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Mak’s Findings: Index Patients Diagnosed and Treated for COVID-19 in Uganda

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On Tuesday May 26, 2020, Makerere University (Mak) Management converged to share findings from the study whose aim of was “to detail characteristics and treatment outcomes of the Coronavirus (COVID 19) pandemic patients in Uganda”. Coronavirus being a novel and rapidly changing pandemic, it was essential that early lessons are obtained and synthesised.  These lessons directly feed into the clinical care guidelines and eventually contribute to the country’s interventions. With funding from the Government of Uganda through the Makerere University Research and Innovations Fund (Mak-RIF), this study was successfully executed.The multidisciplinary research team was coordinated through the Makerere University Lung Institute (MLI) http://mli.mak.ac.ug/. This study was led by Dr. Bruce Kirenga, Director MLI, and Prof. William Bazeyo, Acting Deputy Vice Chancellor (Finance and Administration)-Mak as Principal Investigators. Other investigators were from Entebbe Regional Referral Hospital, Johns Hopkins University, Baltimore, USA, Uganda Peoples Defence Forces, The AIDS Support Organisation (TASO), Mulago National Referral Hospital, the College of health Sciences and Ministry of Health, Uganda.

This study was conducted on the first group of COVID-19 patients (56) at Mulago National Referral hospital and Entebbe Regional Referral hospitals. Patient enrolment has continued but below we exultantly share preliminary findings.

·         Age: the average age of the patients in Uganda was 33 years which is far lower than has is reported elsewhere. In Wuhan China, for example, the average age is 59 while in the New York USA it is as higher (63 years). Older the patient have higher risk of severe forms of disease and ultimately the poorer treatment outcomes.

·         Patient Presentation: Among symptomatic COVID-19 patients, the most common symptoms were fever (21.4%), cough (19.6%), runny nose (16.1%), headache (12.5%), muscle aches (7.1%) and fatigue (7.1%). However, more than half of the patients did not have any of these symptoms at diagnosis. These patients were largely travellers returning from abroad or contacts of the confirmed/symptomatic patients above. Unlike our patients, 80% of hospitalised patients in the western world were symptomatic.

·         Laboratory and imaging tests: Coronavirus has been reported to affect almost all body tissues. To understand the extent of damage, our research team performed a wide range of tests including complete blood count, kidney function tests, troponin, lactate dehydrogenase which identifies for signs of damage to a wide range of body tissues, and C reactive protein-CRP. We found that 10.6% of the patients had low white blood cells, 26.3% had low platelets, and 12.8% had evidence of liver damage, while the kidneys had no evidence of damage. 12.2% had evidence of systemic inflammation and 43% had evidence of nonspecific tissue damage. The electrical heart activity was also checked with the electrocardiograph (ECG). All patients had normal ECG with the exception of one who had a very slow heart (bradycardia). We checked lung damage with Chest X-rays (CXR) and computed Tomography scans (CT). Three patients had significant lung damage on CT and CXR; while one of them had low oxygen saturation.

·         Comorbidity: About 25% of the initial patients (56) reported having other medical conditions in addition to COVID-19. Most of the conditions reported were the non-communicable diseases such as hypertension and diabetes which accounted for 11%. High blood pressure (higher than 140/90mmHg) was the most common comorbid disease recorded in up to 28% of the patients.

·         Disease severity: At admission, only 2 patients met the classification of severe disease (patients with severe respiratory symptoms requiring oxygen therapy) while the rest had mild disease. Temperature and oxygen saturation were monitored three times a day. All the patients recovered without the need for admission to Intensive care unit (ICU) or ventilation. This is contrary to what has been observed elsewhere, where 5% of COVD-19 patients required ICU care.

·         Treatment: To-date, there is no known cure for COVID-19. The current treatments are meant to alleviate symptoms while waiting for the body to mount an immune response to fight off the infection. The patients were able to recover on supportive care through managing the symptoms, treatment with antibiotics for those who had evidence of bacterial infection, hydroxychloroquine and vitamin C. In instances where the patients had comorbid conditions, proper management of these conditions was part of the treatment.

Conclusion: The initial group of COVID-19 patients diagnosed in the country presented with mild disease and exhibited a clinical course of disease that is quite different from what has been observed elsewhere. Imaging and laboratory tests are critical in management of this disease. Prompt identification of patients and initiation of treatment could help to prevent the development of severe forms of the disease. Frequent monitoring of the oxygen saturation is also critical for rapid patient identification and treatment. In light of the increasing number of cases in the country, these findings help in informing the national preparedness plan for COVID-19 (capacity building of health workers in clinical care for COVID-19, the required logistics, continuous research).

Recommendations

1.      Expand testing for COVID-19 in view of the finding that almost half of those confirmed did not have the classical symptoms for COVID 19. Add rhinorrhoea to symptoms for case screening.  

2.      Efforts should be taken to make clinical, laboratory and imaging tests available at all COVID-19 treatment centres to support proper grading of disease severity. At a minimum, pulse oximetry should be routine in management of COVID patients.

3.      Capacity to diagnose and treat non communicable comorbid conditions should be built across the country as part of COVID 19 response. Equipment for proper diagnosis of these diseases should be secured, installed and effectively used.

4.      Strengthen monitoring, evaluation and learning as part COVID-19 care. This will allow continued learning of COVID-19 in general and the effectiveness of the different treatments of the disease.

5.      Research should be supported including biomedical sciences research. This will allow growth of locally generated evidence to support the country’s COVID 19 response.

Acknowledgement

·         The Government of the Republic of Uganda, Makerere University Research and Innovations Fund (Mak-RIF), Ministry of Health, Uganda, Uganda Virus Research Institute, Mulago National Referral Hospital, Entebbe Regional Referral Hospital.   

·         The study participants, all health workers engaged and Makerere University leadership.

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Computing & IS

MakSPH METS Program HISTAC Positions: Software Developers

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MakSPH-METS Program staff interacting with Mildmay's Elizabeth during the DREAMS Data Audit at Kalule in Nyimbwa Subcounty, Luwero District. Photo credit: MakSPH-METS

The Makerere University School of Public Health (MakSPH)-Monitoring and Evaluation Technical Support (METS) Program is a five-year (2020-2025) CDC funded Cooperative Agreement. The overall purpose of the program is to establish coordinated and effective national and district systems for management of strategic information for a robust HIV Program.

MakSPH-METS is also working as a Sub-Awardee to the University of California San Francisco (UCSF) on a multi country program entitled HQ Support of Improved Interoperable HIS towards HIV/AIDS and TB Control through Improved HIS Policy, Governance, Workforce Capacity and systems under PEPFAR (HISTAC). The program will provide technical assistance in areas of data base management, software development, case-based surveillance, HIS design and implementation.

POSITION SUMMARIES

MakSPH METS is therefore seeking to hire qualified individuals for the following position under
the HISTAC project:

Software Developer (3)

The Software Developer shall be responsible for designing, developing, implementing, maintaining, auditing and improving new and existing health information systems and project software. He/she shall be responsible to customize national health information systems and integrate biometric and other technology for patients tracking, monitoring and referral across service sites.

Qualifications and Experience

A bachelor’s degree in computer science and software engineering and Information systems. A minimum of five years’ experience in software development or working with health information systems.

Soft copies of the applications should be submitted as one PDF file to the following email address mets[at]musph.ac.ug by 5:00 pm on March 3, 2021.

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Health

KI, Mak Enter New Phase of Collaboration with Centre for Sustainable Health

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KI’s President, Ole Petter Ottersen, and the Vice Chancellor Prof. Barnabas Nawangwe signed an agreement to establish the Centre of Excellence for Sustainable Health on 29th January 2021. Photo: Ulf Sirbom, Bildmakarna

By Davidson Ndyabahika. Additional Reporting by Michelle Azorbo

Representatives from Karolinska Institutet and Makerere University on Friday (January 29) signed an agreement, furthering an alliance between the two research-led universities.

The collaboration agreement was establishing the Centre of Excellence for Sustainable Health – CESH. This Centre seeks to promote partnerships, develop capacity, resources and tools to drive the agenda for sustainable health.

Professor Barnabas Nawangwe, Vice Chancellor Makerere University, and Prof. Ole Petter Ottersen, President Karolinska Institutet, signed the agreement in a virtual ceremony.

The agreement is a step in the deepening of the collaboration between the institutions and a major leap towards driving the agenda for sustainable health.

“Fueled by our experiences in COVID-19, we see an urgent need to build universal preparedness for health and I am convinced that the new Centre will contribute significantly to this. My vision is that the Centre of Excellence for Sustainable Health will help transform how research and policies are formulated and conducted in the area of sustainable health”, explained KI’s President Ole Petter Ottersen.

Professor Nawangwe said that the signing ceremony marks a milestone of deepening the successful cooperation between Makerere University and Karolinska Institutet

“This is an important next step in the long-standing collaboration between Makerere University and Karolinska Institutet. Deepening our partnership will be a significant contribution to increase action to achieve the Sustainable Development Goals of the United Nations’ 2030 Agenda”, said Professor Nawangwe.

In a dialogue preceding the signing session, the two heads of KI and Mak shared warm experiences and visions for the partnership. They also congratulated each other on the roles the institutions are doing to support efforts to curb the global pandemic.

Professor Nawangwe highlighted the pivotal role Makerere University as a key research institution in Uganda is doing to support national and global efforts in the fight against the coronavirus pandemic.

He says while the pandemic has brought problems, it has shown some realities of what the world is.

“The effects of the pandemic on the African continent have been a blessing in disguise. It has been what I could call ‘a rude awakening of Africa’ because Africa was for the first time completely isolated in many ways. That forced us to begin thinking what do we do? We must find solutions to our problems including health problems. And that is why you see a lot of efforts by our researchers to find solutions for COVID-19,” Professor Nawangwe.

KI’s President Ole Petter Ottersen said many projects that have been set up in the name of global health have largely been short term and sort of ‘hit and run projects’.

He contends that there is a need to put into context collaboration the elements of long-term perspective and with ambitions to end up in policy changes and implementation of new knowledge in order to have a permanent change for the better when it comes to health policies.

According to Ottersen, this global pandemic has put the world at crossroads that requires more attention to be paid to the global challenges whose targets were set for 2030. He also highlighted the need to use this pandemic as an opportunity to bolster efforts to the goals of agenda 2030.

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Health

Address Drivers of Non-compliance to COVID-19 Guidelines, Researchers Urge Government

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L-R: Dr. Misaki Wayengera-MoH-National COVID Taskforce, Dr. Gloria Seruwagi-REFLECT Study PI and Mr. Thomas Mugweri-Kyegegwa District COVID Taskforce engage the community on Britop Radio 94.1 FM in December 2020.

Makerere University researchers and local leaders have asked government and other key stakeholders in refugee management to address community drivers of non-compliance to COVID-19 guidelines as increased cases continue to be registered across the country.

This call was made at the dissemination event of a study conducted by Makerere University titled Refugee Lived Experiences, Compliance and Thinking (REFLECT) in COVID-19. The REFLECT dissemination was undertaken at multiple sites in Kisenyi (Kampala), Kyaka II Refugee Settlement (Kyegegwa) and Adjumani (West Nile) on 14th December 2020.

The REFLECT study observed that compliance levels around COVID-19 guidelines drastically declined between May-August 2020 and continue going down despite increased infections from community transmission. The stakeholders at this event cautioned that addressing the drivers of non-compliance was necessary in light of the overwhelmed health system, currently ongoing political campaigns and massive social gatherings in the Christmas season and beyond.

Since March 2020 the Uganda government and its partners have conducted a fairly successful awareness campaign on the prevention of COVID-19. However, this knowledge has not translated into sustainable behavioural change and while there was strict observance of COVID-19 at the start of the pandemic, compliance has drastically dropped due to a number of reasons. This is why all prevention efforts should now focus on addressing the barriers to non-compliance as the country enters into the second wave and peak period of COVID-19 transmissions.

A study conducted from among 2,092 people in refugee settlements in Uganda has found a serious disconnect between the high knowledge levels and levels of compliance with the recommended COVID-19 preventive measures. A total of 13 settlements were considered for this study including Kisenyi in Kampala, Kyaka II in Kyegegwa district and 11 settlements in Adjumani district, West Nile.

Presenting findings of the study at Kyaka II Refugee Settlement in Kyegegwa, South-Western Uganda, the research team led by Dr Gloria Seruwagi observed that compliance levels had declined over time (between March/April and July/August); unfortunately coinciding with increasing number of COVID-19 cases and deaths.

Inappropriate use of masks was found prevalent in some of the study sites – including sharing of masks, and only wearing them when the refugees meet the Police. Researchers say these practices constitute a source of risk for infection, rather than being protective.

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