This is a research and training grant to build capacity among medical students, residents and faculty in order to promote leadership, independent research and clinical careers in the field of cardiovascular disease (CVD). The second aim of the grant was to magnitude of the CVD problems in Uganda and the distribution of traditional and emerging CVD risk factors in order to formulate appropriate strategies for prevention, early detection, treatment and control. We have expanded the successful infectious disease collaborations to include cardiovascular diseases to enhance capacity for CVD research and training in Uganda.

Makerere University College of Health Science (MakCHS)

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Mbarara University of Science & Technology (MUST)

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Uganda Heart Institute (UHI)

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Case Western Reserve University (CWRU)

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Yale University

 

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In order to achieve a coherent community based training in cardiovascular disease; we developed a competence-based cardiovascular curriculum component in the first year of the award. This year the component was integrated in the curriculum for the medical schools in Makerere and Mbarara in a process supported by the MEPI-MESAU programmatic award to which this cardiovascular project is linked. We have designed a tool to help us assess student’s competences in defined MESAU domains with specific reference to CVD, a pre and post assessment is given to students before and after COBERS placements to determine how much knowledge and skill has been obtained. Students also carry with them a tool to the COBERS site to assess availability of tools for CVD assessment/management as well as their utilization at the health facility. Students are also encouraged to utilize the resources at the community health facility as much as they can to consolidate their knowledge and as they do this they add value to the community as well.

Given the low level of awareness about cardiovascular diseases, we have worked alongside student groups to reach communities. Awareness campaigns to the public have been carried out in collaboration with the medical students. These serve as a training opportunity for students as well as interesting them in the field of cardiology. Increasingly students are becoming more confident in handling CVDs and are taking the lead on the awareness campaign initiative.

Table 1: Awareness campaigns

TABLE SUMMARISING DATA FROM ALL CVD AWARENESS CAMPAIGNS

NO.

DATES

VENUE

NO.OF STUDENTS PARTICIPATED

NO. OF PEOPLE SCREENED

 

3rd May 2012

Dean’s Gardens and Davis Lecture theatre-MakCHS

25

221

 

28th Sept 2012

Mbarara University, Graduation grounds

114

460

 

23rd February 2013

Kampala Constitutional Square

50

695

 

9th October 2013

Makerere University Freedom Square

43

586

 

16th Nov 2013

Mbarara Independence Park grounds

 

928

 

25th October 2014

Budini Secondary School, Kaliro District

27

215

 

8th November 2014

Galloway Students’ hostel

18

65

 

3rd-7th  November 2014

Makerere University Halls (Annual Health Week)

56

700

 

20th -23rd December 2014

Kaboong, Karamoja

60

400

 

29th November 2014

Nsangi-pharmacy students

50

157

 

14th February 2015

Makerere University Sports grounds (St.Augustine Community )

10

150

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There has been a remarkable increase in postgraduate cardiology research since the inception of MEPI-CVD in 2010. Between 2000 and 2010 there were about 7 studies focusing on CVD by graduate students at MakCHS and none at MUST. However, within the past four years, about 26 studies have been done at MakCHS and four at Mbarara. Twenty five postgraduates (residents) have been supported through competitive awards to complete their graduate training at the two institutions.

Fourteen trainees have graduated with the rest graduating early 2015, all trainees have been retained and working in different parts of the country.

No

Student’s Name

Discipline

Sex

Project Title

1.

Nabunnya Yvonne Brenda

MMed, Internal Medicine, Makerere

F

The safety and efficacy of predinisolone in the prevention of re-accumulation of ascites due to endomyocardial fibrosis at Mulago Hospital

2.

Ssinabulya Isaac

MMed, Internal Medicine, Makerere

M

Iinflammatory markers, anti retroviral therapy and carotid intima-media thickness among patients attending Mulago HIV clinics in Uganda.

3.

Muyinda Asad

MMed Internal Medicine, Mbarara

M

Dyslipidemias and associated cardiovascular abnormalities in HIV positive patients in the ISS clinic, Mbarara.

4.

Kigundu Daniel

MMed, Internal Medicine, Makerere

M

Role of Vitamin D in Acute Stroke

5.

Dorah Nampijja

MMed Paediatrics, Mbarara

M

Dyslipidemia and its correlation to blood pressure among hiv infected children on HAART attending Mbarara regional referral Hospital

6.

Namuyonga Judith

MMed, Paediatrics, Makerere

F

Prevalence and factors associated with cardiac disease among HIV positive children in Kampala, Uganda.

7.

Lugero Charles

MMed, Internal Medicine, Makerere

M

Prevalence and clinical correlates of atrial fibrillation among patients admitted on cardiac wards in Mulago Hospital.

8.

Naomi Kebba

MMed Surgery, Makerere

F

Intra operative and post operative factors determining length of stay in ICU among patients undergoing open heart surgery for congenital heart disease at Uganda Heart Institute.

9.

Jonathan Mayito

MMed, Internal Medicine, Makerere

M

Renin-Angiotensin and sympathetic activity, and associated factors in patients with hypertension attending the Mulago hypertension clinic

10.

Peter Kangwagye

MMed, Internal Medicine, Mbarara

M

B-type Natriuretic Peptide (BNP)-guided outpatient diuretic therapy in the treatment of Chronic Heart Failure (CHF) at Mbarara Regional Refferal Hospital

11.

Clement Dove Okello

MMed, Internal Medicine, Makerere

M

Endothelial dysfunction among clinically healthy persons exposed to air pollution in Uganda

12.

Christopher Babua

MMed, Internal Medicine, Makerere

M

Cardiovascular Risk factors and cardiac diseases among patients with chronic kidney disease attending nephrology outpatient clinic in Mulago Hospital

13.

Solomon Kibudde

MMed, Internal Medicine, Makerere

M

Prevalence and predictors of early Cardiotoxicity among adults treated with Anthracycline Chemotherapy at Uganda Cancer Institute

14.

Harriet Nankabirwa

MMed, Internal Medicine, Makerere

F

The prevalence and factors associated with Hyponatraemia among elderly patients

15.

Josephine Achan

MMed, Internal Medicine, Makerere

F

Clinical characteristics and immediate outcome of patients with myocardial infarction admitted in Mulago Hospital

16.

Anthony Batte

MMed, Paediatrics, Makerere

M

Prevalence and factors associated with electrocardiography (ECG) abnormalities among children with congenital heart disease attending Mulago cardiac clinic

17.

Peter Bazze Lutaaya

MMed, Internal Medicine, Makerere

M

Prevalence of dyslipidemia and their correlation with hsCRP among HIV negative in Kiboga MUPD

18.

Ascar Twinobuhungiro

MMed, Internal Medicine, Makerere

M

Hypertension in an urban population in Kampala, Uganda: risk factors and frequency of target-organ damage

19.

Ronald Kabuye

MMed Surgery, Makerere

M

Diagnostic accuracy of modified Allen test in evaluating adequacy of hand

collateral circulation among

20.

Michael Lukoma

MMed, Internal Medicine, Makerere

M

Prevalence of cardiovascular risk factors in psychiatric patients.

 

21.

Martin Muddu

MMed, Internal Medicine, Makerere

M

Prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago hospital

22.

Irene Nayiga

MMed, Paediatrics, Makerere

F

Prevalence of group A streptococcus pharyngeal carriage and clinical manifestation in school children aged 5-15 ears in Sussa sub country, Wakiso district

23.

Sam Olum

MMed, Paediatrics, Makerere

M

Stroke mortality outcomes at 30 days in Mbarara regional referral hospital

24.

Agnes Ngecpe

MMed, Paediatrics, Makerere

F

Prevalence and factors associated with left ventricular dysfunction among children on anthracycline at Uganda Cancer Institute.

25.

Bernard Obongonyinge

MMed, Paediatrics, Makerere

M

Serum digoxin concentration among children with cardiac disease attending Mulago national referral hospital, Kampala Uganda

 

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Drs: Babua Christopher, Lugero Charles, Okello Clement Dove and Etoru  at the 64th Graduation ceremony -Makerere University.

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Drs: Ssinabulya, Nalyazi and  Nabunnya  graduation at the 64th graduation ceremony-Makerere University

 

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Drs: Kibudde Solomon, Bazze Lutaaya Peter and Batte Anthony at the  65th Graduation Ceremony –Makerere University

 

1st Intake (8)

2nd Intake (3)

3rd Intake (7)

4th Intake (7)

Number of trainees enrolled

MakCHS =6

MUST =2

MakCHS =2

MUST =1

MakCHS =7

MUST =0

MakCHS =6

MUST =1

Number of trainees  graduated

MakCHS =6

MUST =2

MakCHS =2

MUST =0

MakCHS =4

MUST =0

MakCHS =0

MUST =0

All the trainees that have completed are retained in Uganda and are practicing in various centers across the country.

  1. Dr. James Kayima completed a one year fellowship in interventional cardiology at CWRU (July 2013 – June 2014)
  2. Dr. Emmy Okello completed a one year fellowship in interventional cardiology at CWRU (July 2014 – June 2015), these two are a great resource and are currently utilizing the established cardiac catheterization lab at the Uganda Heart Institute (UHI).
  3. Dr. Bruce Kirenga has also completed his training at Yale University in pulmonary hypertension.
  4. Dr. Isaac Ssinabulya is undergoing a 6 months training in advanced management of heart failure (July – Dec 2015)at CWRU

UHI provided short term fellowship training in general cardiology to young physician (Dorah Nampijja, Joselyn Rwebembera, Asad Muyinda, Lugero Charles, Judith Namuyonga) thus enabling the utilization of the diagnostic labs at MUST and MakCHS and boosting cardiology training and research.

Through the MEPI-CVD award, a large epidemiological survey has been done in two communities (Peri-urban and rural). A total of 5,314 participants were enrolled ranging from 18 to 79 years. This survey has provided data on epidemiology of CVDs [forexample prevalence of hypertension 22%, diabetes 4.3%, and obesity 13.9%). Two of the 3 MEPI-CVD PhD students have utilized these data for their research projects. Three publications so far and 2 manuscripts have been submitted as well as several others in development from the survey data. These data will also feed into the NCDs policy formulation. The data is available for secondary research and already one research trainee is utilizing the data set to look at the burden of renal disease in this community.

MEPI-CVD is supporting the research training of two additional fellows:

  1. Dr. Robert Kalyesubula: The prevalence and associated factors for renal disease among rural and urban community in Wakiso, District. He is utilizing data from the Wakiso epidemiological survey. He has completed data analysis and is currently writing a manuscript.
  2. Dr. Zhang Zhu: Establishment of the Proportion of Patients in the Uganda Rheumatic Heart Disease Registry with advanced disease requiring urgent surgical interventions. She has submitted manuscript for pulication.

This is the first time in the history of Uganda to have 3 students pursuing PHDs with a CVD focus.

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  1. Dr. Emmy Okello: Topic: Burden, Risk Factors and Outcome of Rheumatic Heart Disease in Uganda. Dr Okello successfully defended his PhD and graduated in January 2015, has 3 publications, a fourth manuscript submitted.
  2. Dr. Jane Nakibuuka: Topic: Improving prevention and outcome of stroke in Uganda: population survey and hospital based study. She has completed data collection, has three publications, a manuscript under review and working on other manuscripts.
  3. Dr. James Kayima: Topic: Hypertension control in Uganda; epidemiology, Genetics and clinical attributes. He has done the genetics analysis at Case Western Reserve University (CWRU). He has two publications, has submitted another manuscript and is working on other manuscripts.

 

Diagnostic labs have been established at MakCHS and MUST. The Echocardiography and ECG machines acquired through this award are providing opportunity for training, research and improved patient care.

The MEPI-CVD team is contributing to the draft policy and strategic plan on NCDs (including CVDs) at the Ministry of Health. A CVD training module had been developed and incorporated into the undergraduate competence based curriculum at MakCHS and MUST. So far about 637 3rd and 4th year students have been trained in primary CVD assessment and interested in CVD research. This is to ensure that every graduating doctor has competence in managing of cardiovascular diseases

  • Emmy Okello: The Pan African Society of Cardiology and The Senegalese Society of Cardiology 4th All Africa Conference in Dakar, Senegal from 16th to 20th May 2013.
  • Naome Kebba: African Association of Thoracic and Cardiovascular Surgeons: Accra Ghana – 30th -31st August 2013
  • Judith Namuyonga: Palliative Care Association of Uganda (PCAU) conference, 29th August 2013; Kampala – Uganda
  • Yvonne Brenda Nabunnya: The world Congress of Cardiology, Melbourne Australia 4-7th May 2014.
  • Judith Namuyonga: The world Congress of Cardiology, Melbourne Australia 4-7th May 2014.
  • Isaac Ssinabulya: Annual scientific meeting Uganda Society for Health Scientists;  29th – 30th May 2014 Kampala – Uganda
  • Isaac Ssinabulya: The 2nd Annual conference of the Eastern Africa Health Professionals Educators Association(EAHPEA), 11th -13th June 2014 Kampala – Uganda
  • Jonathan Mayito: RAAS symposium – 11 – 12 July 2014 South Africa
  • Dorah Nampijja: 2nd World Congress on Clinical Lipidology  5-7th Dec 2014 - Vienna, Austria
  1. Emmy Okello et al; Socioeconomic and environmental risk factors among rheumatic heart disease patients in Uganda PLoS One. 2012;7(8)
  2. Emmy Okello et al; Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda Cardiovasc J Afr 2013; 24: 82–87
  3. James Kayima et al; Hypertension awareness, treatment and control in Africa: A systematic review. BMC Cardiovascular diseases 2013; 13:54
  4. Jane Nakibuuka et al; Utility of Transthoracic Echocardiography and carotid Doppler Ultrasound in differential diagnosis and management of ischemic stroke in a developing country. Journal of Cardiology and Clinical Research 2013;1(2):1012
  5. Longenecker, Chris T; Okello, Emmy; Lwabi, Peter; Costa, Marco A; Simon, Daniel I; Salata, Robert A. Management of rheumatic heart disease in Uganda: the emerging epidemic of non-AIDS comorbidity in resource-limited settings. Journal of acquired immune deficiency syndromes. JAIDS Journal of Acquired Immune Deficiency Syndromes 2014; 65(2):e79-80.
  6. Nakibuuka J, Sajatovic M, Katabira E, Ddumba E, Byakika-Tusiime J, and Furlan AJ. Knowledge and perception of stroke: a population survey in Uganda. ISRN Stroke. Volume 2014, Article ID 309106, http://dx.doi.org/10.1155/2014/309106
  7. Ssinabulya I, Kayima J, Longenecker C, Luwedde M, Semitala F, Kambugu A, Ameda F, Bugeza S, McComsey G, Freers J, Nakanjako D. Subclinical Atherosclerosis among HIV-Infected Adults Attending HIV/AIDS Care at Two Large Ambulatory HIV Clinics in Uganda. PLoS ONE 2014: 9(2): e89537.
  8. Okello E, Beaton A, Mondo CK, Kruszka P, Kiwanuka N, Odoi-Adome R, Freers J. Rheumatic Heart Disease in Uganda: The Association between MHC Class II HLA DR Alleles and Disease. BMC Cardiovascular Diseases 2014; 14:28
  9. Kayima J, Nyakoojo W, Nakanjako D, Costa MA, Longenecker CT, Simon DI. Acute Spontaneous Coronary Artery Thrombosis as Initial Presentation of HIV Infection in a Young Man. Case Rep Cardiol. 2015;2015:342348. doi: 10.1155/2015/342348. Epub 2015 Mar 2.
  10. Nakibuuka J, Sajatovic M, Nankabirwa J, Furlan AJ, Kayima J, Ddumba E, Katabira E, Byakika-Tusiime J. Stroke-Risk Factors Differ between Rural and Urban Communities: Population Survey in Central Uganda. Neuroepidemiology. 2015;44(3):156-65. doi: 10.1159/000381453. Epub 2015 May 7.
  11. Babua C, Kalyesubula R, Okello E, Kakande B, Sebatta E, Mungoma M, Mondo CK. Cardiovascular risk factors among patients with chronic kidney disease attending a tertiary hospital in Uganda. Cardiovasc J Afr. 2015 Jul-Aug;26(4):177-80. doi: 10.5830/CVJA-2015-045.
  12. Nakibuuka J, Sajatovic M, Nankabirwa J, Ssendikadiwa C, Furlan AJ, Katabira E, Kayima J, Kalema N, Byakika-Tusiime J, Ddumba E. Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up. Springerplus. 2015 Aug 25;4:450. doi: 10.1186/s40064-015-1252-8. eCollection 2015.
  13. Kayima J, Nankabirwa J, Sinabulya I, Nakibuuka J, Zhu X, Rahman M, Longenecker CT, Katamba A, Mayanja-Kizza H, Kamya MR. Determinants of hypertension in a young adult Ugandan population in epidemiological transition-the MEPI-CVD survey. BMC Public Health. 2015 Aug 28;15:830. doi: 10.1186/s12889-015-2146-y.
  14. Babua C, Kalyesubula R, Okello E, Kakande B, Sebatta E, Mungoma M, Mondo C. Pattern and presentation of cardiac diseases among patients with chronic kidney disease attending a national referral hospital in Uganda: a cross sectional study. BMC Nephrol. 2015 Aug 4;16:126. doi: 10.1186/s12882-015-0128-z.