Browsing by Author "Tagoola, Abner"

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    Children’s Oxygen Administration Strategies And Nutrition Trial (COAST-Nutrition): a protocol for a phase II randomised controlled trial
    (Wellcome open research, 2021) Kiguli, Sarah; Olopot-Olupot, Peter; Alaroker, Florence; Engoru, Charles; Opoka, Robert O.; Tagoola, Abner; Hamaluba, Mainga; Mnjalla, Hellen; Mogaka, Christabel; Nalwanga, Damalie; Nabawanuka, Eva; Nokes, James; Nyaigoti, Charles; Woensel, Job B. M. van; Thomas, Karen; Harrison, David A.; Maitland, Kathryn
    To prevent poor long-term outcomes (deaths and readmissions) the integrated global action plan for pneumonia and diarrhoea recommends under the 'Treat' element of Protect, Prevent and Treat interventions the importance of continued feeding but gives no specific recommendations for nutritional support. Early nutritional support has been practiced in a wide variety of critically ill patients to provide vital cell substrates, antioxidants, vitamins, and minerals essential for normal cell function and decreasing hypermetabolism. We hypothesise that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery. We suggest that providing additional energy-rich, protein, fat and micronutrient ready-to-use therapeutic feeds (RUTF) to help meet additional nutritional requirements may improve outcome. COAST-Nutrition is an open, multicentre, Phase II randomised controlled trial in children aged 6 months to 12 years hospitalised with suspected severe pneumonia (and hypoxaemia, SpO 2 <92%) to establish whether supplementary feeds with RUTF given in addition to usual diet for 56-days (experimental) improves outcomes at 90-days compared to usual diet alone (control). Primary endpoint is change in mid-upper arm circumference (MUAC) at 90 days and/or as a composite with 90-day mortality. Secondary outcomes include anthropometric status, mortality, readmission at days 28 and 180. The trial will be conducted in four sites in two countries (Uganda and Kenya) enrolling 840 children followed up to 180 days. Ancillary studies include cost-economic analysis, molecular characterisation of bacterial and viral pathogens, evaluation of putative biomarkers of pneumonia, assessment of muscle and fat mass and host genetic studies.
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    Is fat mass a better predictor of 6-month survival than muscle mass among African children aged 6–59 months with severe pneumonia?
    (BioMed Central, 2024-09) Nalwanga, Damalie; Musiime, Victor; Kiguli, Sarah; Olupot-Olupot, Peter; Alaroker, Florence;; Opoka, Robert;; Tagoola, Abner; Mnjalla, Hellen; Mogaka, Christabel; Nabawanuka, Eva; Giallongo, Elisa; Karamagi, Charles; Briend, André; Maitland, Kathryn
    Pneumonia remains the leading cause of mortality among children under 5 years. Poor nutritional status increases pneumonia mortality. Nutritional status assessed by anthropometry alone does not provide information on which body composition element predicts survival. Body composition proxy measures including arm-fat-area (AFA), arm-muscle-area (AMA), and arm-muscle-circumference (AMC) could be useful predictors. To compare the ability of fat and muscle mass indices to predict 6-month survival among children with severe pneumonia. This prospective cohort study was nested in the COAST-Nutrition trial (ISRCTN10829073, 06/06/2018) conducted between June 2020 and October 2022 in Uganda and Kenya. We included children aged 6-59 months hospitalized for severe pneumonia with hypoxemia. Children with severe malnutrition, known chronic lung or cardiac diseases were excluded. Anthropometry and clinical status were assessed at enrolment and at follow-up to day 180. We examined Receiver Operator Characteristic (ROC) curves of fat and muscle mass indices with 6-month survival as the outcome, and compared the areas under the curve (AUCs) using chi-square tests. Cox survival analysis models assessed time-to-mortality. We included 369 participants. The median age was 15-months (IQR 9, 26), and 59.4% (219/369) of participants were male. The baseline measurements were: median MUAC 15.0 cm (IQR 14.0,16.0); arm-fat-area 5.6cm (IQR 4.7, 6.8); arm-muscle-area 11.4cm (IQR 10.0, 12.7); and arm-muscle-circumference 12.2 cm (IQR 11.5, 12.9). Sixteen (4.3%) participants died and 4 (1.1%) were lost-to-follow-up. The AUC for Arm-Fat-Area was not significantly higher than that for Arm-Muscle-Area and Arm-Muscle-Circumference [AUC 0.77 (95%CI 0.64-0.90) vs. 0.61 (95%CI 0.48-0.74), p = 0.09 and 0.63 (95%CI 0.51-0.75), p = 0.16 respectively], but was not statistically different from MUAC (AUC 0.73 (95%CI 0.62-0.85), p = 0.47). Increase in Arm-Fat-Area and Arm-Muscle-Circumference significantly improved survival [aHR 0.40 (95%CI 0.24-0.64), p = < 0.01 and 0.59 (95%CI 0.36-1.06), p = 0.03 respectively]. Survival prediction using Arm-Fat-Area was not statistically different from that of MUAC (p = 0.54). Muscle mass did not predict 6-month survival better than fat mass in children with severe pneumonia. Fat mass appears to be a better predictor. Effects of fat and muscle could be considered for prognosis and targeted interventions. PubMed
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    Prediction models for post-discharge mortality among under-five children with suspected sepsis in Uganda: A multicohort analysis
    (Public Library of Science, 2024-05) Wiens, Matthew O; Nguyen, Vuong; Bone, Jeffrey N.; Kumbakumba, Elias; Businge, Stephen; Tagoola, Abner; Sherine, Sheila Oyella; Byaruhanga, Emmanuel; Ssemwanga, Edward; Barigye, Celestine; Nsungwa, Jesca; Olaro, Charles; Ansermino, J. Mark; Kissoon, Niranjan; Singer, Joel; Larson, Charles P.; Lavoie, Pascal M; Dunsmuir, Dustin; Moschovis, Peter P.; Novakowski, Stefanie; Komugisha, Clare; Tayebwa, Mellon; Mwesigwa, Douglas; Knappett, Martina; West, Nicholas; Mugisha, Nathan Kenya; Kabakyenga, Jerome
    In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis. Four prospective cohort studies of children in two age groups (0–6 and 6–60 months) were conducted between 2012–2021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation. 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74–0.80) for 0-6-month-olds and 0.75 (95%CI 0.72–0.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds. Simple prediction models at admission with suspected sepsis can identify children at risk of post-discharge mortality. Further external validation is recommended for different contexts. Models can be digitally integrated into existing processes to improve peri-discharge care as children transition from the hospital to the community.
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    Repeatability of RRate measurements in children during triage in two Ugandan hospitals
    (Public Library of Science, 2025-01) Asdo, Ahmad; Mawji, Alishah; Omara, Isaac; Aye Ishebukara, Ivan Aine; Komugisha, Clare; Novakowski, Stefanie K; Pillay, Yashodani; Wiens, Matthew O; Akech, Samuel; Oyella, Florence; Tagoola, Abner; Kissoon, Niranjan; Ansermino, John Mark; Dunsmuir, Dustin
    Pneumonia is the leading cause of death in children globally. In low- and middle-income countries (LMICs) pneumonia diagnosis relies on accurate assessment of respiratory rate, which can be unreliable when completed by nurses with less-advanced training. To inform more accurate measurements, we investigate the repeatability of the RRate app used by nurses in Ugandan district hospitals. This secondary analysis included 3,679 children aged 0–5 years. The dataset had two sequential measurements of respiratory rate collected by 14 nurses using the RRate app. We measured agreement between respiratory rate observations while indicating observations’ clustering around WHO fast-breathing thresholds. WHO thresholds are 60 breaths per minute (bpm) for under two months (Age-1), 50 bpm for two to 12 months (Age-2), and 40 bpm for 12.1 to 60 months (Age-3). We assessed the repeatability of the paired measurements per user through the Intraclass Correlation Coefficient (ICC) and calculated an overall ICC value. The respiratory rate measurement took less than 15 seconds for 7,277 (98.9%) of the measurements. Despite respiratory rates clustering around WHO thresholds, breathing classification based on the thresholds (Fast vs normal) was altered between sequential measurements in only 12.6% of children. The mean (SD) respiratory rate by age group was 60 (13.1) bpm for Age-1, 49 (11.9) bpm for Age-2, and 38 (10.1) for Age-3, and the bias (Limits of Agreements) were 0.3 (−10.8–11.3) bpm, 0.4 (−8.5–9.3) bpm, and 0.1 (−6.8, 7.0) bpm for Age-1, Age-2, and Age-3 respectively. The repeatability of the paired respiratory rate measurements was high, with an ICC ≥ 90% for 12 of 14 users and an overall ICC value (95% CI) of 0.95 (0.94–0.95). The RRate measurements were efficient and repeatable. The simplicity, repeatability, and efficiency support its usage in LMICs healthcare facilities, and endorses a more widespread clinical adoption. Subjects
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    Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda
    (Global health action, 2015) Namazzi, Gertrude; Waiswa, Peter; Nakakeeto, Margaret; Nakibuuka, Victoria K.; Namutamba, Sarah; Najjemba, Maria; Namusaabi, Ruth; Tagoola, Abner; Nakate, Grace; Ajeani, Judith; Peterson, Stefan; Byaruhanga, Romano N.
    In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening.Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs.Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities.
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    The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial
    (Trials, 2012) Waiswa, Peter; Peterson, Stefan S.; Namazzi, Gertrude; Kiracho Ekirapa, Elizabeth; Naikoba, Sarah; Byaruhanga, Romano; Kiguli, Juliet; Kallander, Karin; Tagoola, Abner; Nakakeeto, Margaret; Pariyo, George
    Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design: Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates.