel; Boyce, Ross; Mulogo, Edgar
    In rural Uganda, paediatric deaths that occur outside of health facilities often go unnoticed by the health system, and information on their magnitude and causes remains limited. We aimed to assess the causes of mortality of children younger than 5 years at household level in Bugoye subcounty, Uganda. Methods This cross-sectional study was done in all 35 villages of Bugoye subcounty in March and April, 2017. Community health workers collected data on all deaths in all households of the subcounty that occurred between Jan 1, 2016, and Jan 1, 2017, using 2014 WHO standardised verbal autopsy (VA) questionnaires. Causes of death were determined using the InterVA-4 algorithm and cause-specific mortality proportions were calculated using STATA. Findings The VA survey identified 77 deaths among children younger than 5 years that occurred during the study period. Nearly half of these deaths occurred among neonates (n=38 [49%]), followed by ages 1–11 months (n=21 [27%]), and 1–4 years (n=18 [23%]). Among neonates, mortality most commonly occurred in the first 24 h (n=17 [22%]), followed by 8–28 days (n=10 [13%]). The five leading causes of death for all ages were malaria (19%), prematurity (19%), neonatal pneumonia (16%), HIV/AIDS-related illnesses (10%), and acute respiratory tract infections including pneumonia (9%). Malaria was the dominant cause of death for those aged 1–11 months and 1–4 years, accounting for 44% and 33%, respectively. Prematurity and neonatal pneumonia were the leading causes of death among neonates. Most deaths (81%) captured from the VAs could not be traced from the records of the reported health facilities in the district. Interpretation There is a considerable discrepancy between mortality captured by the district and mortality in the communities. Interventions that address common causes of mortality for children younger than 5 years need to be strengthened and extended to rural health facilities. Community death registration systems are lacking and in need of revitalisation. VA surveys could be conducted by district health authorities periodically to collect mortality data in the rural and hard-to-reach areas. Funding Joint AFRO/TDR Small Grants Scheme for implementation research in infectious diseases of poverty.