Browsing by Author "Guwatudde, David"
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- ItemThe burden of hypertension in sub-Saharan Africa : a four-country cross sectional study(BioMed Central, 2015) Guwatudde, David; Nankya-Mutyoba, Joan; Kalyesubula, Robert; Laurence, Carien; Adebamowo, Clement; Ajayi, IkeOluwapo; Bajunirwe, Francis; Njelekela, Marina; Chiwanga, Faraja S.; Reid, Todd; Volmink, Jimmy; Adami, Hans-Olov; Holmes, Michelle D.; Dalal, ShonaENGLISH SUMMARY : Background: Hypertension, the leading single cause of morbidity and mortality worldwide, is a growing publichealth problem in sub-Saharan Africa (SSA). Few studies have estimated and compared the burden of hypertension across different SSA populations. We conducted a cross-sectional analysis of blood pressure data collected through a cohort study in four SSA countries, to estimate the prevalence of pre-hypertension, the prevalence of hypertension,and to identify the factors associated with hypertension. Methods: Participants were from five different population groups defined by occupation and degree of urbanization, including rural and peri-urban residents in Uganda, school teachers in South Africa and Tanzania, and nurses in Nigeria. We used a standardized questionnaire to collect data on demographic and behavioral characteristics, injuries, and history of diagnoses of chronic diseases and mental health. We also made physical measurements (weight, height and blood pressure), as well as biochemical measurements; which followed standardized protocols across the country sites. Modified Poison regression modelling was used to estimate prevalence ratios (PR) as measures of association between potential risk factors and hypertension. Results: The overall age-standardized prevalence of hypertension among the 1216 participants was 25.9 %. Prevalence was highest among nurses with an age-standardized prevalence (ASP) of 25.8 %, followed by school teachers (ASP = 23.2 %), peri-urban residents (ASP = 20.5 %) and lowest among rural residents (ASP = 8.7 %). Only 50.0 % of participants with hypertension were aware of their raised blood pressure. The overall age-standardized prevalence of pre-hypertension was 21.0 %. Factors found to be associated with hypertension were: population group, older age, higher body mass index, higher fasting plasma glucose level, lower level of education, and tobacco use. Conclusions: The prevalence of hypertension and pre-hypertension are high, and differ by population group defined by occupation and degree of urbanization. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.
- ItemFeasibility of a large cohort study in sub-Saharan Africa assessed through a four-country study(Co-Action Publishing, 2015-05-25) Dalal, Shona; Holmes, Michelle D.; Laurence, Carien; Bajunirwe, Francis; Guwatudde, David; Njelekela, Marina; Adebamowo, Clement; Nankya-Mutyoba, Joan; Chiwanga, Faraja S.; Volmink, Jimmy; Ajayi, Ikeoluwapo; Kalyesubula, Robert; Reid, Todd G.; Dockery, Douglas; Hemenway, David; Adami, Hans-OlovBackground: Large prospective epidemiologic studies are vital in determining disease etiology and forming national health policy. Yet, such studies do not exist in sub-Saharan Africa (SSA) notwithstanding the growing burden of chronic diseases. Objective: We explored the feasibility of establishing a large-scale multicountry prospective study at five sites in four sub-Saharan countries. Design: Based on country-specific considerations of feasibility, Nigeria enrolled health care professionals, South Africa and Tanzania enrolled teachers, and Uganda enrolled village residents at one rural and one periurban site each. All sites used a 6-month follow-up period but different approaches for data collection, namely standardized questionnaires filled out by participants or face-to-face interviews. Results: We enrolled 1415 participants from five sites (range 200489) with a median age of 41 years. Approximately half had access to clean-burning cooking fuel and 70% to piped drinking water, yet 92% had access to a mobile phone. The prevalence of chronic diseases was 49% among 45- to 54-year-olds and was dominated by hypertension (21.7% overall) ranging from 4.5 to 31.2% across sites and a serious injury in the past 12 months (12.4% overall). About 80% of participants indicated willingness to provide blood samples. At 6-month follow-up, 68% completed a questionnaire (45 to 96% across sites) with evidence that mobile phones were particularly useful. Conclusions: Our pilot study indicates that a large-scale prospective study in SSA is feasible, and the burden of chronic disease in SSA may already be substantial necessitating urgent etiologic research and primary prevention.
- ItemHealth system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys(Public Library of Science, 2019) Manne-Goehler, Jennifer; Geldsetzer, Pascal; Agoudavi, Kokou; Andall- Brereton, Glennis; Aryal, Krishna K.; Bicaba, Brice Wilfried; Bovet, Pascal; Brian, Garry; Dorobantu, Maria; Gathecha, Gladwell; Gurung, Mongal Singh; Guwatudde, David; Msaidie, Mohamed; Houehanou, Corine; Houinato, Dismand; Jorgensen, Jutta Mari Adelin; Kagaruki, Gibson B.; Karki, Khem B.; Labadarios, Demetre; Martins, Joao S.; Mayige, Mary T.; McClure, Roy Wong; Mwalim, Omar; Mwangi, Joseph Kibachio; Norov, Bolormaa; Quesnel-Crooks, Sarah; Silver, Bahendeka K.; Sturua, Lela; Tsabedze, Lindiwe; Wesseh, Chea Stanford; Stokes, Andrew; Marcus, Maja; Ebert, Cara; Davies, Justine I.; Vollmer, Sebastian; Atun, Rifat; Barnighausen, Till W.; Jaacks, Lindsay M.Background: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. Methods and findings: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. Conclusions: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
- ItemTraining for health services and systems research in Sub-Saharan Africa : a case study at four East and Southern African Universities(BioMed Central, 2013-12) Guwatudde, David; Bwanga, Freddie; Dudley, Lilian; Chola, Lumbwe; Leyna, Germana Henry; Mmbaga, Elia John; Kumwenda, Newton; Protsiv, Myroslava; Atkins, Salla; Zwarenstein, Merrick; Obua, Celestino; Tumwine, James K.Abstract Background The need to develop capacity for health services and systems research (HSSR) in low and middle income countries has been highlighted in a number of international forums. However, little is known about the level of HSSR training in Sub-Saharan Africa (SSA). We conducted an assessment at four major East and Southern African universities to describe: a) the numbers of HSSR PhD trainees at these institutions, b) existing HSSR curricula and mode of delivery, and c) motivating and challenging factors for PhD training, from the trainees’ experience. Methods PhD training program managers completed a pre-designed form about trainees enrolled since 2006. A desk review of existing health curricula was also conducted to identify HSSR modules being offered; and PhD trainees completed a self-administered questionnaire on motivating and challenging factors they may have experienced during their PhD training. Results Of the 640 PhD trainees enrolled in the health sciences since 2006, only 24 (3.8%) were in an HSSR field. None of the universities had a PhD training program focusing on HSSR. The 24 HSSR PhD trainees had trained in partnership with a university outside Africa. Top motivating factors for PhD training were: commitment of supervisors (67%), availability of scholarships (63%), and training attached to a research grant (25%). Top challenging factors were: procurement delays (44%), family commitments (38%), and poor Internet connection (35%). Conclusion The number of HSSR PhD trainees is at the moment too small to enable a rapid accumulation of the required critical mass of locally trained HSSR professionals to drive the much needed health systems strengthening and innovations in this region. Curricula for advanced HSSR training are absent, exposing a serious training gap for HSSR in this region.
- ItemUrban and rural prevalence of diabetes and pre- diabetes and risk factors associated with diabetes in Tanzania and Uganda(Taylor & Francis Open, 2016) Chiwanga, Faraja S.; Njelekel, Marina A.; Diamond, Megan B.; Bajunirwe, Francis; Guwatudde, David; Nankya-Mutyoba, Joan; Kalyesubula, Robert; Adebamowo, Clement; Ajayi, IkeOluwapo; Reid, Todd G.; Volmink, Jimmy; Laurence, Carien; Adami, Hans-Olov; Holmes, Michelle D.; Dalal, ShonaENGLISH SUMMARY : Background: The increase in prevalence of diabetes and pre-diabetes in sub-Saharan Africa underlines the importance of understanding its magnitude and causes in different population groups. We analyzed data from the Africa/Harvard Partnership for Cohort Research and Training (PaCT) studies to determine the prevalence of diabetes and pre-diabetes and risk factors associated with diabetes. Methodology: Participants were randomly selected from peri-urban (n 297) and rural (n 200) communities in Uganda, and teachers were recruited from schools (n 229) in urban Tanzania. We used a standardized questionnaire to collect socio-demographic and self-reported disease status including diabetes status. Blood glucose was also measured after participants fasted for 8 h. We used standard protocols for anthropometric and blood pressure measurement. Results: The overall prevalence of diabetes was 10.1% and was highest in rural Ugandan residents (16.1%) compared to teachers in Tanzania (8.3%) and peri-urban Ugandan residents (7.6%). The prevalence of pre-diabetes was 13.8%. The prevalence of self-reported diabetes was low across all sites, where 68% of participants with diabetes were not captured by self-report. In ultivariable logistic regression analysis, family history (OR 2.5, 95% CI: 1.1, 5.6) and hypertension (OR 2.3, 95% CI: 1.1, 5.2) were significantly associated with diabetes. Conclusions: The prevalence of diabetes and pre-diabetes in Uganda and Tanzania is high, differs markedly between population groups, and remains undiagnosed in an alarmingly high proportion of individuals. These findings highlight the need for large-scale, prospective studies to accurately quantify the burden and identify effective intervention and treatment strategies across diverse African populations.
- ItemUrban–rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations : a multi-country cross-sectional study(BioMed Central, 2016-10-28) Ajayi, IkeOluwapo O.; Adebamowo, Clement; Adami, Hans-Olov; Dalal, Shona; Diamond, Megan B.; Bajunirwe, Francis; Guwatudde, David; Njelekela, Marina; Nankya-Mutyoba, Joan; Chiwanga, Faraja S.; Volmink, Jimmy; Kalyesubula, Robert; Laurence, Carien; Reid, Todd G.; Dockery, Douglas; Hemenway, David; Spiegelman, Donna; Holmes, Michelle D.ENGLISH SUMMARY : Background: Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socioeconomic factors. Methods: Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals. Results: The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p < 0.001). Overall, prevalence of overweight was 374 (31 %) and obesity, 414 (34 %). Female sex was a predictor of overweight and obesity (combined) in peri-urban Uganda [AOR = 8.01; 95 % CI: 4.02, 15.96) and obesity in rural Uganda [AOR = 11.22; 95%CI: 2.27, 55.40), peri-urban Uganda [AOR = 27.80; 95 % CI: 7.13, 108.41) and SA [AOR = 2. 17; 95 % CI: 1.19, 4.00). Increasing age was a predictor of BMI > =25 kg/m2 in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m2 only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m2 compared with the rural and peri-urban sites. Conclusion: The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.