Does pulmonary rehabilitation alter patients’ experiences of living with chronic respiratory disease? A qualitative study.

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

Geographic differences in the prevalence of hypertension in Uganda: Results of a national epidemiological study.

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

Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives

Introduction: Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking. / Methods: We delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study using thematic analysis of semistructured interviews with healthcare professionals and patients regarding (1) the role of music and dance in Ugandan life and (2) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda. / Results: We interviewed 19 participants, made up of 11 patients with long-term respiratory conditions and 8 healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: music and dance (1) were central components of daily life; (2) had an established role supporting health and well-being; and (3) had strong therapeutic potential in respiratory disease management. The fourth theme was (4) the importance of modulating demographic considerations of culture, religion and age. / Conclusion: Music and dance are central to life in Uganda, with established roles supporting health and well-being. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors and codevelopment and adaptation of interventions, such approaches are likely to be well received

The decline of water hyacinth on Lake Victoria was due to biological control by Neochetina spp

There has been some debate recently about the cause of the decline of water hyacinth on Lake Victoria. While much of this evidence points to classical biological control as the major factor, the El Niño associated weather pattern of the last quarter of 1997 and the first half of 1998 has confused the issue. We argue first that the reductions in water hyacinth on Lake Victoria were ultimately caused by the widespread and significant damage to plants by Neochetina spp., although this process was increased by the stormy weather associated with the El Niño event; second that increased waves and current on Lake Victoria caused by El Niño redistributed water hyacinth plants around the lake; and third that a major lake-wide resurgence of water hyacinth plants on Lake Victoria has not occurred and will not occur unless the weevil populations are disrupted. We conclude that the population crash of water hyacinth on Lake Victoria would not have occurred in the absence of the weevils, but that it may have been hastened by stormy weather associated with the El Niño event

A pre–post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda

Rupert Jones,1 Bruce J Kirenga,2 Wincelsas Katagira,2 Sally J Singh,3 Jill Pooler,4 Alphonse Okwera,2 Richard Kasiita,5 Doyo G Enki,6 Siobhan Creanor,6 Andy Barton4 1Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK; 2Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda; 3Cardio-Respiratory Directorate, University Hospitals of Leicester NHS Trust, Leicester, 4Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK; 5Department of Physiotherapy, Mulago Hospital, Kampala, Uganda; 6Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK Setting: The study was conducted at Mulago Hospital, Kampala, Uganda.Objective: As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD).Design: In a pre–post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken.Results: In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR.Conclusion: PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD. Keywords: tuberculosis, exercise training, self-management, nonpharmacological intervention&nbsp

Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives

IntroductionMusic and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking.MethodsWe delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study using thematic analysis of semistructured interviews with healthcare professionals and patients regarding (1) the role of music and dance in Ugandan life and (2) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.ResultsWe interviewed 19 participants, made up of 11 patients with long-term respiratory conditions and 8 healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: music and dance (1) were central components of daily life; (2) had an established role supporting health and well-being; and (3) had strong therapeutic potential in respiratory disease management. The fourth theme was (4) the importance of modulating demographic considerations of culture, religion and age.ConclusionMusic and dance are central to life in Uganda, with established roles supporting health and well-being. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors and codevelopment and adaptation of interventions, such approaches are likely to be well received.</jats:sec

Study protocol for a randomised controlled trial assessing the impact of pulmonary rehabilitation on maximal exercise capacity for adults living with post-TB lung disease: Global RECHARGE Uganda

Introduction: The burden of post-tuberculosis (TB) lung disease (PTBLD) is steadily increasing in sub-Saharan Africa, causing disability among TB survivors. Without effective medicines, the mainstay of PTBLD treatment evolves around disease prevention and supportive treatment. Pulmonary rehabilitation (PR), a low-cost, non-pharmacological intervention has shown effectiveness in a group of PTBLD individuals but has not been tested in a clinical trial. This study aims to assess the impact of a 6-week PR programme on maximal exercise capacity and other outcomes among adults in Uganda living with PTBLD. Methods and analysis: This is a randomised waiting-list controlled trial with blinded outcome measures, comparing PR versus usual care for patients with PTBLD. A total of 114 participants will be randomised (1:1) to receive either usual care (on the waiting list) or PR, with follow-up assessments at 6 weeks and 12 weeks postintervention. The primary outcome is change in walking distance measured by the Incremental Shuttle Walk Test from baseline to the end of 6 weeks of PR. All secondary outcomes will be compared between the PR and usual care arms from baseline to 6-week and 12-week follow-ups. Secondary outcomes include self-reported respiratory symptoms, physical activity, psychological well-being, health-related quality of life and cost–benefit analysis. All randomised participants will be included in the intention-to-treat analysis population. The primary efficacy analysis will be based on both per-protocol and modified intention-to-treat populations. Ethics and dissemination: The trial has received ethical clearance from the Mulago Hospital Research and Ethics Committee (MHREC 1478), Kampala, Uganda as well as the Uganda National Council for Science and Technology (SS 5105). Ethical approval has been obtained from the University of Leicester, UK research ethics committee (Ref No. 22349). Study findings will be published in appropriate peer-reviewed journals and disseminated at appropriate local, regional and international scientific meetings and conferences. Trial registration number: ISRCTN18256843. Protocol version: Version 1.0 July 2019