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A 10-year retrospective study of lung cancer in Uganda
(BMC Cancer, 2022-02-15) Bogere, Naghib; Bongomin, Felix; Katende, Andrew; Omaido, Blair Andrew; Namukwaya, Elizabeth; Mayanja‑Kizza, Harriet; Walusansa, Victoria
Background: Lung cancer is a leading cause of cancer-related deaths in Uganda. In this study, we aimed to describe the baseline characteristics and survival of patients with lung cancer at the Uganda Cancer Institute (UCI). Methods: We retrospectively reviewed medical records of all patients with a histological diagnosis of lung cancer registered at UCI between January 2008 and August 2018. Data on demographic, clinical, and treatment characteris‑ tics, and vital status were abstracted and analyzed. Patients with undocumented vital status on the medical records were contacted through phone calls. We determined survival as time from histological diagnosis to death. The Kaplan-Meier survival analysis was performed to estimate the median survival time and the 5-year overall survival rate. Results: Of the 207 patients enrolled, 56.5% (n=117) were female, median age was 60 years (range: 20–94), 78.7% (n=163) were never-smokers and 18 (8.7%) were living with HIV. Presumptive anti-tuberculosis treatment was given to 23.2% (n=48). Majority had non-small cell lung cancer (96.6%, n=200) with 74.5% (n=149) adenocarcinoma and 19% (n=38) squamous cell carcinoma. All had advanced (stage III or IV) disease with 96.1% (n=199) in stage IV. Chemotherapy (44.9%, n=93) and biological therapy (34.8%, n=72) were the commonest treatments used. Over‑ all survival at 6months, 1-, 2- and 5-years was 41.7, 29.7, 11.8, and 1.7%, respectively. The median survival time of 4.4months was not statistically signifcantly diferent between participants with NSCLC or SCLC (4.5 versus 3.9months, p=.335). Conclusion: In Uganda, adenocarcinoma is the predominant histologic subtype of lung cancer and patients are pre‑ dominantly females, and non-smokers. Patients present late with advanced disease and poor overall survival. Public awareness should be heightened to facilitate early detection and improve outcomes.
Absolute eosinophil count correlates with temperature and CD4 count independently of HIV infection among tuberculosis patients
(Tropical Medicine and International Health, 2020-09) Baruch Baluku, Joseph; Tukumbo Anguzu, Godwin; Bongomin, Felix; Mirembe Byonanebye, Dathan
objective To determine clinical correlates of the peripheral absolute eosinophil count (AEC) among bacteriologically confirmed TB patients in Uganda. materials and methods We evaluated data of bacteriologically confirmed adult TB patients who had a peripheral blood AEC measurement at the National TB Treatment Center in Uganda during a cross-sectional study. We performed linear regression analysis for correlates of log-transformed AEC. results We included 235 patients in this analysis with a median (interquartile range, IQR) age of 31 (24–39) years. 60.4% were male, and 33.6% had TB/HIV co-infection. In a multivariable linear regression model that controlled for age, residence type, HIV status, weight loss, anorexia, body mass index, CD8+ T-cell count, haemoglobin level and TB bacillary load, males had a 47.0% higher AEC than females (adjusted coefficient (R2 ) = 0.385, 95% confidence interval (CI) 0.012–0.759 P = 0.043). Also, a 1 °C raise in temperature resulted in an 11.5% decrease in the AEC (R2 = 0.122 95% CI ( 0.233 to 0.011) P = 0.031) while a 1 cell/mm3 increase in the CD4+ T cell count resulted in a 0.10% increase in the AEC (R2 = 0.001 95% CI (0.000–0.001) P = 0.032). conclusion The AEC was higher among males than females, consistent with the normal population distribution of AEC among Ugandans. The AEC was weakly but positively correlated with the CD4 count and negatively correlated with temperature.
Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey
(Journal of Infection and Public Health, 2023-08-16) Tufa, Tafese Beyene; Bongomin, Felix; Fathallah, Akila; Luísa S.M., Ana; Hashad f, Rola; Soussi Abdallaoui g, Maha; Ahmed Nail h, Abdelsalam; Adetona Fayemiwo, Samuel; Penney, Richard O.S.; Orefuwa, Emma; Denning, David W.
Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. Results: Initial data was collected from 48 African countries covering 99.65 % of the population.Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population > 850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies
Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study
(Tropical medicine and health, 2021-02-19) Bongomin, Felix; Olum, Ronald; Kyazze, Andrew Peter; Ninsiima, Sandra; Nattabi, Gloria; Nakyagaba, Lourita; Nabakka, Winnie; Kukunda, Rebecca; Ssekamatte, Phillip; Kibirige, Davis; Cose, Stephen; Nakimuli, Annettee; Baruch Baluku, Joseph; Andia-Biraro, Irene
Background: Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda. Methods: We conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda. Results: The prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37). Conclusions: Despite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.
Aspergillus-specific IgM/IgG antibody serostatus of patients hospitalized with moderate-critical COVID-19 in Uganda
(African Health Sciences, 2022-09-03) Bongomin, Felix; Kwizera, Richard; Mande, Emmanuel; Aloyo, Sharley Melissa; Achan, Beatrice; Namusobya, Martha; Sereke, Senai Goitom; Batte, Charles; Kiguli, Sarah; Baruch Baluku, Joseph; Joloba, Moses L; Kirenga, Bruce J
Invasive pulmonary aspergillosis is known to complicate the coronavirus diseases-2019 (COVID-19), especially those with crit ical illness. We investigated the baseline anti-Aspergillus antibody serostatus of patients with moderate-critical COVID-19 hos pitalized at 3 COVID-19 Treatment Units in Uganda. All 46 tested patients, mean age 30, and 11% with underlying respiratory disease had a negative serum anti-Aspergillus IgM/IgG antibody immunochromatographic test on day 3 (mean) of symptom onset (range 1-26), but follow up specimens to assess seroconversion were not available.
Azole-Containing Agar Plates and Antifungal Susceptibility Testing for the Detection of Azole-Resistant Aspergillus Species in Hospital Environmental Samples
(Mary Ann Liebert, 2023) Ghazanfari, Mona; Abastabar, Mahdi; Haghani, Iman; Moazeni, Maryam; Hedayati, Shakiba; Yaalimadad, Sanaz; Shirvan, Bahador Nikoueian; Bongomin, Felix; Hedayati, Mohammad T.
The indoor environment of hospitals should be considered as an important reservoir of azole resistant Aspergillus species. In this study, we evaluated azole-containing agar plates (ACAPs) and antifungal susceptibility testing (AFST) for the detection of azole-resistant Aspergillus species in hospital environmental samples. Between September 2021 and January 2022, environmental samples (108 instruments and 12 air) were collected from different wards of 4 educational hospitals in Mazandaran province, Iran. All samples were cultured using ACAPs. Recovered Aspergillus isolates were molecularly identified at species level using partial DNA sequencing of beta-tubulin gene. AFST of Aspergillus species was performed using the Clinical and Laboratory Standards Institute M38-A3 guideline. Screening for cyp51A mutations was also done. Overall, 18 (15.0%) isolates of Aspergillus species were recovered from ACAPs, of which Aspergillus tubingensis (50%) and Aspergillus fumigatus (38.9%) were the commonest species. No isolate of Aspergillus species grew on posaconazole (PCZ)-containing agar plates. Among the 18 Aspergillus isolated species from ACAPs, 83.3% were related to samples from instruments. Of the nine isolates of A. tubingensis, 22.2% and 44.4% isolates showed minimum inhibitory concentration (MIC) = 2 mg/mL against voriconazole (VCZ) and itraconazole, respectively; and 44.4% isolates showed MIC= 1 mg/mL against PCZ. Of the seven isolates of A. fumigatus, one (14.3%) was resistant to VCZ. This isolate showed F46Y, G54E, G138C, M172V, M220I, D255E, T289F, G432C, and G448S mutation in cyp51A. Our finding showed the emergence of high MICs in cryptic and non-fumigatus species of Aspergillus such as A. tubingensis and VCZ resistance in A. fumigatus in indoor environment of hospitals
Breakthrough mother-to-child transmission of HIV in a low-health facility in Uganda
(Elsevier Ltd, 2023-07-29) Okello, Benjamin; Nyana, Harriet; Luwukya, Richards; Odongkara, Moses; Kibone, Winnie; Bongomin, Felix
Objectives: Mother-to-child transmission (MTCT) of HIV can be minimized using elimination of MTCT (eMTCT) services. This study aimed to determine the proportion of infants who tested positive for HIV despite receiving eMTCT services in a rural setting in Northern Uganda. Methods: We retrospectively reviewed the early infant diagnosis register for the year January 2019 through June 2021 to collect data on participants enrolled in eMTCT services at Lalogi Health Centre IV in Omoro district, Uganda. Breakthrough HIV infection was defined as a positive HIV RNA on a dried blood sample at 18 months in a patient who received eMTCT services as recommended by national guidelines. Results: A total of 118 infants were enrolled in the study, 64 (54.2%) of whom were female. Most of the participants (n = 111, 94.1%) were on nevirapine prophylaxis for at least 6 weeks, 115 (97.5%) were exclusively breastfed, two (1.7%) were on complementary feeding, and one (0.8%) was not breastfed. Only five (4.2%) infants were lost to follow-up, four (3.4%) had incomplete data, and three (2.5%) had breakthrough HIV infections (positive HIV RNA and HIV antibody tests). All three cases of breakthrough HIV infection (one male and two female infants) were born to mothers who were diagnosed with HIV at delivery and were on nevirapine prophylaxis for less than 6 weeks. Conclusion: Our findings indicate that while eMTCT services were largely successful in minimizing vertical transmission of HIV in the rural setting in Northern Uganda, there were still some cases of breakthrough HIV infection associated with non-adherence to nevirapine prophylaxis and delayed maternal HIV diagnosis. Therefore, adhering to the national guidelines on nevirapine prophylaxis for at least 6 weeks for children born to mothers with HIV is recommended to further reduce the risk of vertical transmission of HIV.
Burden and associated phenotypic characteristics of tuberculosis infection in adult Africans with diabetes: a systematic review
(Scientific Reports, 2023-11-11) Kibirige, Davis; Andia‑Biraro, Irene; Kyazze, Andrew Peter; Olum, Ronald; Bongomin, Felix; Mwanje Nakavuma, Rose; Ssekamatte, Phillip; Emoru, Reagan; Nalubega, Goretti; Chamba, Nyasatu; Kilonzo, Kajiru; Naftal Laizer, Sweetness; Elauteri Mrema, Lucy; Olomi, Willyhelmina; Minja, Lilian Tina; Ntinginya, Nyanda Elias; Sabi, Issa; Hill, Philip C.; te Brake, Lindsey; van Crevel, Reinout; Sharples, Katrina; Critchley, Julia
Diabetes mellitus (DM) increases the risk of developing tuberculosis infection (TBI). However, the evidence on the burden and phenotypic characteristics of TBI in African patients with DM is limited. This study aimed to determine the prevalence and characterisation of TBI in native African patients living with DM. We searched PubMed, EMBASE, and African Journals Online for original studies reporting information on the prevalence and characteristics of TBI in adult Africans with DM. A forest plot was used to describe the pooled prevalence estimate of TBI and the corresponding 95% confdence intervals (CI). Six studies conducted in four African countries involving 721 participants with DM were included in this systematic review. The pooled prevalence estimate of TBI was 40% (95% CI 20–60%, I 2 = 98.52%, p< 0.001). Age ≥ 40 years and glycated haemoglobin levels independently predicted TBI positivity in patients with DM in three studies. Africans with DM have a high prevalence of TBI, especially those who are older or with poorly controlled diabetes. This justifes the need for studies to explore how to screen and manage TBI to avert the progression to active TB disease.
Burden and associated phenotypic characteristics of tuberculosis infection in adult Africans with diabetes: a systematic review
(Springer Nature, 2023) Kibirige, Davis; Biraro, IreneAndia; Kyazze, Andrew Peter; Olum, Ronald; Bongomin, Felix; Nakavuma, Rose Mwanje; Ssekamatte, Phillip; Emoru, Reagan; Nalubega, Goretti; Chamba, Nyasatu; Kilonzo, Kajiru; Laizer, Sweetness Naftal; Mrema, Lucy Elauteri; Olomi, Willyhelmina; Minja, LilianTina; Ntinginya, Nyanda Elias; Sabi, Issa; Hill, Philip C.; Brake, Lindsey te; Crevel, Reinout van; Sharples, Katrina; Critchley, Julia
Diabetes mellitus (DM) increases the risk of developing tuberculosis infection (TBI). However, the evidence on the burden and phenotypic characteristics of TBI in African patients with DM is limited. This study aimed to determine the prevalence and characterisation of TBI in native African patients living with DM. We searched PubMed, EMBASE, and African Journals Online for original studies reporting information on the prevalence and characteristics of TBI in adult Africans with DM. A forest plot was used to describe the pooled prevalence estimate of TBI and the corresponding 95% confdence intervals (CI). Six studies conducted in four African countries involving 721 participants with DM were included in this systematic review. The pooled prevalence estimate of TBI was 40% (95% CI 20–60%, I 2 = 98.52%, p< 0.001). Age ≥ 40 years and glycated haemoglobin levels independently predicted TBI positivity in patients with DM in three studies. Africans with DM have a high prevalence of TBI, especially those who are older or with poorly controlled diabetes. This justifes the need for studies to explore how to screen and manage TBI to avert the progression to active TB disease
Cardiovascular risk factors among people with drug-resistant tuberculosis in Uganda
(BMC, 2022-10-10) Baruch Baluku, Joseph; Nabwana, Martin; Nalunjogi, Joanitah; Muttamba, Winters; Mubangizi, Ivan; Nakiyingi, Lydia; Ssengooba, Willy; Olum, Ronald; Bongomin, Felix; Andia-Biraro, Irene; Worodria, William
Background Tuberculosis (TB) and its risk factors are independently associated with cardiovascular disease (CVD). We determined the prevalence and associations of CVD risk factors among people with drug-resistant tuberculosis (DRTB) in Uganda. Methods In this cross-sectional study, we enrolled people with microbiologically confirmed DRTB at four treatment sites in Uganda between July to December 2021. The studied CVD risk factors were any history of cigarette smoking, diabetes mellitus (DM) hypertension, high body mass index (BMI), central obesity and dyslipidaemia. We used modified Poisson regression models with robust standard errors to determine factors independently associated with each of dyslipidaemia, hypertension, and central obesity. Results Among 212 participants, 118 (55.7%) had HIV. Overall, 196 (92.5%, 95% confidence interval (CI) 88.0-95.3) had≥1 CVD risk factor. The prevalence; 95% CI of individual CVD risk factors was: dyslipidaemia (62.5%; 55.4–69.1), hypertension (40.6%; 33.8–47.9), central obesity (39.3%; 32.9–46.1), smoking (36.3%; 30.1–43.1), high BMI (8.0%; 5.0–12.8) and DM (6.5%; 3.7–11.1). Dyslipidaemia was associated with an increase in glycated haemoglobin (adjusted prevalence ratio (aPR) 1.14, 95%CI 1.06–1.22). Hypertension was associated with rural residence (aPR 1.89, 95% CI 1.14– 3.14) and previous history of smoking (aPR 0.46, 95% CI 0.21–0.98). Central obesity was associated with increasing age (aPR 1.02, 95%CI 1.00–1.03), and elevated diastolic blood pressure (aPR 1.03 95%CI 1.00–1.06). Conclusion There is a high prevalence of CVD risk factors among people with DRTB in Uganda, of which dyslipidaemia is the commonest. We recommend integrated services for identification and management of CVD risk factors in DRTB.
Clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 at Case Hospital, Uganda
(Interdisciplinary Perspectives on Infectious Diseases, 2022-06-08) Apiyo, Mirriam; Olum, Ronald; Kabuye, Amina; Khainza, Betty; Amate, Anne M.; Byabashaija, Vittal; Nomujuni, Derrick; Sebbaale, Kato; Senfuka, Peter; Kazibwe, Simon; Sharma, Gurav; Davidson, Lindsay; Bongomin, Felix
Data on clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in private health facilities in Uganda is scarce. We conducted a retrospective cohort study of patients hospitalized with COVID-19 at Case Hospital, Kampala, Uganda, between June 2020 and September 2021. Data of 160 participants (median age 45 years (interquartile range [IQR]: 37–57) and 63.5% male) was analyzed. Seventy-seven (48.1%) participants had non-severe, 18 (11.3%) severe, and 83 (51.9%) critical COVID 19 illness. In 62 participants with chest computed tomography £ndings, 54 (87%) had bilateral disease, with 22 (35%) having ground-glass opacities. e median duration of hospitalization was 5 days (IQR: 3–9 days). Overall, 18 (11.3%) participants died. Survival at 14 and 28 days was 89% and 72%, respectively. Factors strongly associated with all-cause mortality were as follows: age >50 years (odds ratio [OR]: 8.6, 95% con£dence interval [CI]: 1.1–69.2, and p 0.042), having at least 1 comorbidity (OR: 3.2, 95% CI: 1.1–8.9, and p 0.029), hypertension (OR: 3.2, 95% CI: 1.2–8.6, and p 0.024), diabetes mellitus (OR: 2.9, 95% CI: 1.0–8.5, andp 0.056), and oxygen saturation <92% (OR: 5.1, 95% CI: 1.8–14.4, and p 0.002). In this private health facility, mortality was about 1 in 10 patients, and more people presented with critical illness in the second wave of the pandemic, and most deaths occurred after 2 weeks of hospitalization.
Cor pulmonale complicating chronic pulmonary aspergillosis with fatal consequences: Experience from Uganda
(Medical mycology case reports, 2019-07-04) Bongomin, Felix; Kwizera, Richard; Atukunda, Angella; Kirengaa, Bruce J.
Cor pulmonale is a rare complication of pulmonary aspergillosis (CPA). A 45-year-old Ugandan male with a history of recurrent community-acquired pneumonias was admitted with symptoms of progressive difficulty in breathing, chronic productive cough, non-exertional left sided chest pain and progressive weight loss occurring over a 12-month period. Chest CT scan and echocardiography confirmed the diagnosis of CPA with an asper gilloma complicating bronchiectasis, complicated with cor pulmonale. However, this was previously clinically misdiagnosed as PTB.
COVID-19 vaccine acceptance among high-risk populations in Uganda
(Therapeutic Advances in Infectious Disease, 2021) Bongomin, Felix; Olum, Ronald; Andia-Biraro, Irene; Nakwagala, Frederick Nelson; Hudow Hassan, Khalid; Nassozi, Dianah Rhoda; Kaddumukasa, Mark; Byakika-Kibwika, Pauline; Kiguli, Sarah; Kirenga, Bruce J.
Background: Immunization is an important strategy for controlling the COVID-19 pandemic. COVID-19 vaccination was recently launched in Uganda, with prioritization to healthcare workers and high-risk individuals. In this study, we aimed to determine the acceptability of COVID-19 vaccine among persons at high risk of COVID-19 morbidity and mortality in Uganda. Methods: Between 29 March and 14 April 2021, we conducted a cross-sectional survey consecutively recruiting persons at high risk of severe COVID-19 (diabetes mellitus, HIV and cardiovascular disease) attending Kiruddu National Referral Hospital outpatient clinics. A trained research nurse administered a semi-structured questionnaire assessing demographics, COVID-19 vaccine related attitudes and acceptability. Descriptive statistics, bivariate and multivariable analyses were performed using STATA 16. Results: A total of 317 participants with a mean age 51.5±14.1years were recruited. Of this, 184 (60.5%) were female. Overall, 216 (70.1%) participants were willing to accept the COVID-19 vaccine. The odds of willingness to accept COVID-19 vaccination were four times greater if a participant was male compared with if a participant was female [adjusted odds ratio (AOR): 4.1, 95% confidence interval (CI): 1.8–9.4, p=0.00]. Participants who agreed (AOR: 0.04, 95% CI: 0.01–0.38, p=0.003) or strongly agreed (AOR: 0.04, 95% CI: 0.01–0.59, p=0.005) that they have some immunity against COVID-19 were also significantly less likely to accept the vaccine. Participants who had a history of vaccination hesitancy for their children were also significantly less likely to accept the COVID-19 vaccine (AOR: 0.1, 95% CI: 0.01–0.58, p=0.016). Conclusion: The willingness to receive a COVID-19 vaccine in this group of high-risk individuals was comparable to the global COVID-19 vaccine acceptance rate. Increased sensitization, myth busting and utilization of opinion leaders to encourage vaccine acceptability is recommended.
COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome
(Dove Medical Press, 2021-10-09) Bongomin, Felix; Sereke, Senai Goitom; Okot, Jerom; Katsigazi, Ronald; Kandole, Tadeo Kiiza; Oriekot, Anthony; Olum, Ronald; Atukunda, Angella; Baruch Baluku, Joseph; Nakwagala, Frederick
Background: Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke. Case Presentation: A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were worsening cough, difficulty in breathing, fever and altered mental status for 3 days with a background of a 1-month history of coughing with associated drenching night sweats and weight loss. The reverse transcriptase–polymerase chain reaction for SARS-CoV-2 of her nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were positive. Urine lipoarabinomannan and sputum GeneXpert were positive for Mycobacterium tuberculosis. Computed tomography of the brain showed a large acute ischemic infarct in the territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is, fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and oxygen therapy, the patient passed on within 36 hours of admission.
Diagnostic Accuracy of Clinical Diagnostic Scoring Systems for Childhood Tuberculosis: A Systematic Review and Meta-analysis
(Oxford University Press, 2023-12-11) Kakinda, Michael; Olum, Ronald; Baluku, Joseph Baruch; Bongomin, Felix
Background. Diagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, point-based scoring systems and diagnostic algorithms have been developed to improve the diagnostic yields in this population. However, there are no updated systematic reviews of the existing childhood TB scoring systems and algorithms. Hence, we systematically reviewed the diagnostic accuracy of the childhood TB diagnostic scoring systems and algorithms. Methods. We systematically searched PubMed, CINAHL, Embase, Scopus, and Google Scholar databases for relevant articles published until 30 March 2023. QUADAS-2 was used to assess their study quality. Diagnostic accuracy measures (ie, sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) were pooled using a random-effects model. Results. We included 15 eligible studies, with a total of 7327 study participants aged <15 years, with 10 evaluations of childhood TB diagnostic scoring systems and algorithms. Among these algorithms and scoring systems, only 3 were evaluated more than once. These were the Keith Edwards scoring system with 5 studies (sensitivity, 81.9%; specificity, 81.2%), Kenneth Jones criteria with 3 studies (sensitivity, 80.1%; specificity, 45.7%), and the Ministry of Health–Brazil algorithm with 3 studies (sensitivity, 79.9%; specificity, 73.2%). Conclusions. We recommend using the Keith Edwards scoring system because of its high sensitivity and specificity. Further research is necessary to assess the effectiveness of scoring systems and algorithms in identifying TB in children with HIV and malnutrition.
Efect of COVID‑19 pandemic on inpatient service utilization and patient outcomes in Uganda
(Scientifc Reports, 2023) Andia‑Biraro, Irene; Baruch Baluku, Joseph; Olum, Ronald; Bongomin, Felix; Kyazze, Andrew Peter; Ninsiima, Sandra; Ssekamatte, Phillip; Kibirige, Davis; Biraro, Samuel; Seremba, Emmanuel; Kabugo, Charles
COVID-19 has had devastating efects on health systems but reports from sub-Saharan Africa are few. We compared inpatient admissions, diagnostic tests performed, clinical characteristics and inpatient mortality before and during the COVID-19 pandemic at an urban tertiary facility in Uganda. We conducted a retrospective chart review of patients admitted at Kiruddu National Referral Hospital in Uganda between January–July 2019 (before the pandemic) and January–July 2020 (during the pandemic). Of 3749 inpatients, 2014 (53.7%) were female, and 1582 (42.2%) had HIV. There was a 6.1% decline in admissions from 1932 in 2019 to 1817 in 2020. There were signifcantly fewer diagnostic tests performed in 2020 for malaria, tuberculosis, and diabetes. Overall, 649 (17.3%) patients died. Patients admitted during the COVID-19 pandemic (adjusted odds ratio [aOR] 1.2, 95% confdence interval [CI] 1.04–1.5, p= 0.018), patients aged≥ 60 years (aOR 1.6, 95% CI 1.2–2.1, p= 0.001), HIV co-infected (aOR 1.5, 95% CI 1.2–1.9, p < 0.001), and those admitted as referrals (aOR 1.5, 95% CI 1.2–1.9, p < 0.001) had higher odds of dying. The COVID-19 pandemic disrupted inpatient service utilization and was associated with inpatient mortality. Policy makers need to build resilience in health systems in Africa to cope with future pandemics.
The first Helicobacter pylori-induced Guillain–Barré syndrome in Sudan
(John Wiley & Sons Ltd., 2023-10-31) Ahmed, Ayman; Misbah EL-Sadig, Sarah; Fathi Eltigani, Hala; Bongomin, Felix; Edwar Siddig, Emmanuel
We report the first known case of Guillain–Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H.py lori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H.pylori-inducing neurological disorders.
The first Helicobacter pylori-induced Guillain–Barré syndrome in Sudan
(Wiley, 2023-10-31) Ahmed, Ayman; EL-Sadig, Sarah Misbah; Eltigani, Hala Fathi; Bongomin, Felix; Siddig, Emmanuel Edwar
We report the first known case of Guillain–Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H.pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H.pylori-inducing neurological disorders.
Gender diferences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study
(Springer, 2021-10-18) Baruch Baluku, Joseph; Mukasa, David; Bongomin, Felix; Stadelmann, Anna; Nuwagira, Edwin; Haller, Sabine; Ntabadde, Kauthrah; Turyahabwe, Stavia
Background: Gender diferences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could afect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda. Methods: We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged≥18 years, had confrmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical signifcance was set at p<0.05. Results: Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p<0.001). Men were signifcantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not difer between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p=0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p=0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR=4.87, 95% CI 1.28–18.58, p=0.020), an increase in alanine aminotransferase levels (aHR=1.05, 95% CI 1.02–1.07, p<0.001), and his tory of ART default (aHR=3.86, 95% CI 1.31–11.37, p=0.014) while a higher baseline CD4 count was associated with lower mortality (aHR=0.94, 95% CI 0.89–0.99, p=0.013 for every 10 cells/mm3 increment). Conclusion: Mortality was higher among men than women with DRTB/HIV co-infection which could be explained by several sociodemographic and clinical differences.
High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit
(Oxford University Press, 2021-10-18) Bongomin, Felix; Fleischer, Brian; Olum, Ronald; Natukunda, Barbra; Kiguli, Sarah; Byakika-Kibwika, Pauline; Baruch Baluku, Joseph; Nakwagala, Frederick Nelson
Background. We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods. We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results. Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n = 91) or critical (66%, n = 315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P = .011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91–0.95; P < .001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00–1.02; P = .042). The risk of death was 1.4-fold higher in female participants compared with their male coun terparts (hazards ratio, 1.4; 95% CI, 1.0–2.0; P = .025). Conclusions. In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.

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