- Physician and Epidemiologist with a passion for clinical work, teaching and research. Research interests in HIV/AIDS,... morePhysician and Epidemiologist with a passion for clinical work, teaching and research. Research interests in HIV/AIDS, TB and Sepsis.Interest in investigation and outbreak responses.edit
Background Sepsis is the leading cause of global mortality, and it is frequently attributed to lower respiratory tract infections and subsequent acute respiratory distress syndrome (ARDS). Patients from sub-Saharan Africa (sSA) are... more
Background Sepsis is the leading cause of global mortality, and it is frequently attributed to lower respiratory tract infections and subsequent acute respiratory distress syndrome (ARDS). Patients from sub-Saharan Africa (sSA) are underrepresented in existing studies of sepsis, and little is known about ARDS in sSA. Severe respiratory distress (SRD) is a surrogate for ARDS defined by the WHO as O2 saturation <90% or respiratory rate >30 breaths/minute and a systolic blood pressure >90 mmHg plus suspected infection in the absence of cardiac failure. In the context of the current COVID-19 pandemic, a better understanding of SRD in sSA is urgently needed. In this study, we aimed to determine the prevalence, clinical characteristics, and in-hospital mortality of adults with SRD in sSA. Methods We analyzed pooled individual-level data from 16 studies of hospitalized patients conducted in 6 countries throughout sSA from 2009 to 2019. We used multiple imputation with chained equations with 10 iterations to impute missing data. We performed multivariable logistic regression to estimate associations between patient vital signs, laboratory studies, SRD, and in-hospital mortality. We characterized factors associated with in-hospital mortality in the subset of patients with SRD. Results The pooled data included 7385 patients with a median age of 37 years, of whom 3584 (49%) were women, 2282 (31%) were living with HIV, 3190 (43%) had a known acute infection, and 946 (13%) had SRD. The mortality for the total population and for patients with SRD was 15% and 22%, respectively. Older age, lower temperature, increased heart rate, increased respiratory rate, decreased oxygen saturation, Glasgow Coma Scale score <15, HIV infection, and SRD were associated with increased in-hospital mortality. For every increase of 5 breaths/minute, there was a 72% increase in the odds of in-hospital mortality, and conversely for every 1% increase in O2 saturation there was a 5% reduction in the odds of in-hospital mortality. In a subset of patients with available laboratory values, decreased hemoglobin and increased lactate were independently associated with increased inhospital mortality. We found similar associations with in-hospital mortality in the subset of patients with SRD. Conclusions In the first comprehensive evaluation of the prevalence, characteristics, and outcomes of hospitalized patients from sSA with WHO-defined SRD, we found that the prevalence of SRD was high and independently associated with in-hospital mortality. These findings can serve as a benchmark for future studies of patients with SRD in sSA including those with COVID-19.
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Background:Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in sub-Saharan Africa (SSA) and can rapidly progress to cirrhosis and hepatocellular carcinoma. Recent data demonstrate ongoing HBV... more
Background:Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in sub-Saharan Africa (SSA) and can rapidly progress to cirrhosis and hepatocellular carcinoma. Recent data demonstrate ongoing HBV transmission among HIV-infected adults in SSA, suggesting that complications of HIV/HBV co-infection could be prevented with HBV vaccination. Because HBV vaccine efficacy is poorly understood among HIV-infected persons in SSA, we sought to characterize the humoral response to the HBV vaccine in HIV-seropositive Ugandan adults.Methods:We enrolled HIV-infected adults in Kampala, Uganda without serologic evidence of prior HBV infection. Three HBV vaccine doses were administered at 0, 1 and 6 months. Anti-HBs levels were measured 4 weeks after the third vaccine dose. “Response” to vaccination was defined as anti-HBs levels ≥10 IU/L and “high response” as ≥100 IU/L. Regression analysis was used to determine predictors of response.Results:Of 251 HIV-positive adults screened, 132 (53%) had no prior HBV infection or immunity and were enrolled. Most participants were women [89 (67%)]; median (IQR) age was 32 years (27–41), and 68 (52%) had received antiretroviral therapy (ART) for >3 months. Median (IQR) CD4 count was 426 (261–583), and 64 (94%) of the 68 receiving ART had undetectable plasma HIV RNA. Overall, 117 (92%) participants seroconverted to the vaccine (anti-HBs ≥10 IU/L), with 109 (86%) participants having high-level response (anti-HBs ≥100IU/L). In multivariate analysis, only baseline CD4 >200 cells/mm3 was associated with response [OR=6.97 (1.34–34.71), p=0.02] and high-level response [OR=4.25 (1.15–15.69)], p=0.03].Conclusion:HBV vaccination was effective in eliciting a protective humoral response, particularly among those with higher CD4 counts. Half of the screened patients did not have immunity to HBV infection, suggesting a large at-risk population for HBV infection among HIV-positive adults in Uganda. Our findings support including HBV vaccination as part of routine care among HIV-positive adults.
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This presentation provides an overview of the evidence-based medicine approach to clinical medicine and patient care
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Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of... more
Malaria in pregnancy has been associated with maternal morbidity, placental malaria, and adverse birth outcomes. However, data are limited on the relationships between longitudinal measures of malaria during pregnancy, measures of placental malaria, and birth outcomes. This is a nested observational study of data from a randomized controlled trial of intermittent preventive therapy during pregnancy among 282 participants with assessment of placental malaria and delivery outcomes. HIV-uninfected pregnant women were enrolled at 12-20 weeks of gestation. Symptomatic malaria during pregnancy was measured using passive surveillance and monthly detection of asymptomatic parasitaemia using loop-mediated isothermal amplification (LAMP). Placental malaria was defined as either the presence of parasites in placental blood by microscopy, detection of parasites in placental blood by LAMP, or histopathologic evidence of parasites or pigment. Adverse birth outcomes assessed included low birth wei...
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This study sought to assess the burden, pattern and predictors of dyslipidaemia in 425 adult diabetic patients in Uganda. The median (IQR) age of the study participants was 53 (43.5-62) years with a female majority (283, 66.9%).... more
This study sought to assess the burden, pattern and predictors of dyslipidaemia in 425 adult diabetic patients in Uganda. The median (IQR) age of the study participants was 53 (43.5-62) years with a female majority (283, 66.9%). Dyslipidaemia defined as presence of ≥ 1 lipid abnormalities was observed in 374 (88%) study participants. Collectively, the predictors of dyslipidaemia were: female gender, study site (private hospitals), type of diabetes (type 2 diabetes mellitus), statin therapy, increased body mass index and diastolic blood pressure. Proactive screening of dyslipidaemia and its optimal management using lipid lowering therapy should be emphasised among adult diabetic patients in Uganda.
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Background Infection prevention and control (IPC) practices are required to prevent nosocomial infection by severe acute respiratory syndrome coronavirus 2. In low- and middle-income countries, where resources are often limited, IPC... more
Background Infection prevention and control (IPC) practices are required to prevent nosocomial infection by severe acute respiratory syndrome coronavirus 2. In low- and middle-income countries, where resources are often limited, IPC practices are infrequently assessed. Aim To assess the availability of the core components of World Health Organization (WHO) IPC practices at health facilities in Southwestern Uganda. Methods We assessed the availability of WHO IPC core components using a modified WHO Infection Prevention and Control Assessment tool. We determined differences between government versus private ownership and by type of health facility. Findings We assessed 111 of 224 (50%) health facilities in four districts. The most frequently achieved core component of IPC strategies was environmental cleanliness with 75 of 111 (68%) facilities scoring >85%. The most infrequently achieved core component of IPC strategies was personal protective equipment (PPE) with only one of seven (14%) hospitals and no other facilities scoring >85%. Of the 20 hospital or health center IV facilities, five (25%) received an overall score of >85% compared to only one of 91 (1%) health center II or III facilities (OR 30.0 [95% CI: 3.27-274.99], p=0.003). Of the 73 government facilities, two (3%) received an overall score of >85% compared to five of 38 (13%) private facilities (odds ratio [OR] 0.24 [95% CI: 0.04-1.37], p=0.11). Conclusion Few facilities in four districts in Southwestern Uganda achieved >85% availability of WHO IPC core components. Provision of PPE in these facilities should be prioritized.
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Research Interests: Epidemiology and Medicine
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In rapidly evolving global situations such as the COVID-19 pandemic, research needs to incorporate the realities of different global contexts. Identifying knowledge gaps and setting research priorities in different global contexts helps... more
In rapidly evolving global situations such as the COVID-19 pandemic, research needs to incorporate the realities of different global contexts. Identifying knowledge gaps and setting research priorities in different global contexts helps to effectively direct resources and scientific efforts towards the most pressing needs, including relevant public health interventions to tackle the direct and indirect impact of the pandemic. Collaborative international research initiatives such as the COVID-19 Clinical Research Coalition are necessary to confront both the current pandemic and prepare for future outbreaks. As evidenced by this Clinical Epidemiology Working Group (WG), the COVID-19 pandemic has emphasized the importance of global communication to optimize evidence-based thinking and collaboration. We present here a list of prioritized research questions in clinical epidemiology that aims to streamline COVID-19 research priority areas for low-resource settings.
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Research Interests: Nursing, Mental Health, Medicine, Critical Care, Critical Care Medicine, and 15 moreProspective studies, Humans, Blood Glucose, Female, Male, Hypoglycemia, Sepsis, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Prognosis, Hospital Mortality, Multiple Organ Failure, and Predictive value of tests
Background: Lithium is an integral drug used in the management of acute mania, unipolar and bipolar depression and prophylaxis of bipolar disorders. Thyroid abnormalities associated with treatment with lithium have been widely reported in... more
Background: Lithium is an integral drug used in the management of acute mania, unipolar and bipolar depression and prophylaxis of bipolar disorders. Thyroid abnormalities associated with treatment with lithium have been widely reported in medical literature to date. These include goitre, hypothyroidism, hyperthyroidism and autoimmune thyroiditis. This current review explores the varied thyroid abnormalities frequently encountered among patients on lithium therapy and their management, since lithium is still a fundamental and widely drug used in psychiatry and Internal Medicine. Methods: PubMed database and Google scholar were used to search for relevant English language articles relating to lithium therapy and thyroid abnormalities up to December 2012. The search terms used were lithium treatment, thyroid abnormalities, thyroid dysfunction, goitre, hypothyroidism, hyperthyroidism, thyrotoxicosis, autoimmune thyroiditis, lithium toxicity, treatment of affective disorders and depressi...
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To determine the role of primary antifungal prophylaxis in the prevention of cryptococcal meningitis and all-cause mortality in advanced HIV infection. This was a systematic review and meta-analysis of randomized trials and observational... more
To determine the role of primary antifungal prophylaxis in the prevention of cryptococcal meningitis and all-cause mortality in advanced HIV infection. This was a systematic review and meta-analysis of randomized trials and observational studies. Google Scholar™, PubMed and Embase databases were searched for relevant studies. Quality was assessed using different criteria, depending on study type. Publication bias was assessed and subgroup and sensitivity analyses were performed. When the results of the meta-analysis were homogeneous, the fixed-effects model was used; when the results of the meta-analysis were heterogenous, the random effects model was used. Primary prophylaxis prevented cryptococcal meningitis but did not confer protection against overall mortality, although there was evidence of a reduction in cryptococcal-specific mortality in resource-limited settings. Primary antifungal prophylaxis should be recommended in patients with advanced HIV infection in resource-limited settings with a high incidence of cryptococcal meningitis.