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1.
NPJ Prim Care Respir Med ; 29(1): 32, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31417087

RESUMO

The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6-12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5-126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5-39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7-40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.

2.
Glob Public Health ; : 1-14, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345124

RESUMO

Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.

3.
PLoS One ; 14(6): e0217900, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170234

RESUMO

BACKGROUND: Tuberculosis (TB) is the 9th leading cause of death from a single infectious agent. Patients live in a complex health care system with both formal and informal providers, and it is important that a TB diagnosis is not missed at the first interaction with the health care system. In this study, we highlight the health seeking behavior of patients and missed opportunities for early TB diagnosis for which interventions could be instituted to ensure early TB diagnosis and prompt TB treatment initiation. METHODS: This study was nested in a cross-sectional study that assessed the accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the referral hospitals in Uganda. We documented the symptom profile of presumptive TB patients and assessed the health seeking behavior of those with chronic cough by calculating proportion of patients that visited each type of health facility and further calculated the odds of being TB positive given the type of health facility initially visited for consultation. RESULTS: A total of 1,863 presumptive TB patients were enrolled of which 979 (54.5%) were male, and 1795 (99.9%) had chronic cough. A total of 1352 (75.4%) had previously sought care for chronic cough, with 805 (59.6%) seeking care from a public health facility followed by private health facility (289; 21.4%). Up to 182 (13.5%) patients visited a drug store for chronic cough. Patients whose first contact was a private health facility were more likely to have a positive GeneXpert test (adjOR 1.4, 95% CI: 1.0-1.9; p = 0.047). CONCLUSIONS: Chronic cough is a main symptom for many of the presumptive TB patients presenting at referral hospitals, with several patients having to visit the health system more than once before a TB diagnosis is made. This suggests the need for patients to be thoroughly evaluated at first interface with the health care system to ensure prompt diagnosis and treatment initiation. Improved TB diagnosis possibly with the GeneXpert test, at first contact with the health care system has potential to increase TB case finding and break the transmission cycle in the community.

4.
PLoS One ; 14(5): e0216901, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091275

RESUMO

BACKGROUND: Determining mycobacterial burden is important in assessing severity of disease, evaluating infectiousness and predicting patient treatment outcomes. Mycobacterial burden assessed by smear microscopy grade and time to culture positivity is clearly interpretable by most physicians. GeneXpert (Xpert) has been recommended by WHO as a first line tuberculosis (TB) diagnostic test as an alternative to smear microscopy. Xpert gives cycle threshold (Ct) values as a potential measure for mycobacterial burden. For physicians to clearly interpret Ct values as measures of mycobacterial burden, this study compared the Xpert quantification capabilities with those of smear microscopy and culture. The study also determined a linear relationship between Xpert Ct values and MGIT culture time to positivity (MGIT-TTP) and associated factors. A cut off Ct value which best predicts smear positivity was also determined using the Receiver Operator Curve analysis method. RESULTS: Excluding missing results and rifampicin resistant TB cases, a moderately strong correlation of 0.55 between Xpert Ct value and smear grade was obtained. A weak correlation of 0.37 was obtained between Xpert Ct values and MGIT time to positivity while that between Xpert Ct values and LJ culture was 0.34. The Xpert Ct values were found to increase by 2.57 for every unit increase in days to positive and HIV status was significantly associated with this relationship. A cut off Ct value of 23.62 was found to best predict smear positivity regardless of HIV status. CONCLUSION: Our study findings show that GeneXpert Ct values are comparable to smear microscopy as a measure of M. tuberculosis burden and can be used to replace smear microscopy. However, given the low correlation between Xpert Ct value and culture positivity, Xpert Ct values cannot replace culture as a measure of M. tuberculosis burden among TB patients.

5.
PLoS One ; 14(5): e0216568, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095641

RESUMO

BACKGROUND: Asthma is one of the neglected diseases in Africa with a high prevalence. Allergic fungal diseases have been reported to complicate asthma progression and treatment outcomes. However, data about fungal asthma and its associated complications are limited in Africa. We aimed to estimate the burden of fungal asthma among adults and children in Africa using a systematic review. METHODS: We first engaged the Institute for Health Metrics and Evaluation (IHME) to highlight the trend in morbidity and mortality attributed to asthma in Africa. We then searched PubMed, HINARI and Google Scholar for all studies of any design focusing on fungal asthma in any African country. Languages were restricted to English and French, but not year of publication. We estimated the weighted prevalence of allergic fungal infections among asthmatics with a 95% CI and pooled the results using a random effects model. This study is registered with PROSPERO, number CRD42019117319. RESULTS: The IHME data showed that there has been a gradual increase in morbidity and mortality due to asthma in African adults with a prevalence of 4%. Our search retrieved 5233 citations. We retained 20 studies that met our selection criteria. These were from 13 African countries published between 1967 and 2018. There were eight cross-sectional studies and twelve review articles. The average asthma prevalence in Africa was 6% from these studies. The prevalence of fungal sensitisation was relatively high (3-52%) in the asthmatic population with an average of 28% and a pooled estimate of 23.3%, mostly due to Aspergillus species. Prevalence of Allergic bronchopulmonary apsergillosis was estimated at 1.6-21.2%. Diagnosis of fungal allergy was mostly made by skin prick tests. There was no data on the use of medication to manage fungal asthma. None of the studies evaluated the association between fungal allergy and asthma severity. Data were lacking in children. CONCLUSION: There is a high prevalence of fungal sensitization among Africans with asthma. Fungal asthma is a significant problem in Africa but there remains a paucity of data on the epidemiology and associated complications. There is urgent need for national epidemiological studies to estimate the actual burden of fungal asthma in Africa.

6.
COPD ; 16(1): 58-65, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31032662

RESUMO

The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35-95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8 kg/m2. Participants with BMI < 19.8 kg/m2 had a 2.28 greater odds (95% CI 1.83-2.86) of having COPD and had a 0.21 (0.13-0.30) lower FEV1 and 0.34 (0.27-0.41) lower FEV1/FVC z-score compared to those with BMI ≥ 19.8 kg/m2. The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.

7.
NPJ Prim Care Respir Med ; 29(1): 12, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31028270

RESUMO

Approximately three billion individuals are exposed to household air pollution (HAP) from the burning of biomass fuels worldwide. Household air pollution is responsible for 2.9 million annual deaths and causes significant health, economic and social consequences, particularly in low- and middle-income countries. Although there is biological plausibility to draw an association between HAP exposure and respiratory diseases, existing evidence is either lacking or conflicting. We abstracted systematic reviews and meta-analyses for summaries available for common respiratory diseases in any age group and performed a literature search to complement these reviews with newly published studies. Based on the literature summarized in this review, HAP exposure has been associated with acute respiratory infections, tuberculosis, asthma, chronic obstructive pulmonary disease, pneumoconiosis, head and neck cancers, and lung cancer. No study, however, has established a causal link between HAP exposure and respiratory disease. Furthermore, few studies have controlled for tobacco smoke exposure and outdoor air pollution. More studies with consistent diagnostic criteria and exposure monitoring are needed to accurately document the association between household air pollution exposure and respiratory disease. Better environmental exposure monitoring is critical to better separate the contributions of household air pollution from that of other exposures, including ambient air pollution and tobacco smoking. Clinicians should be aware that patients with current or past HAP exposure are at increased risk for respiratory diseases or malignancies and may want to consider earlier screening in this population.

8.
BMC Public Health ; 19(1): 227, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795752

RESUMO

BACKGROUND: Recent large-scale population data on the prevalence of asthma and its risk factors are lacking in Uganda. This survey was conducted to address this data gap. METHODS: A general population based survey was conducted among people ≥12 years. A questionnaire was used to collect participants socio-demographics, respiratory symptoms, medical history, and known asthma risk factors. Participants who reported wheeze in the past 12 months, a physician diagnosis of asthma or current use of asthma medications were classified as having asthma. Asthmatics who were ≥ 35 years underwent spirometry to determine how many had fixed airflow obstruction (i.e. post bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio < lower limit of normal (LLN). Descriptive statistics were used to summarize participants' characteristics. Prevalence of asthma was calculated as a proportion of asthmatics over total survey population. To obtain factors independently associated with asthma, a random-effects model was fitted to the data. RESULTS: Of the 3416 participants surveyed, 61.2% (2088) were female, median age was 30 years (IQR, 20-45) and 323 were found to have asthma. Sixteen people with asthma ≥35 years had fixed airflow obstruction. The prevalence of asthma was 11.0% (95% CI:8.9-13.2; males 10.3%, females 11.4%, urban 13.0% and rural 8.9%. Significantly more people with asthma smoked than non-asthmatics: 14.2% vs. 6.3%, p < 0.001, were exposed to biomass smoke: 28.0% vs. 20.0%, p < 0.001, had family history of asthma: 26.9% vs. 9.4%, p, < 0.001, had history of TB: 3.1% vs. 1.30%, p = 0.01, and had hypertension: 17.9% vs. 12.0%, p = 0. 003. In multivariate analysis smoking, (adjusted odds ratio (AOR), 3.26 (1.96-5.41, p < 0.001) family history of asthma, AOR 2.90 (98-4.22 p- < 0.001), nasal congestion, AOR 3.56 (2.51-5.06, p < 0.001), biomass smoke exposure, AOR 2.04 (1.29-3.21, p = 0.002) and urban residence, AOR 2.01(1.23-3.27, p = 0.005) were independently associated with asthma. CONCLUSION: Asthma is common in Uganda and is associated with smoking, biomass smoke exposure, urbanization, and allergic diseases. Health care systems should be strengthened to provide asthma care. Measures to reduce exposure to the identified associated factors are needed.


Assuntos
Asma/etiologia , Hipersensibilidade/complicações , Pulmão/fisiopatologia , Fumaça/efeitos adversos , Fumar/efeitos adversos , Urbanização , Adolescente , Adulto , Idoso , Asma/epidemiologia , Asma/fisiopatologia , Biocombustíveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , População Rural , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
9.
Am J Trop Med Hyg ; 100(2): 386-391, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30594259

RESUMO

Understanding risk factors for tuberculosis (TB) and their prevalence helps guide early diagnosis. We determined their prevalence among bacteriologically negative and bacteriologically confirmed TB patients in five regional referral hospitals in Uganda. This cross-sectional study considered 1,862 adult presumptive TB participants. We performed fluorescent microscopy, Xpert MTB/RIF (Xpert), Lowenstein-Jensen culture, human immunodeficiency virus, and random blood sugar testing on recruited patients. Prevalence and prevalence ratios of risk factors were compared among bacteriologically negative and confirmed cases. Odds ratios and 95% confidence interval (CI) were determined for significant risk factors in bacteriologically confirmed patients. Of the 1,862 participants, 978 (55%) were male and the median age of the participants was 36 years (interquartile range: 27-48). Up to 273 (15%) had a positive result on all three TB tests. Most prevalent risk factors (prevalence ratio [PR] > 1.0) among bacteriologically negative and positive TB patients were cigarette smoking (9.3% versus 2.1%; PR = 2.1), biosmoke (24% versus 39.7%; PR = 1.7), contact (4.2% versus 6.5%; PR = 1.6), male gender (51.4% versus 72.5%; PR = 1.4), alcohol use (17.2% versus 24.4%; PR = 1.4), diabetes (0.7% versus 0.9%; PR = 1.3), and family history of TB (12.1% versus 13.7%; PR = 1.1). The risk factors and their adjusted prevalence rate ratios (95% CI) of being bacteriologically positive were male (1.8 [1.4-2.4]), biosmoke exposure (1.5 [1.2-2.0]), and history of cigarette smoking (1.6 [1.1-2.4]). Among bacteriologically confirmed patients in Uganda, cigarette smoking, biosmoke exposure, contact, male gender, alcohol use, diabetes, and family history of TB are important risk factors for TB. Interventions for TB control in people with these risk factors would help in TB control efforts.

10.
Artigo em Inglês | MEDLINE | ID: mdl-30445808

RESUMO

Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10⁻4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62⁻8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25⁻6.07) and with HAP (aOR 3.93, 95% CI: 1.15⁻13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04⁻5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09⁻4.58) but not HAP (aOR 1.86, 95% CI: 0.61⁻5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.

11.
Artigo em Inglês | MEDLINE | ID: mdl-30486291

RESUMO

Air pollution is a major cause of sub-optimal lung function and lung diseases in childhood and adulthood. In this study we compared the lung function (measured by spirometry) of 537 Ugandan children, mean age 11.1 years in sites with high (Kampala and Jinja) and low (Buwenge) ambient air pollution levels, based on the concentrations of particulate matter smaller than 2.5 micrometres in diameter (PM2.5). Factors associated with lung function were explored in a multiple linear regression model. PM2.5 level in Kampala, Jinja and Buwenge were 177.5 µg/m³, 96.3 µg/m³ and 31.4 µg/m³ respectively (p = 0.0000). Respectively mean forced vital capacity as % of predicted (FVC%), forced expiratory volume in one second as % of predicted (FEV1%) and forced expiratory flow 25⁻75% as % of predicted (FEF25⁻75%) of children in high ambient air pollution sites (Kampala and Jinja) vs. those in the low ambient air pollution site (Buwenge subcounty) were: FVC% (101.4%, vs. 104.0%, p = 0.043), FEV1% (93.9% vs. 98.0, p = 0.001) and FEF25⁻75% (87.8 vs. 94.0, p = 0.002). The proportions of children whose %predicted parameters were less than 80% predicted (abnormal) were higher among children living in high ambient air pollution than those living in lower low ambient air pollutions areas with the exception of FVC%; high vs. low: FEV1 < 80%, %predicted (12.0% vs. 5.3%, p = 0.021) and FEF25⁻75 < 80%, %predicted (37.7% vs. 29.3%, p = 0.052) Factors associated with lung function were (coefficient, p-value): FVC% urban residence (-3.87, p = 0.004), current cough (-2.65, p = 0.048), underweight (-6.62, p = 0.000), and overweight (11.15, p = 0.000); FEV1% underweight (-6.54, p = 0.000) and FEF25⁻75% urban residence (-8.67, p = 0.030) and exposure to biomass smoke (-7.48, p = 0.027). Children in study sites with high ambient air pollution had lower lung function than those in sites with low ambient air pollution. Urban residence, underweight, exposure to biomass smoke and cough were associated with lower lung function.

12.
Trials ; 19(1): 571, 2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30340648

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the end result of a susceptible individual being exposed to sufficiently deleterious environmental stimuli. More than 90% of COPD-related deaths occur in low- and middle-income countries (LMICs). LMICs face unique challenges in managing COPD; for example, deficient primary care systems present challenges for proper diagnosis and management. Formal diagnosis of COPD requires quality-assured spirometry, which is often limited to urban health centres. Similarly, standard treatment options for COPD remain limited where few providers are trained to manage COPD. The Global Excellence in COPD Outcomes (GECo) studies aim to assess the performance of a COPD case-finding questionnaire with and without peak expiratory flow (PEF) to diagnose COPD, and inform the effectiveness and implementation of COPD self-management Action Plans in LMIC settings. The ultimate goal is to develop simple, low-cost models of care that can be implemented in LMICs. This study will be carried out in Nepal, Peru and Uganda, three distinct LMIC settings. METHODS/DESIGN: We aim to assess the diagnostic accuracy of a simple questionnaire with and without PEF to case-find COPD (GECo1), and examine the effectiveness, cost-effectiveness and implementation of a community-health-worker-supported self-management Action Plan strategy for managing exacerbations of COPD (GECo2). To achieve the first aim, we will enrol a randomly selected sample of up to 10,500 adults aged ≥ 40 years across our three sites, with the goal to enrol 240 participants with moderate-to-severe COPD in to GECo2. We will apply two case-finding questionnaires (Lung Function Questionnaire and CAPTURE) with and without PEF and compare performance against spirometry. We will report ROC areas, sensitivity and specificity. Individuals who are identified as having COPD grades B-D will be invited to enrol in an effectiveness-implementation hybrid randomised trial of a multi-faceted COPD self-management Action Plan intervention delivered by CHWs. The intervention group will receive (1) COPD education, (2) facilitated-self management Action Plans for COPD exacerbations and (3) monthly visits by community health workers. The control group will receive COPD education and standard of care treatment provided by local health providers. Beginning at baseline, we will measure quality of life with the EuroQol-5D (EQ-5D) and St. George's Respiratory Questionnaire (SGRQ) every 3 months over a period of 1 year. The primary endpoint is SGRQ at 12 months. Quality-adjusted life years (QALYs) using the Short-Form 36 version 2 will also be calculated. We will additionally assess the acceptability and feasibility of implementing COPD Action Plans in each setting among providers and individuals with COPD. DISCUSSION: This study should provide evidence to inform the use of pragmatic models of COPD diagnosis and management in LMIC settings. TRIAL REGISTRATION: NCT03359915 (GECo1). Registered on 2 December 2017 and NCT03365713 (GECo2). Registered on 7 December 2017. Trial acronym: Global Excellence in COPD Outcomes (GECo1; GECo2).

13.
Clin Infect Dis ; 2018 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-30239605

RESUMO

Background: People with pulmonary tuberculosis (TB) are at risk of developing chronic respiratory disorders due to residual lung damage. So far, the scope of the problem in high burden TB countries is relatively unknown. Methods: Chronic respiratory symptoms (cough and phlegm lasting >2 weeks) and radiological lung abnormalities were compared between adults with and without a history of TB among the general population of Uganda. Multivariable regression models were used to estimate odds ratios with adjustment for age, gender, smoking, education, setting and region. Random effects models accounted for village clustering effect. Results: Of 45,293 invited people from 70 villages, 41,154 (90.9%) participated in the survey. 798 had a history of TB and among them, 16% had respiratory symptoms and 41% x-ray abnormalities. Adjusted odds ratios showed strong evidence for individuals with a history of TB having increased risk of respiratory symptoms (OR=4·02, 95%CI: 3·25-4·96) and x-ray abnormalities (OR=17·52, 95%CI: 14·76-20·79); attributing 6% and 24% of the respective population risks. Conclusions: In Uganda, a history of TB was a strong predictor of respiratory symptoms and lung abnormalities, before older age and smoking. Eliminating TB disease could reduce the prevalence of chronic respiratory symptoms as much as eliminating smoking.

14.
Respir Res ; 19(1): 184, 2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30241519

RESUMO

BACKGROUND: HIV and asthma are highly prevalent diseases in Africa but few studies have assessed the impact of HIV on asthma prevalence in high HIV burden settings. The objective of this analysis was to compare the prevalence of asthma among persons living with HIV (PLHIV) and those without HIV participating in the Uganda National Asthma Survey (UNAS). METHODS: UNAS was a population-based survey of persons aged ≥12 years. Asthma was diagnosed based on either self-reported current wheeze concurrently or within the prior 12 months; physician diagnosis; or use of asthma medication. HIV was defined based on confidential self-report. We used Poisson regression with robust standard errors to estimate asthma prevalence and the prevalence ratio (PR) for HIV and asthma. RESULTS: Of 3416 participants, 2067 (60.5%) knew their HIV status and 103 (5.0%) were PLHIV. Asthma prevalence was 15.5% among PLHIV and 9.1% among those without HIV, PR 1.72, (95%CI 1.07-2.75, p = 0.025). HIV modified the association of asthma with the following factors, PLHIV vs. not PLHIV: tobacco smoking (12% vs. 8%, p = < 0.001), biomass use (11% vs. 7%, p = < 0.001), allergy (17% vs. 11%, p = < 0.001), family history of asthma (17% vs. 11%, p = < 0.001), and prior TB treatment (15% vs. 10%, p = < 0.001). CONCLUSION: In Uganda the prevalence of asthma is higher in PLHIV than in those without HIV, and HIV interacts synergistically with other known asthma risk factors. Additional studies should explore the mechanisms underlying these associations. Clinicians should consider asthma as a possible diagnosis in PLHIV presenting with respiratory symptoms.

15.
Int J Chron Obstruct Pulmon Dis ; 13: 2375-2385, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30122917

RESUMO

Purpose: Chronic respiratory disease (CRD) including COPD carries high and rising morbidity and mortality in Africa, but there are few available treatments. Pulmonary rehabilitation (PR) is a non-pharmacological treatment with proven benefits in improving symptoms and exercise capacity, which has not been tested in Africa. We aimed to evaluate the lived experience of people with CRD, including physical and psychosocial impacts, and how these are addressed by PR. Patients and methods: A team of respiratory specialists, nurses, and physiotherapists implemented PR to meet the clinical and cultural setting. PR consisted of a 6-week, twice-weekly program of exercise and self-management education. Forty-two patients were recruited. Qualitative data were collected through interviews with patients at baseline and six weeks post-completion, focus group discussions, ethnographic observations, and brief interviews. Results: Before and after PR, a total of 44 semi-structured interviews, 3 focus group discussions, and 4 ethnographic observations with brief interviews were conducted. Participants reported profound problems with respiratory symptoms, functional impairment, wide-reaching economic and psychological impacts, and social isolation. Patients who were debilitated by their condition before PR reported that PR addressed all their major concerns. It was reported that breathlessness, pain, immobility, weight loss, and other CRD-related symptoms were reduced, and social and intimate relationships were improved. Local materials were used to improvise the exercises, enabling some to be maintained at home. Recommendations for future PR programs included patient information to take home as a reminder of the exercises, and to show their families, and the support of a community health worker to help maintenance of exercises at home. Conclusion: PR has the potential to restore the physical, mental, and social functioning in patients with CRD, whereas medication has much more narrow effects. PR offers a major new option for treatment of a neglected group of patients.

16.
PLoS One ; 13(8): e0201001, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30067823

RESUMO

BACKGROUND: Hypertension accounts for more than 212 million global disability-adjusted life-years, and more than 15 million in sub-Saharan Africa. Identifying factors underlying the escalating burden of hypertension in sub-Saharan Africa may inform delivery of targeted public health interventions. METHODS: As part of the cross-sectional nationally representative Uganda National Asthma Survey conducted in 2016, we measured blood pressure (BP) in the general population across five regions of Uganda. We defined hypertension as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or on-going use of medications for the purpose of lowering BP among adults (≥18 years of age); pre-hypertension as systolic BP between 120 and 140 mmHg and/or diastolic BP bteween 80 and 90 mmHg among adolescents and adults (≥12 years of age). FINDINGS: Of 3416 participants who met inclusion criteria, 38.9% were male, and mean age ± SD was 33.8 ± 16.9 years. The age- and sex-adjusted prevalence of hypertension was 31.5% (95% confidence interval [CI] 30.2 to 32.8). The adjusted prevalence of hypertension was highest in the Central Region (34.3%; 95% CI 32.6 to 36.0), and it was comparable to that in the West and East Regions. However, compared with the Central Region, hypertension was significantly less prevalent in the North (22.0%; 95 CI 19.4 to 24.6) and West Nile Regions (24.1%; 95% CI 22.0 to 26.3). Adjustment for demographic characteristics (occupation, monthly income, and educational attainment) of participants did not account for the significantly lower prevalence of hypertension in the North and West Nile Regions. The prevalence of pre-hypertension was 38.8% (95% CI 37.7 to 39.8), and it was highly prevalent among young adults (21-40 years of age: 42.8%; 95% CI 41.2-44.5%) in all regions. CONCLUSIONS: Hypertension is starkly prevalent in Uganda, and numerous more people, including young adults are at increased risk. The burden of hypertension is highest in the Central, Western, and Eastern regions of the country; demographic characteristics did not fully account for the disparate regional burden of hypertension. Future studies should explore the potential additional impact of epidemiological shifts, including diet and lifestyle changes, on the development of hypertension.

17.
BMJ Glob Health ; 3(4): e000745, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30057796

RESUMO

Introduction: Pulmonary tuberculosis (TB) is an important risk factor for chronic respiratory disease due to residual lung damage. Yet, the WHO End TB strategy does not mention post-TB chronic lung disorders (PTBLDs) and programmatic interventions to address PTBLD are lacking. This study assessed the scope of current guidelines and evidence on PTBLD to inform policy and research action. Methods: A systematic literature search was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Eight databases (TRIP, International Guideline Library, MEDLINE/PubMed, EMBASE, Web of Science, Global Health, Cochrane Library) were searched for records on PTBLD published between 1 January 1990 and 1 December 2017. Non-English records, case series, conference abstracts and letters to editors were excluded. Data were extracted and charted on publication year, location, PTBLD condition(s) and main study outcome. Results: A total of 212 guidelines and 3661 articles were retrieved. After screening, only three international TB guidelines mentioned TB sequelae, but none described how to identify or manage the condition. A total of 156 articles addressed PTBLD: 54 (35%) mentioned unspecified TB sequelae; 47 (30%) specific post-TB conditions including aspergillosis, bronchial stenosis or bronchiectasis; 52 (33%) post-TB obstructive disorders or lung function impairment; and 20 (13%) post-TB respiratory symptoms or chest X-ray abnormalities. The first two groups mostly assessed surgery or ventilation techniques for patient management, while the last two groups typically assessed prevalence or predictors of disease. Conclusion: This is the first review to provide a comprehensive overview of the current literature on PTBLD. The scope of evidence around the burden of PTBLD warrants inclusion and recognition of the problem in international TB guidelines. Research is now needed on early detection of PTBLD and patient management options that are suitable for high-burden TB countries.

18.
Emerg Infect Dis ; 24(8)2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30016256

RESUMO

Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.

19.
BMJ Open Respir Res ; 5(1): e000276, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30018764

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) will soon be the third leading global cause of death and is increasing rapidly in low/middle-income countries. There is a need for local validation of the Saint George's Respiratory Questionnaire (SGRQ), which can be used to identify those experiencing lifestyle impairment due to their breathing. Methods: The SGRQ was professionally translated into Luganda and reviewed by our field staff and a local pulmonologist. Participants included a COPD-confirmed clinic sample and COPD-positive and negative members of the community who were enrolled in the Lung Function in Nakaseke and Kampala (LiNK) Study. SGRQs were assembled from all participants, while demographic and spirometry data were additionally collected from LiNK participants. Results: In total, 103 questionnaires were included in analysis: 49 with COPD from clinic, 34 community COPD-negative and 20 community COPD-positive. SGRQ score varied by group: 53.5 for clinic, 34.4 for community COPD-positive and 4.1 for community COPD-negative (p<0.001). The cross-validated c statistic for SGRQ total score predicting COPD was 0.87 (95% CI 0.75 to 1.00). SGRQ total score was associated with COPD severity (forced expiratory volume in 1 s per cent of predicted), with an r coefficient of -0.60 (-0.75, -0.39). SGRQ score was associated with dyspnoea (OR 1.05/point; 1.01, 1.09) and cough (1.07; 1.03, 1.11). Conclusion: Our Luganda language SGRQ accurately distinguishes between COPD-positive and negative community members in rural Uganda. Scores were correlated with COPD severity and were associated with odds of dyspnoea and cough. We find that it can be successfully used as a respiratory questionnaire for obstructed adults in Uganda.

20.
Thorax ; 73(10): 983-985, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29752346

RESUMO

Data on asthma treatment outcomes in Africa are limited. 449 patients with asthma (age 5-93 years) in Uganda were followed up for 2 years to determine rates of exacerbations and mortality and associated factors. During follow-up the median number of exacerbations per patient was 1 (IQR 0-5) and 17 patients died (3.7%, 27.3 deaths per 1000 person years). Considering only the first year of follow-up, 59.6% of the patients experienced at least one exacerbation, 32.4% experienced three or more exacerbations. A multivariable model showed that the likelihood of experiencing at least one exacerbation in the first year of follow-up was lower with better baseline asthma control (higher asthma control test (ACT) score), with OR 0.87 (95% CI: 0.82 to 0.93, P=0.000), and was higher with more exacerbations in the year prior to enrolment (OR for log number of exacerbations 1.28, 95% CI: 1.04 to 1.57, P=0.018). Better asthma control (OR 0.93, 95% CI: 0.88 to 0.99, P=0.021) and number of baseline exacerbations (OR 1.35,95% CI: 1.11 to 1.66, P=0.005) were also the only factors that were independently associated with experiencing three or more exacerbations during the first year of follow-up. The only factor found to be associated with all-cause mortality was FEV1, with higher recent FEV1 associated with lower all-cause mortality (OR 0.30, 95% CI: 0.14 to 0.65; P=0.002). Rates of asthma exacerbations and mortality are high in Uganda and are associated with poor asthma control. Health systems should be strengthened to care for asthma patients.

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