Browsing by Author "Tomson, Goran"

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    Community effectiveness of malaria treatment in Uganda—a long way to Abuja targets
    (Annals of tropical paediatrics, 2005) Nsungwa-Sabiiti, Jesca; Tomson, Goran; Pariyo, George; Ogwal-Okeng, Jasper; Peterson, Stefan
    At the Roll Back Malaria summit for African countries in Abuja, the heads of state committed to ensure that by the year 2005 at least 60% of those suffering from malaria would have access to effective treatment within 24 hours of onset of symptoms. Aim: The aim of the study was to assess community effectiveness of malaria treatment in children. Method: A community-based survey of 500 households was undertaken in western Uganda. Results: A total of 260 (52%) children were reported to have had fever within the previous 2 weeks: 87% received some kind of treatment, 44% were said to have been treated within 24 hours of onset of symptoms, 47% received appropriate anti-malarials, 25% received the correct dosage, and 24% took the drug for the recommended period of time; altogether, only 7% received all the treatment steps. Conclusion: With drug efficacies of 50–90%, we estimate a community effectiveness of 4–6%, which is far from the 2005 Abuja target. The greatest need for improvement in the Home Based Fever Management strategy is in reducing delay in treatment and improving dosage and duration of treatment.
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    Community health workers – a resource for identification and referral of sick newborns in rural Uganda
    (Tropical medicine & international health, 2013) Kayemba Nalwadda, Christine; Guwatudde, David; Waiswa, Peter; Kiguli, Juliet; Namazzi, Gertrude; Namutumba, Sarah; Tomson, Goran; Peterson, Stefan
    To determine community health workers’ (CHWs) competence in identifying and referring sick newborns in Uganda. methods Case-vignettes, observations of role-plays and interviews were employed to collect data using checklists and semistructured questionnaires, from 57 trained CHWs participating in a community health facility–linked cluster randomised trial. Competence to identify and refer sick newborns was measured by knowledge of newborn danger signs, skills to identify sick newborns and effective communication to mothers. Proportions and median scores were computed for each attribute with a pre-defined pass mark of 100% for knowledge and 90% for skill and communication. results For knowledge, 68% of the CHWs attained the pass mark. The median percentage score was 100 (IQR 94 100). 74% mentioned the required five newborn danger signs unprompted. ‘Red umbilicus/cord with pus’ was mentioned by all CHWs (100%), but none mentioned chest in-drawing and grunting as newborn danger signs. 63% attained the pass mark for both skill and communication. The median percentage scores were 91 (IQR 82 100) for skills and 94 (IQR 89, 94) for effective communication. 98% correctly identified the four case-vignettes as sick or not sick newborn. ‘Preterm birth’ was the least identified danger sign from the case-vignettes, by 51% of the CHWs. conclusion CHWs trained for a short period but effectively supervised are competent in identifying and referring sick newborns in a poor resource setting.
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    Comparison of fasting plasma glucose and haemoglobin A1c point-of-care tests in screening for diabetes and abnormal glucose regulation in a rural low income setting
    (Diabetes Research and Clinical Practice, 2014) Mayega, Roy William; Guwatudde, David; Makumbi, Fredrick Edward; Nakwagala, Frederick Nelson; Peterson, Stefan; Tomson, Goran; Ostenson, Claes-Goran
    Glycated haemoglobin (HbA1C) has been suggested to replace glucose tests in identifying diabetes and pre-diabetes. We assessed agreement between fasting plasma glucose (FPG) and HbA1C rapid tests in classifying abnormal glucose regulation (AGR), and their utility for preventive screening in rural Africa. Methods: A population-based survey of 795 people aged 35–60 years was conducted in a mainly rural district in Uganda. FPG was measured using On-Call1 Plus glucometers, and classified using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. HbA1C was measured using A1cNow1 kits and classified using ADA criteria. Body mass index and blood pressure were measured. Percentage agreement between the two tests was computed. Results: Using HbA1C, 11.3% of participants had diabetes compared with 4.8% for FPG. Prevalence of HbA1C-defined pre-diabetes (26.4%) was 1.2 times and 2.5 times higher than FPG-defined pre-diabetes using ADA (21.8%) and WHO (10.1%) criteria, respectively. With FPG as the reference, agreement between FPG and HbA1C in classifying diabetes status was moderate (Kappa = 22.9; Area Under the Curve (AUC) = 75%), while that for AGR was low (Kappa = 11.0; AUC = 59%). However, agreement was high (over 90%) among negative tests and among participants with risk factors for type 2 diabetes (obesity, overweight or hypertension). HbA1C had more procedural challenges than FPG.
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    Diabetes and Pre-Diabetes among Persons Aged 35 to 60 Years in Eastern Uganda: Prevalence and Associated Factors
    (PLoS ONE, 2013) Mayega, Roy William; Guwatudde, David; Makumbi, Fredrick; Nakwagala, Frederick Nelson; Peterson, Stefan; Tomson, Goran; Ostenson, Claes-Goran
    Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and prediabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa. Methods: A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call® Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG ≥6.1mmol L-1 (World Health Organization (WHO) criteria or ≥5.6mmol L-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L-1, or being on diabetes treatment. Results: The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95%CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95%CI 7.3-10.2) using WHO criteria and 20.2% (95%CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95%CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95%CI 0.4-0.9; APRR 0.6, 95%CI 0.4-0.8; APRR 0.5, 95%CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs. Conclusions: There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary.
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    Health system preparedness for newborn care: a health facility assessment in rural Uganda
    (BMC Health Services Research, 2014) Kayemba, Christine; Peterson, Stefan; Tomson, Goran; Guwatudde, David; Kiguli, Juliet; Namazzibner Tagoola4, Gertrude Peter Waiswa1,2; Namutamba, Sarah; Namugaya, Faith; Nambuya, Harriet
    Newborn deaths must be reduced to achieve Millennium Development Goal four. Health facilities have a critical role to play in the fight to save the 2.9 million newborns that die in the world every year. It is not clear if health facilities in rural Uganda have the capacity to care for newborns. To assess the capacity of health facilities to care for newborns in Iganga and Mayuge districts in eastern Uganda for the three main mortality causes: preterm/ low birth weight, asphyxia and sepsis.
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    ‘I never thought that this baby would survive; I thought that it would die any time’: perceptions and care for preterm babies in eastern Uganda
    (Tropical medicine & international health, 2010) Waiswa, Peter; Nyanzi, Stella; Namusoko-Kalungi, Sarah; Peterson, Stefan; Tomson, Goran; Pariyo, George W.
    To explore the current care for and perceptions about preterm babies among community members in eastern Uganda. methods A neonatal midwife observed care of preterm babies in one general hospital and 15 health centres using a checklist and a field diary. In-depth interviews were conducted with 11 community health workers (CHWs) and also with 10 mothers, six fathers and three grandmothers of preterm babies. Three focus group discussions were conducted with midwives and women and men in the community. Content analysis of data was performed. results Community members mentioned many features which may correctly be used to identify preterm babies. Care practices for preterm babies at health facilities and community level were inadequate and potentially harmful. Health facilities lacked capacity for care of preterm babies in terms of protocols, health workers’ skills, basic equipment, drugs and other supplies. However, community members and CHWs stated that they accepted the introduction of preterm care practices such as skinto- skin and kangaroo mother care. conclusion In this setting, care for preterm babies is inadequate at both health facility and community level. However, acceptance of the recommended newborn care practices indicated by the community is a window of opportunity for introducing programmes for preterm babies. In doing so, consideration needs to be given to the care provided at health facilities as well as to the gaps in community care that are largely influenced by beliefs, perceptions and lack of awareness.
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    Modifiable Socio-Behavioural Factors Associated with Overweight and Hypertension among Persons Aged 35 to 60 Years in Eastern Uganda
    (PLoS ONE, 2012) Mayega, Roy William; Makumbi, Fredrick; Rutebemberwa, Elizeus; Peterson, Stefan; O¨stenson, Claes- Goran; Tomson, Goran; Guwatudde, David
    Few studies have examined the behavioural correlates of non-communicable, chronic disease risk in lowincome countries. The objective of this study was to identify socio-behavioural characteristics associated with being overweight or being hypertensive in a low-income setting, so as to highlight possible interventions and target groups. Methods: A population based survey was conducted in a Health and Demographic Surveillance Site (HDSS) in eastern Uganda. 1656 individuals aged 35 to 60 years had their Body Mass Index (BMI) and blood pressure (BP) assessed. Seven lifestyle factors were also assessed, using a validated questionnaire. Logistic regression was used to identify sociobehavioural factors associated with being overweight or being hypertensive. Results: Prevalence of overweight was found to be 18% (25.2% of women; 9.7% of men; p,0.001) while prevalence of obesity was 5.3% (8.3% of women; 2.2% of men). The prevalence of hypertension was 20.5%. Factors associated with being overweight included being female (OR 3.7; 95% CI 2.69–5.08), peri-urban residence (OR 2.5; 95% CI 1.46–3.01), higher socioeconomic status (OR 4.1; 95% CI 2.40–6.98), and increasing age (OR 1.8; 95% CI 1.12–2.79). Those who met the recommended minimum physical activity level, and those with moderate dietary diversity were less likely to be overweight (OR 0.5; 95% CI 0.35–0.65 and OR 0.7; 95% CI 0.49–3.01). Factors associated with being hypertensive included peri-urban residence (OR 2.4; 95%CI 1.60–3.66), increasing age (OR 4.5; 95% CI 2.94–6.96) and being over-weight (OR 2.8; 95% CI 1.98– 3.98). Overweight persons in rural areas were significantly more likely to be hypertensive than those in peri-urban areas (p = 0.013). Conclusions: Being overweight in low-income settings is associated with sex, physical activity and dietary diversity and being hypertensive is associated with being overweight; these factors are modifiable. There is need for context-specific health education addressing disparities in lifestyles at community levels in rural Africa.