Impaired renal function in a rural Ugandan population cohort

Background: Kidney disease is an important cause of morbidity and mortality globally. However, there are limited data on the prevalence of impaired kidney function in sub-Saharan Africa. We aimed to determine the prevalence of reduced kidney function and associated factors in a rural Ugandan population. Methods: We undertook a study of a representative sample of the General Population Cohort in South-western Uganda. We systematically collected data on cardiovascular disease risk factors, anthropometric measurements and blood tests including haemoglobin, HIV, HbA1c and serum creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula, without the race component of the equation. Results: A total of 5,979/6,397 (93.5%) participants had valid creatinine results. The mean age was 39 years (Range: 16-103 years) and 3,627 (60.7%) were female. HIV prevalence was 9.7% and about 40% of the population were pre-hypertensive or hypertensive. The mean serum creatinine level was 0.75 mg/dl (95% CI 0.74–0.75), and the average eGFR was 109.3 ml/min/1.73 m2 (95% CI 108.8–109.9). The overall prevalence of eGFR <60 ml/min/1.73 m2 was 1.64% (98/5,979) (95% CI 1.34–1.99). Additionally, 4,792 (80.2%) were classified as normal eGFR (≥90 ml/min/1.73 m2), 1,089 (18.2%) as low eGFR (60–89 ml/min/1.73 m2), 91 (1.52%) as moderately reduced eGFR (30–59 ml/min/1.73 m2), 4 (0.07%) as severely reduced eGFR (15-29 ml/min/1.73 m2), and 3 (0.05%) classified as having kidney failure (eGFR <15 ml/min/1.73 m2). When age-standardised to the WHO Standard Population the prevalence of eGFR<60 ml/min/1.73 m2 was 1.79%. Age above 35 years and the presence of hypertension (OR 2.86, 95% CI 1.15-7.08) and anaemia (OR 2.14, 95% CI 1.12-4.09) were associated with eGFR<60 ml/min/1.73 m2. Conclusion: In a systematic survey of people in rural Uganda, we found a substantial proportion had eGFR<60 ml/min/1.73 m2, and this was strongly associated with high blood pressure and anaemia

Association of impaired kidney function with mortality in rural Uganda: results of a general population cohort study.

OBJECTIVE: To determine the association between baseline kidney function and subsequent all-cause mortality. DESIGN AND SETTING: A general population-based cohort study from rural Uganda. PARTICIPANTS: People aged 18 years and above with measured baseline estimated glomerular filtration rate (eGFR), recruited from survey rounds in 2011-2012 or 2014-2015 and followed up to March 2019. OUTCOME MEASURE: The primary outcome was all-cause mortality, identified through reports from community health workers and verified by verbal autopsy. The association between baseline eGFR category and mortality was determined using multivariable Cox regression. RESULTS: Of 5812 participants in both rounds, we included 5678 (97.7%) participants with kidney function and mortality data; the median age was 36 years (IQR 24-50), 60.7% were female, 10.3% were hypertensive, 9.8% were HIV-positive and 1.5% were diabetic. During a median follow-up of 5.0 years (IQR 3.7-6.0) there were 140 deaths. In age-adjusted and sex-adjusted analyses, eGFR 90 mL/min/1.73 m2. After inclusion of additional confounders (HIV, body mass index, diabetes, hypertension, alcohol and smoking status) into the model, eGFR <45 mL/min/1.73 m2 at baseline remained strongly associated with mortality (HR 6.12, 95% CI 2.27 to 16.45), although the sample size fell to 3102. Test for trend showed strong evidence (p<0.001) that the rate of mortality increased progressively as the category of baseline kidney function decreased. When very high eGFR was included as a separate category in age-adjusted and sex-adjusted analyses, baseline eGFR ≥120 mL/min/1.73 m2 was associated with increased risk of mortality (HR 2.68, 95% CI 1.47 to 4.87) compared with the reference category of 90-119 mL/min/1.73 m2. CONCLUSION: In a prospective cohort in rural Uganda we found that impaired baseline kidney function was associated with subsequently increased total mortality. Improved understanding of the determinants of kidney disease and its progression is needed in order to inform interventions for prevention and treatment

POS-331 Association of impaired kidney function with mortality in rural Uganda: results of a general population cohort study

Introduction: The burden of kidney disease in sub-Saharan Africa is currently poorly understood. Very limited monitoring and treatment is available for people affected. The association with other diseases and with mortality is unknown in this setting. We sought to determine the association between kidney function and subsequent all-cause mortality. Methods: In a general population cohort with detailed measurement of health-related parameters in rural Uganda, we estimated the baseline glomerular filtration rate (GFR) between 2011-2014 in 5,678 participants. We followed participants up to March 2019 with regular ascertainment of mortality and migration. Using multivariable cox regression, we determined associations between baseline eGFR and mortality. Results: The median age of the participants at baseline was 36 years (IQR 24-50), 60.7% were female, 14.6% hypertensive, 9.7% HIV-positive and 1.8% diabetic. We registered 140 deaths with a median follow-up of 5.0 years. Adjusting for age and sex, HIV, hypertension, diabetes, BMI, marital status, and alcohol and tobacco use participants with eGFR ≤45 mls/min/1.73m2 had six-fold higher mortality compared to those with eGFR ≥90mls/min/1.73m2 (HR 6.12 (95% CI 2.27-16.45)) with strong evidence of a linear trend for risk of mortality as renal function declined (P<0.001). Conclusions: In a prospective cohort with high rates of follow-up we found that baseline kidney function was associated with subsequently increased mortality in a graded manner. Improved understanding of the determinants of kidney disease and its progression are needed in order to inform interventions for prevention and treatment

Group membership and certification effects on incomes of coffee farmers in Uganda

Discrepancies in certification effects on smallholder incomes have been found in scientific literature. Unobserved farmer-group heterogeneity is a likely reason. For the long-standing Robusta coffee farmer-groups in Uganda, we find no significant effect of certification on net-farm income. But, we find 20 percentage point differences in net-farm income between certified and non-certified farmers explained by membership duration. In contrast, the recently founded certified Arabica coffee farmer-groups have positive net-farm income effects of 151 per cent, partly explained by a higher degree of vertical integration. With or without certification, long-standing group membership is found to have positive income effects

Incidence and short term outcomes of neonates with hypoxic ischemic encephalopathy in a Peri Urban teaching hospital, Uganda: a prospective cohort study

Abstract Background Hypoxic Ischemic Encephalopathy carries high case fatality rates ranging between 10–60%, with 25% of survivors have an adverse long-term neurodevelopment outcome. Despite the above, there is paucity of data regarding its magnitude and short term outcomes in a low resource setting like Uganda. Therefore we set out to determine the incidence and short term outcomes of Newborns with Hypoxic Ischemic Encephalopathy at St.Francis Hospital, Nsambya. Methods This was a Prospective Cohort study conducted between October 2015 and January 2016 at St. Francis Hospital, Nsambya, Kampala- Uganda. Term Newborn babies were enrolled. Umbilical cord arterial blood gas analysis was done for Newborns with low Apgar scores at 5 min. Clinical examination was done on all newborns within 48 h of life, for features of encephalopathy. Neonates with Hypoxic Ischemic Encephalopathy were followed up by a daily clinical examination and a short term outcome was recorded on day seven. Results The incidence of Hypoxic Ischemic Encephalopathy was 30.6 cases per 1000 live births. The majority, 10 (43.5%) had mild Hypoxic Ischemic Encephalopathy, followed by 8 (34.8%), 5 (21.7%) that had moderate and severe Hypoxic Ischemic Encephalopathy respectively. A total of (6) 26% died, and (15) 65.2% were discharged within 1 week. Lack of a nutritive suckling reflex (nasogastric feeding), poor Moro reflex, and requirement for respiratory support (oxygen therapy by nasal prongs) were the common complications by day seven. Conclusions The burden of Hypoxic Ischemic Encephalopathy is high with a case fatality rate of 26%. There is need to conduct a longitudinal study to determine the long term complications of HIE

Stakeholder engagement in prioritizing sustainability assessment themes for smallholder coffee production in Uganda

Many sustainability assessment frameworks have been developed in recent years, but translating them into practical tools to guide decision making remains challenging. By engaging coffee stakeholders in Uganda, we demonstrate a process of translating the widely-accepted framework for Sustainability Assessments of Food and Agriculture Systems (SAFA), developed by the Food and Agriculture Organisation of the United Nations (FAO), to smallholder production systems. Stakeholders prioritized the sustainability themes in terms of relevance and feasibility, and subsequently identified relevant sub-themes. We find that the structure and scope of some generally accepted themes need appropriate modifications in order to address the social and structural heterogeneity of smallholder production systems. Although importance and feasibility rankings significantly vary within and between stakeholder groups, governance and economic themes are commonly perceived as very important though equally the least feasible for smallholders. Thus, the inclusion of the ‘farmer-group’ structure as part of the sustainability assessment criteria is perceived as necessary especially toward achieving governance-related goals. These findings emphasize the need of engaging stakeholders in defining locally adapted sustainability assessment criteria

Sustainability Performance of Certified and Non-certified Smallholder Coffee Farms in Uganda

The transition toward sustainable agricultural production can be supported with improved insight into the performance of existing farming systems. The Sustainability Assessments of Food and Agriculture Systems (SAFA) framework published by the Food and Agriculture Organization (FAO) provides a comprehensive and harmonised framework to assess and compare farming systems. We used the indicator-based SAFA consistent Sustainability Monitoring and Assessment RouTine (SMART) Farm Tool to analyze and compare the sustainability performance of certified organic and fair trade as well as non-certified smallholder farms in Uganda. Using the respective sustainability scores, we analyzed the synergies and trade-offs between sustainability themes using the non-parametric Spearman correlation test. We find that certification is associated with improved sustainability performance of smallholder coffee farms. It enhances the achievement of governance goals through its influences on group organization and collective capacities - this results in positive effects on other sustainability dimensions. Major synergies were observed between social and governance themes, and between economic and environmental themes. Although, the extent and distribution of the synergies and trade-offs varied among farms, they were consistent between the production systems. These results show that the production systems can potentially have more influence on the sustainability performance than certification per se

Mechanisation in smallholder organic production

The training manual explains the principles, challenges and opportunities for smallholder organic farmers to apply mechanisation to reduce drudgery in organic farming, focussing on crop production. It invites participants, through didactic suggestions, to discuss the broad topic

Organic Vegetable Production - Basic Principles and Methods - A Resource Manual for Trainers

The manual offers a generic introduction to organic vegetable production. It highlights aspects such as seed selection, nursery management, field establishment, weed management, pest and disease management, harvesting, and postharvest management