Anaemia among patients with congestive cardiac failure in Uganda – its impact on treatment outcomes

Background. Anaemia increases morbidity and mortality in patients with congestive cardiac failure (CCF). Few studies have examined the prevalence of anaemia and its impact among patients with CCF in sub-Saharan Africa. We assessed the prevalence of anaemia and its influence on treatment outcome in patients with CCF attending a large referral hospital in Kampala, Uganda.Methods. Echocardiography was done and haemoglobin levels were determined in 157 patients with CCF admitted to Mulago Hospital. The patients were followed up for 2 weeks and their treatment outcome was recorded.Results. Of the 157 patients, 101 (64.3%) had anaemia (meanhaemoglobin concentration .11.9 g/dl for women and .12.9 g/dl for men) at admission. Increasing age and hypertensive heart disease were significantly associated with anaemia (odds ratio (OR) 2.92, confidence interval (CI) 1.41 - 6.05,

Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case-Control Study from Kampala, Uganda.

Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case-control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1-150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80-254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37-142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42-141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22-56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated

Principles, design and processes of integrated agricultural research for development: experiences and lessons from LKPLS under the SSACP

With increasing recognition holding the promise of overcoming the outstanding problems faced byAfrican agriculture, IAR4D faces the danger of being ‘blurred’ by past approaches and falling short of its potential to deliver the desired impacts in diverse multi-stakeholder, biophysical, socio- economic, cultural, technological and market contexts unless its actualisation and working is clearly understood. In this paper, we present the conceptualisation and principles of and knowledge-based experiences and lessons from the implementation of the sub-Saharan Africa Challenge Programme (SSACP) in the Lake Kivu Pilot Learning Site (LKPLS). The presentation covers the formation and facilitation of IPs for the actualisation of IAR4D to evolve mechanisms for the early recognition of interlinked issues in natural resource management, productivity and value addition technologies, markets, gender and policy arrangements. These have autonomously triggered flexible, locally directed interactions to innovate options from within or outside their environment for resolving the challenges, and have moved along a new institutional and technological change trajectory. Emerging lessons point to the endowment of IP members with selfhelp knowledge interactions, training in IAR4D, quality of facilitation and research to be key determinants of the power behind of self-regulating mechanisms

"I think my body has become addicted to those tablets" Chronic heart failure patients' understanding of and beliefs about their illness and its treatment: a qualitative longitudinal study from Uganda

Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services.Serial qualitative in-depth interviews were conducted with Heart Failure patients who were purposively sampled and recruited in Mulago National Referral Hospital until thematic saturation was reached. In-depth interviews were conducted at three time points over the course of their illness with intervals of 3 months between interviews. A grounded theory approach was used in data analysis. The University of Edinburgh ethics committee, Mulago Hospital Research Ethics committee and the Uganda National Council of Science and Technology (Reference numbers D/GC/178; MREC 33, SS 3083 respectively) approved the research.A total of 40 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer), were conducted with 21 patients. The findings revealed that heart failure patients were unaware of the symptoms of the illness and their definition of illness differed from that of health professionals. Patients understood their diagnosis, cause of illness, prognosis and the importance of the medicines differently from health professionals, and had insufficient information on self-care. Lay beliefs were used to explain many aspects of the illness and treatments. All these influenced where patients sought care and their adherence to treatment, self-care and follow up leading to uncontrolled disease.There is a high level of health illiteracy among heart failure patients in Uganda. Patients rely on lay beliefs to make health decisions and medical information is often miscomprehended. There is an urgent need for health education using culturally appropriate information

Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals

Abstract Background The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients’ and health care professionals’(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients’ and HPs’ views of HF patients’ needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. Methods Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. Results Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO health systems strengthening approach. Conclusion Management of HF in Uganda requires an approach that targets multidimensional needs, embraces multidisciplinary care and strengthens health systems which are all important tenets of palliative care

Principles, design and processes of integrated agricultural research for development: experiences and lessons from LKPLS under the SSACP

With increasing recognition holding the promise of overcoming the outstanding problems faced by African agriculture, IAR4D faces the danger of being ‘blurred’ by past approaches and falling short of its potential to deliver the desired impacts in diverse multi-stakeholder, biophysical, socio-economic, cultural, technological and market contexts unless its actualisation and working is clearly understood. In this paper, we present the conceptualisation and principles of and knowledge-based experiences and lessons from the implementation of the sub-Saharan Africa Challenge Programme (SSACP) in the Lake Kivu Pilot Learning Site (LKPLS). The presentation covers the formation and facilitation of IPs for the actualisation of IAR4D to evolve mechanisms for the early recognition of interlinked issues in natural resource management, productivity and value addition technologies, markets, gender and policy arrangements. These have autonomously triggered flexible, locally directed interactions to innovate options from within or outside their environment for resolving the challenges, and have moved along a new institutional and technological change trajectory. Emerging lessons point to the endowment of IP members with selfhelp knowledge interactions, training in IAR4D, quality of facilitation and research to be key determinants of the power behind of self-regulating mechanisms