Browsing by Author "Rwebembera, Joselyn"

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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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    Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study
    (The Lancet Global Health, 2021) Okello, Emmy; Ndagire, Emma; Muhamed, Babu; Sarnacki, Rachel; Nakitto, M.G.; Kansiime, Rosemary; Longenecker, Chris T.; Lwabi, Peter; Agaba, Collins; Omara, Isaac Otim; Oyella, Linda Mary; Rwebembera, Joselyn; Watkins, David; Carapetis, Jonathan R.
    Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3–17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5–14 years and characterised clinical features of definite and possible acute rheumatic fever cases. Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5–14 years as 25 cases (95% CI 13·7–30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1–21·0) per 100 000 person-years in Mbarara district (west).
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    Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study
    (The Lancet Global Health, 2021) Okello, Emmy; Ndagire, Emma; Babu, Muhamed; Rachel, Sarnacki; Meghna, Murali; Jafesi, Pulle; Jenifer, Atala; Asha, C. Bowen; Marc, P. DiFazio; Nakitto, M. G.; Nada, S. Harik; Kansiime, Rosemary; Chris, T. Longenecker; Lwabi, Peter; Agaba, Collins; Scott, A. Norton; Omara, Isaac Otim; Oyella, Linda Mary; Tom, Parks; Rwebembera, Joselyn; Christopher, F. Spurney; Elizabeth, Stein; Laura, Tochen; David, Watkins; Meghan, Zimmerman; Jonathan, R. Carapetis; Craig, A. Sable; Andrea, Beaton
    Background Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. Methods For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3–17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5–14 years and characterised clinical features of definite and possible acute rheumatic fever cases. Findings Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5–14 years as 25 cases (95% CI 13·7–30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1–21·0) per 100 000 person-years in Mbarara district (west). Interpretation To the best of our knowledge, this is the first population-based study to estimate the incidence of acute rheumatic fever in sub-Saharan Africa. Given the known rheumatic heart disease burden, it is likely that only a proportion of children with acute rheumatic fever were diagnosed. These data dispel the long-held hypothesis that the condition does not exist in sub-Saharan Africa and compel investment in improving prevention, recognition, and diagnosis of acute rheumatic fever.
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    Microalbuminuria and Retinopathy among Hypertensive Nondiabetic Patients at a Large Public Outpatient Clinic in Southwestern Uganda
    (International journal of nephrology, 2018) Kangwagye, Peter; Rwebembera, Joselyn; Wilson, Tony; Bajunirwe, Francis
    Routine testing of microalbuminuria and retinopathy is not done among patients with high blood pressure in resource-limited settings. We determined the prevalence of microalbuminuria and retinopathy and their risk factors among hypertensive patients at a large hospital in western Uganda. We consecutively recruited nondiabetic patients with hypertension at the outpatients’ clinic over a period of 3 months. Spot urine samples were tested for urine albumin. Direct fundoscopy was done to assess retinal vasculature and optic disc for signs of hypertensive retinopathy. Logistic regression was done with retinopathy and microalbuminuria as primary .We enrolled 334 patients and, of these, 208 (62.3%) were females, with median age of 55 years (range: 25–90). The prevalence of microalbuminuria was 59.3% (95% CI: 50.1–72.2) and that of retinopathy was 66.8% (95% CI: 58.6–76.5). The independent correlates of retinopathy and microalbuminuria were systolic blood pressure (SBP) > 140 mmHg (OR = 2.76, 95% CI: 1.29–5.93) and treatment with beta-blockers (OR = 2.16, 95% CI: 1.05–4.44). Use of ACEIs was unrelated to the study outcomes.The prevalence of retinopathy and microalbuminuria is high. Clinicians should aim for better control of blood pressure and routinely perform fundoscopy and urine albumin, especially for patients with poorly controlled blood pressure.
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    Rheumatic Heart Disease Treatment Cascade in Uganda
    (Circulation: Cardiovascular Quality and Outcomes, 2017) Chris, T. Longenecker; Stephen, R. Morris; Aliku, Twalib O.; Andrea, Beaton; Marco, A. Costa; Kamya, Moses R.; Kityo, Cissy; Lwabi, Peter; Mirembe, Grace; Nampijja, Dorah; Rwebembera, Joselyn; Craig, Sable; Robert, A. Salata; Amy, Scheel; Daniel, I. Simon; Ssinabulya, Isaac; Okello, Emmy
    Background Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda to identify appropriate targets for intervention. Methods and Results Using data from the Uganda RHD Registry (n=1504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016; (2) retained in care; (3) appropriately prescribed BPG; and (4) optimally adherent to BPG (>80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (interquartile range) age was 23 (15–38) years, 69% were women, and 82% had clinical RHD. Median follow-up time was 2.4 (0.9–4.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% confidence interval, 54.1%–59.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription (91.6%; 95% confidence interval, 89.1%–93.5%) and optimal adherence (91.4%; 95% confidence interval, 88.7–93.5). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence. Conclusions Our study suggests that improving retention in care—possibly by decentralizing RHD services—would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.
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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.