scholarly journals Severe COVID-19 in Uganda across Two Epidemic Phases: A Prospective Cohort Study

2021 ◽  
Author(s):  
Barnabas Bakamutumaho ◽  
Matthew J. Cummings ◽  
Nicholas Owor ◽  
John Kayiwa ◽  
Joyce Namulondo ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Sub Saharan Africa ◽  
Severe Illness ◽  
Treatment Unit ◽  
Duration Of Illness ◽  
Community Transmission ◽  
Male Sex ◽  
Sub Saharan ◽  
Care Capacity ◽  
Peak Phase

Among a prospective cohort of children and adults admitted to a national COVID-19 treatment unit in Uganda from March to December 2020, we characterized the epidemiology of and risk factors for severe illness. Across two epidemic phases differentiated by varying levels of community transmission, the proportion of patients admitted with WHO-defined severe COVID-19 ranged from 5% (7/146; 95% CI: 2–10) to 33% (41/124; 95% CI: 25–42); 21% (26/124; 95% CI: 14–29%) of patients admitted during the peak phase received oxygen therapy. Severe COVID-19 was associated with older age, male sex, and longer duration of illness before admission. Coinfection with HIV was not associated with illness severity; malaria or tuberculosis coinfection was rare. No patients died during admission. Despite low mortality, hospital incidence of severe COVID-19 during the first epidemic peak in Uganda was substantial. Improvements in vaccine deployment and acute care capacity, including oxygen delivery, are urgently needed to prevent and manage severe COVID-19 in sub-Saharan Africa.

scholarly journals Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

2020 ◽  
Vol 8 (9) ◽  
pp. e1203-e1212 ◽  
Author(s):  
Valerie McCormack ◽  
Fiona McKenzie ◽  
Milena Foerster ◽  
Annelle Zietsman ◽  
Moses Galukande ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cancer Survival ◽  
Breast Cancer Survival ◽  
Sub Saharan Africa ◽  
Sub Saharan

Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study

2021 ◽  
Author(s):  
Matthew J. Cummings ◽  
Barnabas Bakamutumaho ◽  
Nicholas Owor ◽  
John Kayiwa ◽  
Joyce Namulondo ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Sub Saharan Africa ◽  
Rapid Diagnostics ◽  
Suspected Sepsis ◽  
Laboratory Capacity ◽  
Antimicrobial Management ◽  
Sub Saharan ◽  
Tb 32

The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.

scholarly journals Blood lead level in infants and subsequent risk of malaria: A prospective cohort study in Benin, Sub-Saharan Africa

PLoS ONE ◽  
2019 ◽  
Vol 14 (7) ◽  
pp. e0220023
Author(s):  
Amanda Garrison ◽  
Babak Khoshnood ◽  
David Courtin ◽  
Jacqueline Milet ◽  
André Garcia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Subsequent Risk

scholarly journals Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries

2020 ◽  
Author(s):  
Najmul Haider ◽  
Abdinasir Yusuf Osman ◽  
Audrey Gadzekpo ◽  
George O. Akpede ◽  
Danny Asogun ◽  
...  
Keyword(s):  
South Africa ◽  
North America ◽  
Health System ◽  
Sierra Leone ◽  
Sub Saharan Africa ◽  
Community Transmission ◽  
Holistic Assessment ◽  
Sub Saharan

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. This paper defines the term lockdown and describes the design, timing and implementation of lockdown in nine countries in Sub Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. It also discusses the manner in which lockdown is enforced, the need to mitigate the harms of lockdown, and the association between lockdown and the reported number of COVID-19 cases and deaths. While there are some commonalities in the implementation of lockdown, a more notable finding is the variation in the design, timing and implementation of lockdown measures across the nine countries. We found that the number of reported cases is heavily dependent on the number of tests done, and that testing rates ranged from 9 to 21,261 per million population. The reported number of COVID-19 deaths per million population also varies, but is generally low when compared to countries in Europe and North America. While lockdown measures may have helped inhibit some community transmission, the pattern and nature of the epidemic remains unclear. Of concern are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic harms. This paper highlights the need for inter-sectoral and trans-disciplinary research capable of providing a rigorous and holistic assessment of the harms and benefits of lockdown.

scholarly journals ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study

2019 ◽  
Vol 43 (10) ◽  
pp. 2357-2364
Author(s):  
Meghan Prin ◽  
Stephanie Pan ◽  
Clement Kadyaudzu ◽  
Guohua Li ◽  
Anthony Charles
Keyword(s):  
Cohort Study ◽  
Risk Stratification ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Prospective cohort study reveals unexpected aetiologies of livestock abortion in northern Tanzania

2021 ◽  
Author(s):  
Kate M Thomas ◽  
Tito Kibona ◽  
John R Claxton ◽  
William A de Glanville ◽  
Felix Lankester ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Current Knowledge ◽  
Neospora Caninum ◽  
Rift Valley Fever Virus ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Valley Fever ◽  
Sub Saharan

Livestock abortion is an important cause of productivity losses worldwide and many infectious causes of abortion are zoonotic pathogens that impact on human health. Little is known about the relative importance of infectious causes of livestock abortion in Africa, including in subsistence farming communities that are critically dependent on livestock for food, income, and wellbeing. We conducted a prospective cohort study of livestock abortion, supported by cross-sectional serosurveillance, to determine aetiologies of livestock abortions in livestock in Tanzania. This approach generated several important findings including detection of a Rift Valley fever virus outbreak in cattle; high prevalence of C. burnetii infection in livestock; and the first report of Neospora caninum, Toxoplasma gondii, and pestiviruses associated with livestock abortion in Tanzania. Our approach provides a model for abortion surveillance in resource-limited settings. Our findings add substantially to current knowledge in sub-Saharan Africa, providing important evidence from which to prioritise disease interventions.

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