Browsing by Author "Siddharthan, Trishul"

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    The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis
    (Public Library of Science, 2024-02) Wennemann, Sophie; Mudarshiru, Bbuye; Zawedde-Muyanja, Stella; Siddharthan, Trishul; Jackson, Peter D
    Abstract More than half the global population burns biomass fuels for cooking and home heating, especially in low-middle income countries. This practice is a prominent source of indoor air pollution and has been linked to the development of a variety of cardiopulmonary diseases, including Tuberculosis (TB). The purpose of this cross-sectional study was to investigate the association between current biomass smoke exposure and self-reported quality of life scores in a cohort of previous TB patients in Uganda. We reviewed medical records from six TB clinics from 9/2019-9/2020 and conducted phone interviews to obtain information about biomass smoke exposure. A random sample of these patients were asked to complete three validated quality-of-life surveys including the St. Georges Respiratory Questionnaire (SGRQ), the EuroQol 5 Dimension 3 Level system (EQ-5D-3L) which includes the EuroQol Visual Analog Scale (EQ-VAS), and the Patient Health Questionnaire 9 (PHQ-9). The cohort was divided up into 3 levels based on years of smoke exposure–no-reported smoke exposure (0 years), light exposure (1–19 years), and heavy exposure (20+ years), and independent-samples-Kruskal-Wallis testing was performed with post-hoc pairwise comparison and the Bonferroni correction. The results of this testing indicated significant increases in survey scores for patients with current biomass exposure and a heavy smoke exposure history (20 + years) compared to no reported smoke exposure in the SGRQ activity scores (adj. p = 0.018) and EQ-5D-3L usual activity scores (adj. p = 0.002), indicating worse activity related symptoms. There was a decrease in EQ-VAS scores for heavy (adj. p = 0.007) and light (adj. p = 0.017) exposure groups compared to no reported exposure, indicating lower perceptions of overall health. These results may suggest worse outcomes or baseline health for TB patients exposed to biomass smoke at the time of treatment and recovery, however further research is needed to characterize the effect of indoor air pollution on TB treatment outcomes.
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    Effectiveness of low-dose theophylline for the management of biomass-associated COPD (LODOT-BCOPD): study protocol for a randomized controlled trial
    (Trials, 2021) Siddharthan, Trishul; Pollard, Suzanne L.; Sekitoleko, Isaac; Namazzi, Esther; Alupo, Patricia; Kalyesubula, Robert; Kirenga, Bruce
    COPD is a leading cause of death globally, with the majority of morbidity and mortality occurring in low- and middle-income country (LMIC) settings. While tobacco-smoke exposure is the most important risk factor for COPD in high-income settings, household air pollution from biomass smoke combustion is a leading risk factor for COPD in LMICs. Despite the high burden of biomass smoke-related COPD, few studies have evaluated the efficacy of pharmacotherapy in this context. Currently recommended inhaler-based therapy for COPD is neither available nor affordable in most resource-limited settings. Low-dose theophylline is an oral, once-a-day therapy, long used in high-income countries (HICs), which has been proposed for the management of COPD in LMICs in the absence of inhaled steroids and/or bronchodilators. The Low-dose Theophylline for the Management of Biomass-Associated COPD (LODOT-BCOPD) trial investigates the clinical efficacy and cost-effectiveness of low-dose theophylline for the management of biomass-related COPD in a low-income setting.
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    Efficacy of convalescent plasma for treatment of COVID-19 in Uganda
    (BMJ Open Resp Res, 2021) Kirenga, Bruce; Byakika-Kibwika, Pauline; Muttamba, Winters; Kayongo, Alex; Namakula, Olive Loryndah,; Mugenyi, Levicatus; Kiwanuka, Noah; Lusiba, John; Atukunda, Angella; Mugume, Raymond; Ssali, Francis; Ddungu, Henry; Katagira, Winceslaus; Sekibira, Rogers; Kityo, Cissy; Kyeyune, Dorothy; Acana, Susan; Aanyu-Tukamuhebwa, Hellen; Kabweru, Wilberforce; Nakwagala, Fred; Sentalo Bagaya, Bernard; Kimuli, Ivan; Nantanda, Rebecca; Buregyeya, Esther; Byarugaba, Baterana; Olaro, Charles; Mwebesa, Henry; Lutaakome Joloba, Moses; Siddharthan, Trishul; Bazeyo, William
    Convalescent plasma (CCP) has been studied as a potential therapy for COVID-19, but data on its efficacy in Africa are limited. Objective In this trial we set out to determine the efficacy of CCP for treatment of COVID-19 in Uganda. Measurements Patients with a positive SARS-CoV- 2 reverse transcriptase (RT)-PCR test irrespective of disease severity were hospitalized and randomized to receive either COVID-19 CCP plus standard of care (SOC) or SOC alone. The primary outcome was time to viral clearance, defined as having two consecutive RT-PCR- negative tests by day 28. Secondary outcomes included time to symptom resolution, clinical status on the modified WHO Ordinal Clinical Scale (≥1-point increase), progression to severe/ critical condition (defined as oxygen saturation <93% or needing oxygen), mortality and safety.
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    Feasibility of collecting and processing of COVID-19 convalescent plasma for treatment of COVID-19 in Uganda
    (PLoS ONE, 2021) Muttamba, Winters; Lusiba, John; Namakula, Loryndah Olive; Byakika-Kibwika, Pauline; Ssali, Francis; Ddungu, Henry; Mugenyi, Levicatus; Kiwanuka, Noah; Sekibira, Rogers; Kityo, Cissy; Keyune, Dorothy; Acana, Susan; Musinguzi, Ambrose; Masasi, Ayub; Byamugisha, Joseph; Mpanju, David; Musoki, Walter Jack; Tukamuhebwa, Hellen Aanyu; Nakwagala, Fred; Sentalo Bagaya, Bernard; Kayongo, Alex; Kimuli, Ivan; Nantanda, Rebecca; Katagira, Winceslaus; Buregyeya, Esther; Byanyima, Rosemary; Byarugaba, Baterana; Siddharthan, Trishul; Mwebesa, Henry; Charles, Olaro; Lutaakome Joloba, Moses; Bazeyo, William; Kirenga, Bruce
    Evidence that supports the use of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 is increasingly emerging. However, very few African countries have undertaken the collection and processing of CCP. The aim of this study was to assess the feasibility of collecting and processing of CCP, in preparation for a randomized clinical trial of CCP for treatment of COVID-19 in Uganda. Methods In a cross-sectional study, persons with documented evidence of recovery from COVID-19 in Uganda were contacted and screened for blood donation via telephone calls. Those found eligible were asked to come to the blood donation centre for further screening and consent. Whole blood collection was undertaken from which plasma was processed. Plasma was tested for transfusion transmissible infections (TTIs) and anti-SARS CoV-2 antibody titers. SARS-CoV-2 testing was also done on nasopharyngeal swabs from the donors.
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    A Novel Case-Finding Instrument for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Country Settings
    (International Journal of Chronic Obstructive Pulmonary Disease, 2020) Siddharthan, Trishul; Wosu, Adaeze C; Alupo, Patricia; Kalyesubula, Robert; Kirenga, Bruce; Checkley, William
    Low- and middle-income countries (LMICs) account for >90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings.We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow.We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61–0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78–0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow.COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.
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    Prevalence and factors contributing to mental health challenges among school-going adolescents: a case of a climate-vulnerable Manafwa Watershed in Uganda
    (BioMed Central, 2024-10) Batte, Charles; Apio, Pamela Okwir; Semulimi, Andrew Weil; Nuwasiima, Shivan; Kasoma, Ronald Mutebi; Mwesigwa, Martin Menya; Twinamasiko, Nelson; Siddharthan, Trishul; Mukisa, John; Mukunya, David; Abaatyo, Joan; Nalugya, Joyce Sserunjogi
    Globally, mental health challenges are common among school-going adolescents, with a prevalence of 50.2% and 43.6% for depression and anxiety disorders, respectively. In Northeastern Uganda, a prevalence of 26.6% and 8.6% for anxiety and depressive disorders respectively were reported among children. School-going adolescents are at higher risk of developing these mental health challenges and this could be worsened by natural disasters like landslides. We aimed to determine the prevalence and factors contributing to mental health challenges (having at least one of following; depression, anxiety, anger, disruptive behaviour and social concept) among school adolescents in the Manafwa Watershed area.BACKGROUNDGlobally, mental health challenges are common among school-going adolescents, with a prevalence of 50.2% and 43.6% for depression and anxiety disorders, respectively. In Northeastern Uganda, a prevalence of 26.6% and 8.6% for anxiety and depressive disorders respectively were reported among children. School-going adolescents are at higher risk of developing these mental health challenges and this could be worsened by natural disasters like landslides. We aimed to determine the prevalence and factors contributing to mental health challenges (having at least one of following; depression, anxiety, anger, disruptive behaviour and social concept) among school adolescents in the Manafwa Watershed area.This was a cross-sectional study in 3 districts of the Manafwa watershed area (Bududa, Manafwa, and Butaleja). We selected school-going adolescents aged 13-18 years because of the nature of study tools. Mental health challenges (anxiety, depression, anger, disruptive behaviour and self-concept) were assessed using the Beck Youth Inventory-II. Descriptive statistics and inferential analysis were performed to determine factors associated with mental health challenges.METHODSThis was a cross-sectional study in 3 districts of the Manafwa watershed area (Bududa, Manafwa, and Butaleja). We selected school-going adolescents aged 13-18 years because of the nature of study tools. Mental health challenges (anxiety, depression, anger, disruptive behaviour and self-concept) were assessed using the Beck Youth Inventory-II. Descriptive statistics and inferential analysis were performed to determine factors associated with mental health challenges.A total of 762 adolescents participated, with a median age of 17 years (interquartile range =16-17 years). More than half of the students were females. The prevalence of mental health challenges was 65% with a (confidence interval) = 54.0% - 75.0%; the majority 44% of the participants had anxiety, and 31% had disruptive behaviour. Families with more than five children [adjusted odds ratio = 1.18, 95% confidence interval= 1.08-1.29, p value = <0.001] and substance abuse [adjusted odds ratio = 1.20, 95% confidence interval= 1.15-1.24, p value <0.001] were significantly associated with mental health challenges.RESULTSA total of 762 adolescents participated, with a median age of 17 years (interquartile range =16-17 years). More than half of the students were females. The prevalence of mental health challenges was 65% with a (confidence interval) = 54.0% - 75.0%; the majority 44% of the participants had anxiety, and 31% had disruptive behaviour. Families with more than five children [adjusted odds ratio = 1.18, 95% confidence interval= 1.08-1.29, p value = <0.001] and substance abuse [adjusted odds ratio = 1.20, 95% confidence interval= 1.15-1.24, p value <0.001] were significantly associated with mental health challenges.The prevalence of mental health challenges among students was high with majority having anxiety and disruptive behaviour. Adolescents from families with more than five children and those with substance abuse were more likely to have mental health challenges. We therefore recommend that various stakeholders such as the Ministry of Health, and the Ministry of Education, design a curriculum that caters to the mental health needs of children. Family planning awareness, awareness on Government laws prohibiting alcohol and substance use, and parenting skills should be raised by the local leaders.CONCLUSIONThe prevalence of mental health challenges among students was high with majority having anxiety and disruptive behaviour. Adolescents from families with more than five children and those with substance abuse were more likely to have mental health challenges. We therefore recommend that various stakeholders such as the Ministry of Health, and the Ministry of Education, design a curriculum that caters to the mental health needs of children. Family planning awareness, awareness on Government laws prohibiting alcohol and substance use, and parenting skills should be raised by the local leaders.