Epidemiology and management of diarrheal disease in HIV infected patients

AbstractDiarrhea is the most common gastrointestinal symptom in human immunodeficiency virus (HIS infection. It affects up to 90% of patients, becoming more frequent and severe as the immune system deteriorates. It often is associated with significant morbidity and mortality particularly in the developing countries. Gastrointestinal infections, some of which are attributable to inadequate sanitation and poor hygiene are the predominant cause of diarrhea, although multiple medications, including traditional herbs, also may be causes. The basic principles of management include detection of treatable causes, relief of symptoms, prevention of malnutrition, and psychosocial support. In up to 60% of cases, no cause can be identified, partly because of inadequate investigative facilities. Symptomatic treatment is the mainstay of management particularly when no cause can be identified. Unfortunately this can be extremely difficult when the patient is severely immune-suppressed. There is poor response to motility control drugs, such as loperamide, and others, such as octrectlde, are too expensive. Fluid replacement should be started early to prevent excessive dehydration. This should be combined with nutritional support to prevent malnutrition. Psychosocial support, including counselling, for both the patient and the caring relatives, is required to alleviate anxiety, particularly when the diarrhea becomes intractable

Journal of the International AIDS Society: an important step forward

This editorial welcomes readers to the launch of Journal of the International AIDS society

Cultural adaptation and validation of the Kidney Disease and Quality of Life-Short Form (KDQOL-SF™) version 1.3 questionnaire in Uganda

Background: Chronic kidney disease is on the rise in sub-Saharan African countries such as Uganda, and patients often present with advanced disease requiring kidney replacement therapies. Health-related quality of life is a key outcome in chronic kidney disease management but, in Uganda, no tools have been validated to measure this. The aim of this study was to culturally adapt and validate the Kidney Disease Quality of Life-Short Form version 1.3 (KDQOL-SF™) questionnaire for use in the Ugandan setting. Methods: We conducted a four-phase, mixed-methods study which included translation, cultural adaptation, optimisation of face validity and field testing. Our participants included healthcare workers, and patients aged 18 years with an estimated glomerular filtration rate <15 mL/min/1.73 m2. Results: The tool was culturally adapted and translated into one of the Ugandan languages, Luganda, which, with an English version of the tool, was validated and field tested. Over 80% of the subdomains had less than  10% floor and ceiling effects. For reliability, Cronbach’s α coefficient scores ranged from 0.96 to 0.41, with 10 out of 18 subdomains scoring >0.70, indicating acceptable internal consistency. The tool demonstrated  discriminant validity, with patients with comorbidities reporting lower quality of life scores, as postulated. Conclusions: The Luganda and English versions of the KDQOL-SF questionnaire have sufficient face and content validity, reliability and acceptability to assess the quality of life of patients with kidney failure in Uganda

Prevalence, patterns and factors associated with hypertensive crises in Mulago hospital emergency department; a cross-sectional study

Background: Hypertension is increasing in sub-Saharan Africa (SSA) and it’s the single most important modifiable stroke risk factor, yet it’s control is not routinely emphasized. The prevalence, pattern and factors associated with hypertensive urgencies and emergencies in Uganda is not well established. A cross-sectional study, was conducted between November 2015 and February 2016, using a complete clinical examination and pre-tested standardized questionnaire subjects were enrolled. The prevalence of hypertensive crises and associations of demo- graphic and clinical factors determined using logistic regression.Results: The prevalence of hypertensive crises was 5.1%, (203/4000) of all admissions at the medical section of the accident and emergency ward of Mulago National Referral  Hospital.  The hypertensive urgencies and emergencies accounted for 32.5% and 67.5% respectively among study subjects with hypertension. Among those with hypertensive crises, 41.1% were aged 45-65 years and half were female. Self-reported compliance was significantly different between those with hypertensive crisis compared to non-hypertensive crisis with OR; (95% CI) 52.4; (24.5 – 111.7), p-value =<0.001. Acute stroke was the commonest hyper- tensive emergency.Conclusion: Hypertensive emergencies are common and significantly associated with poor compliance to prescribed anti-hy- pertensive drugs. Acute stroke is the commonest presentation in our setting.Keywords: Hypertensive crises, prevalence, factors associated

Health-related quality of life, palliative care needs and 12-month survival among patients with end stage renal disease in Uganda: protocol for a mixed methods longitudinal study.

BACKGROUND: The prevalence of chronic kidney disease is on the rise globally and in sub-Saharan Africa. Due to its "silent" nature, many patients often present with advanced disease. At this point options for care are often limited to renal replacement therapies such as hemodialysis and kidney transplantation. In resource limited settings, these options are associated with catastrophic expenditures and increased household poverty levels. Early palliative care interventions, if shown to ensure comparable quality of life (QoL), can significantly mitigate this by focusing care on comfort, symptom control and QoL rather than primarily on prolonging survival. METHODS: A mixed methods longitudinal study, recruiting patients with End Stage Renal Disease (ESRD) on hemodialysis or conservative management and following them up over 12 months. The study aims are to: 1) measure and compare the health-related quality of life (HRQoL) scores of patients with ESRD receiving hemodialysis with those receiving conservative management, 2) measure and compare the palliative care needs and outcomes of patients in the two groups, 3) explore the impact of treatment modality and demographic, socio-economic and financial factors on QoL and palliative care needs and outcomes, 4) review patient survival over 12 months and 5) explore the patients' lived experiences. The Kidney Disease Quality Of Life Short Form version 1.3 (KDQOL-SF) will be used to measure HRQoL; the African Palliative Care Association Palliative care Outcome Score (APCA POS) and the Palliative care Outcome Score for renal symptoms (POS-S Renal) will be used to assess palliative care needs and outcomes; and semi-structured in-depth interviews to explore the patients' experiences of living with ESRD. Data collection will be carried out at 0, 3, 6, 9 and 12 months. DISCUSSION: To the best of our knowledge, no similar study has been conducted in sub-Saharan Africa. This will be an important step towards raising awareness of patients' need and preferences and the strengths and limitations of available health care services for ESRD in resource limited settings

Influence of Dietary Salt Knowledge, Perceptions, and Beliefs on Consumption Choices After Stroke in Uganda

Background Previous research on Uganda\u27s poststroke population revealed that their level of dietary salt knowledge did not lead to healthier consumption choices. Purpose Identify barriers and motivators for healthy dietary behaviors and evaluate the understanding of widely accepted salt regulation mechanisms among poststroke patients in Uganda. Methods Convergent parallel mixed methods triangulation design comprised a cross-sectional survey (n = 81) and 8 focus group discussions with 7-10 poststroke participants in each group. We assessed participant characteristics and obtained insights into their salt consumption attitudes, perceptions, and knowledge. Qualitative responses were analyzed using an inductive approach with thematic analytic procedures. Relationships between healthy dietary salt compliance, dietary salt knowledge, and participant characteristics were assessed using logistic regression analyses. Results Healthy dietary salt consumption behaviors were associated with basic salt knowledge (P \u3c  .0001), but no association was found between compliance and salt disease-related knowledge (P = .314). Only 20% and 7% obtained health-related salt knowledge from their health facility and educational sources, respectively, whereas 44% obtained this information from media personalities; 92% of participants had no understanding of nutrition labels, and only 25% of the study population consumed potash—an inexpensive salt substitute that is both rich in potassium and low in sodium. Conclusion One barrier to healthy dietary consumption choices among Uganda\u27s stroke survivors is a lack of credible disease-related information. Improving health-care provider stroke-related dietary knowledge in Uganda and encouraging the use of potash as a salt substitute would help reduce hypertension and thereby lower the risk of stroke

Post-stroke depression among stroke survivors attending two hospitals in Kampala Uganda

Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere.Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD.Results: Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD.Conclusion: There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient’s inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.Keywords: Stroke, post-stroke depression

Clinic Attendance for Medication Refills and Medication Adherence amongst an Antiretroviral Treatment Cohort in Uganda: A Prospective Study

Background. Regular clinic attendance for antiretroviral (ARV) drug refills is important for successful clinical outcomes in HIV management. Methods. Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy (ART) in a district hospital in Uganda were prospectively monitored over a 28-week period. Results. Of the 2267 total scheduled clinic visits, 40 (1.8%) were missed visits. Among the 392 clients, 361 (92%) attended all appointments for their refills (regular attendance). Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal (≥95%) medication adherence [odds ratio (OR) = 3.89, 95% CI: 1.48 to 10.25, exact P = .013]. In multivariate analysis, clients in age category 35 years and below were less likely to achieve regular clinic attendance. Conclusion. Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in resource-constrained settings. Where human resource constraints do not allow pill counts or other time-consuming measures, then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure