Browsing by Author "Walusansa, Abdul"

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Assessment of the Adherence to Standard Operating Procedures of Covid-19 among Market Vendors in Sironko District
(Asian Journal of Medicine and Health, 2021-08-24) Kudamba, Ali; Walusansa, Abdul; Ssenku, Jamil E.; Okurut, Shaban A.; Namagembe, Habib; Nakitende, Sumayah; Mubajje, Muhamad Shaban; Kafero, Hussein Mukasa
Introduction: Coronavirus disease is one of leading causes of deaths in recent times that has surpassed cardiovascular and other respiratory diseases. The World Health Organization (WHO) setup Standard Operating Procedures (SOPs) that have been adopted by the different governments to curtail its spread. Nonetheless, information on the adherence to the SOPs amongst market vendors is not well elucidated. Moreover, markets are centers of convergence of many people which increases the risks of community transmission. Therefore, our study, investigated theextent of the adherence to the SOPs amongst market vendors in Sironko district. Methodology: A quantitative study with cross-sectional design was adopted with a sample size of 221 randomly selected participants. Pretested structured questionnaires were used in the data collection. Categorical data was presented in tables and graphs with frequency (%). Pearson’s Chisquare (X2) was used to examine the statistical significance of our results. The analysis was done by using the statistical software MedCalc version 20.0008. All the analyses were done at 95% level of significance and a p<0.05 was considered statistically significant. Results: A total of 221 participants were involved: 126, 57 % female, 80, 36% aged between 31-40 years and 158, 72% married. Fever, dry cough, chest pain, arches & pain loss of speech & movements were the most reported signs and symptoms of COVID-19 (p<0.0001). Most of the respondents were aware of the SOPs, hand washing soap and adequate water were readily available (p<0.0001). The commonly implemented SOP was wearing face masks (p<0.0001). The radio talk shows & broadcasting were the main sources of information(p<0.0001). The inadequate facemasks and limited finances constrained the Implementation of SOPs (p<0.0001). Conclusion: Most market vendors were aware of the COVID-19 SOPs and claimed they adhered. However, there is need to carry out a qualitative study to confirm the above claims.
COVID-19 in the Eyes of Community Leaders in Selected Rural Districts in Eastern Uganda
(Journal of Advances in Medical and Pharmaceutical Sciences, 2021-05-14) Walusansa, Abdul; Iramiot, Jacob S.; Mpagi, Joseph L; Kudamba, Ali; Okurut, Shaban A.; Namuli, Aidah; Wasige, Godfrey; Nabuuma, Hawa; Kafeero, Hussein M.; Lubowa, Muhammad; Ssenku, Jamilu E.
Introduction: Corona virus disease (COVID-19) is one of the topmost global hindrances to human existence. Rural settings have been reported to be more vulnerable in some parts of the world. In Uganda, community leaders in rural villages are among the immediate personnel mandated to support compliance with preventive guidelines, and to identify and report/deliver COVID-19 cases to health units. We examined the potential risks of COVID-19 transmission, knowledge levels, perceptions and opinions of Village Council Leaders (VCLs) in selected districts in Eastern Uganda, to support the design of risk-based COVID-19 control measures in rural settings, to protect lives better. Methodology: A convenience sample of ten VLCs were purposively selected in three districts in Eastern Uganda. Pretested questionnaires and in-depth interviews were used to assess the knowledge levels, perceptions, and opinions of respondents about COVID-19. An observational survey was also conducted to examine the barriers to effective control of COVID-19, with reference to health guidelines set by the Ugandan government and the World Health Organization. Data was analyzed using HyperRESEARCH 2.8 software, and STATA version-15.0. Results: Eighty percent of VCLs reported that they were formally engaged in the fight against COVID-19, and the common means of engagement were; dissemination of COVID-19 information by word of mouth, regulation of public events, and monitoring of visitors that come from distant places. All clients reported having received some information about this pandemic, but there was generally low knowledge on some vital aspects: 70% of the respondents did not know the meaning of COVID-19; 100% were uninformed on these common symptoms; headache, sore throat, nausea, and loss of taste & smell; 10% did not know if willingness to conform to health guidelines may affect COVID-19 prevention, and they believed that domestic animals are viable vectors. Radio was the commonest source of COVID-19 information, but it was confounded by poor quality of radio-signals. Most respondents were of the view that in the communities they lead; inaccessibility to authentic health information, financial constraints, and belief that COVID-19 is a fallacy, were some of the leading obstacles to the fight against the pandemic. Low awareness and misconceptions on COVID-19 could be explained by; technological challenges, low literacy levels, and dissemination of wrong information about this pandemic. From the observational survey, the major factors which might intensify the risk of COVID-19 spread were: scarcity of requirements for hand hygiene, face protection, violation of health guidelines and directives, porous borders, terrain, and use of potentially polluted open water sources. Conclusion: Communities in Eastern Uganda are vulnerable to the drastic spread of COVID-19 due to challenges related to: low awareness, poor compliance with preventive guidelines, finances, technology, terrain, illiteracy, scarcity of protective wear and hygiene resources. Awareness creation, material aid, execution of preventive rules, and more research on COVID-19 are warranted.
Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management
(Hindawi, 2022-01-11) Mukasa Kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Kato, Charles Drago; Wampande, Eddie; Kajumbula, Henry; Kateete, David; Walusansa, Abdul; Kudamba, Ali; Kigozi, Edgar; Katabazi, Fred Ashaba; Namaganda, Maria Magdalene; Ssenku, Jamilu E.; Sendagire, Hakim
Background. Hepatitis B virus (HBV) is the leading cause of liver-related diseases. In Uganda, there is a regional disparity in the HBV burden. Our study was aimed at establishing the circulating genotypes in a low and a high endemic region to give plausible explanations for the differences in regional burden and guide the future management of the disease. Methods. A total of 200 HBsAg-seropositive subjects were recruited into the study by convenience sampling. The HBsAg Rapid Test Strip (Healgen Scientific Limited Liability Company, Houston, TX77047- USA) was used to screen for HBsAg while the Roche machine (Roche, Basel Switzerland/Abbot Technologies (USA)) was used to determine the viral load. The Chemistry Analyzer B120 (Mindray, China) was used for chemistry analysis. For HBV genotyping, total DNA was extracted from whole blood using the QIAamp® DNA extraction kit. Nested PCR amplification was performed using Platinum Taq DNA Polymerase (Invitrogen Corporation, USA) to amplify the 400 bp HBV polymerase gene. Purification of nested PCR products was performed using Purelink PCR product purification kit (Life Technologies, USA). Automated DNA sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit on 3130 Genetic Analyzer (Applied Biosystems, USA). The NCBI HBV genotyping tool (https://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi) was used for determination of genotype for each HBV sequence. Pearson’s chi-square, multinomial logistic regression, and Mann–Whitney U tests were used for the analysis. All the analyses were done using SPSS version 26.0 and MedCalc software version 19.1.3 at 95% CI. A p < 0:05 was considered statistically significant. Results. Majority of our study subjects were female (64.5%), youth (51.0%), and married (62.0%). Overall, genotype A was the most prevalent (46%). Genotype D and the recombinant genotype D/E were proportionately more distributed in the high endemic (38.2%) and low endemic (36.5%) regions, respectively. Genotype D was significantly more prevalent in the high endemic region and among the elderly (p < 0:05). Genotype D was significantly associated with elevated viral load and direct bilirubin (p < 0:05). The recombinant genotype D/E was significantly associated with elevated viral load (p < 0:05). Similarly, genotype A was significantly associated with elevated AST and GGT, lowered viral load, and normal direct bilirubin levels (p < 0:05). Conclusion. There is disproportionate distribution of genotypes A and D and the recombinant genotype D/E in the low and high endemic regions of Uganda. This probably could explain the differences in endemicity of HBV in our country signifying the need for regional specific HBV management and control strategies.
Hepatitis B virus (HBV) serological patterns among the HBsAg negative hospital attendees screened for immunization
(Scientific Reports, 2022-05-06) Kafeero, Hussein Mukasa; Ndagire, Dorothy; Ocama, Ponsiano; Kato, Charles Drago; Wampande, Eddie; Walusansa, Abdul; Kajumbula, Henry; Kateete, David; Sendagire, Hakim
The Hepatitis B virus (HBV) is a highly infectious virus and is endemic in Uganda. It is one of the major etiological agents for liver diseases including liver cancer. In this work, we evaluated the prevalence of the HBV serological markers and the associated socio-demographic factors among hepatitis B surface antigen (HBsAg) seronegative persons screened during routine immunization against the virus in eastern Uganda. Data on the socio-demographic characteristics were collected using a structured questionnaire, while that on the serological markers were obtained from serum samples and evaluated by using the 5-panel HBV One Step Hepatitis B Virus Combo Test Device ( FastepR, HBV-P43M). The following markers were evaluated by the panel: HBsAg, HBsAb, HBcAb, and HBeAb. Data were analyzed using SPSS (version 26), and multinomial logistic regression was used to elicit the adjusted odds ratio. All the analysis were performed at a 95% confidence limit, and a P value ≤ 0.05 was considered significant. The 424 participants included in this study were mainly female (62.3%), married (55.4%) and aged 30 years and above (54.2%). The seropositivity of the HBsAb, HBeAb, HBcAb marker prevalence rates was 48(11.3%), 73(17.2%) and 45(10.6%) respectively. The majority of the participants (327, 77.1%) did not present with any marker. Married paricipants were significantly associated with reduced HBsAb seropositvity rate, whereas young people aged 18–29 years were associated the with increased odds of HBsAb seropositivity (p < 0.05). Male participants were significantly associated with the HBeAb and HBcAb seropositivity (p < 0.05). Similarly, contact with an HBV infected person was significantly associated with HBeAb and HBcAb seropositivity (p < 0.05). Further still, blood transfusion was significantly associated with the increased risk of HBcAb seropositivity (P < 0.05). This study has revealed a prevalence of HBV serological markers among the HBsAg seronegative persons in this community and an increased risk of transmission of the virus in the community. Our findings have key consequences pertaining the interventions that are pertinent in the control and prevention of the spread of the virus among apparently health persons. Hepatitis B virus (HBV) is the causative agent for liver inflammatory diseases, which, if not diagnosed in a timely manner and subsequently managed, are likely to progress to chronic liver diseases, liver fibrosis, liver cirrhosis, and liver cancer1. The virus has been implicated as one the most common oncogenic virus in humans2. It is a highly transmissible virus and is 50 to 100 times more infectious than Human Immune deficiency Virus (HIV). In addition, it has extreme resilience, allowing it to survive for several days on dry surfaces. This complicates its epidemiology and explains the increased chances of intra-familial horizontal transmissions3. Despite the presence of a safe and highly efficacious vaccine, HBV infection is still one of the major global health problems4. The Uganda Population-Based Impact Assessment (UPHIA) 2016–2017 survey reported a drastic decrease in the prevalence of HBV in Uganda5. According to this survey, the national prevalence of HBV dropped from 10% in the general population in 20156 to 4.3% in 2016 and 4.1% in 2017, with east-central posting a prevalence of 2.1%. However, HBV is a chronic infection and these data are suggestive of either massive death of the chronically infected persons or a higher level of sero-conversion to HBsAb between the sampling intervals. Nevertheless, the rapid sero-conversion indicated by a high prevalence of the HBsAb with normal levels of the correlates of liver damage over a short period of time seems to be unrealistic. Similarly, the drastic decrease in the risk of infection because of improved immunity or public health awareness appears idealistic. The relative importance of the socio-demographic factors to HBV infection varies from population to population7, and their contribution to community spread of HBV have been previously reported with concordance in some studies and contradictions in other studies8– 12. Understanding these sociodemographic factors related to infection and their relationship with markers of HBV exposure will provide plausible answers to the recent drastic decline in HBV in Uganda. To understand the sero-prevalence of hepatitis B virus, screening of a large number of people is needed. Serological markers for detection of HBV are diverse13 and include hepatitis B surface antibody (HBsAb), hepatitis B pre-core antibody (HBeAb), hepatitis B pre-core antigen (HBeAg), hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg). However, in resource limited settings, screening for hepatitis B virus infection is limited to only the HBsAg using the rapid diagnostic test. Unfortunately, the use of a single marker of exposure is associated with vast irregularities in the diagnosis of HBV. This inconclusive diagnosis is likely to mislead clinicians in their decisions when managing the HBV-infected persons as well as the decision to discard donated blood for transfusion by local and regional blood banks. HBV exposure markers have high sensitivity but low specificity, justifying the need to investigate them not in isolation for comprehensive case management and explicit assessment of blood for transfusion. The Anti-HBc is characteristic of a hidden HBV carrier state and/ or resolved disease14. Anti-HBs antibodies are associated with acquired immunity either due to previous exposure and natural response to the virus or due to vaccination15, whereas the Anti-HBe antibody is a marker of the minimally infective phase and disease remission or recovery from the infection16. Thus, as eluded from above, the relative significance of different sociodemographic risk factors for infection, the comparative expression of markers of liver damage and the relative prevalence of different markers of exposure to HBV at the community level can provide constructive clues on the trend of HBV prevalence and infectivity in a population. Consequently, we sought to understand the current state of the risk factors for HBV infection and the prevalence of the markers of immunity against HBV among HBsAg seronegative individuals to justify the drastic reduction in the burden of HBV in Uganda.
The Malaria-Poverty Dilemma in Peri-Urban University Communities in Eastern Uganda
(Journal of Advances in Medicine and Medical Research, 2021-04-28) Warsame, Abdishakur E.; Ssenku, Jamilu E.; Mpagi, Joseph L.; Iramiot, Stanley J; Okurut, Shaban A; Kudamba, Ali; Nkambo, Mujibu; Namuli, Aidah; Nakizito, Joweria; Gidudu, George; Nabuuma, Hawa; Kafeero, Hussein M; Nachuha, Sarah; Walusansa, Abdul
Description Introduction: Malaria remains the world’s leading vector-born cause of mortality and morbidity, and Eastern Uganda contains some of the country’s highest prevalence rates. Though academic societies, such as universities, may be prone to high malaria transmission, the extent of the burden and risk factors in university communities of Eastern Uganda are poorly understood. The aim in this study was to examine malaria prevalence, preventive strategies, and risk factors, among University communities in Eastern Uganda; to inform targeted malaria eradication efforts in academic settings. Methods: A mixed methods approach was applied. A case study of Islamic University in Uganda (IUIU), located in Eastern Uganda, was selected. A retrospective approach was used to determine malaria prevalence in IUIU from August to December 2019. Stratified random sampling was used to select IUIU community members; these were subjected to semi-structured questionnaires and Key informant Interviews (KII) to examine the preventive approaches and risk factors. An observational survey was also conducted to identify barriers to malaria prevention. Data was analyzed using descriptive statistics, graphs, Chi-square, and pictures; with STATA version-15.0. Results: The study involved 255 respondents (204, 80% students, 51, 20% staff); 130, 51% were males, 125, 49% were females. Malaria prevalence was; 12.9%, 11.7% and 12.7% for students, staff, and the general study population respectively. Lowest prevalence was registered in November (8.3% for students, 0% for staff), and the highest in December (18.4% for students, 6.7% for staff)Overall malaria prevalence in IUIU was significantly greater than Uganda’s national prevalence (χ2=182.009; p<0.0001; 95%CI). The commonest intervention was, sleeping under insecticide-treated mosquito-nets (96%), and the rarest was usage of medicinal herbs (15%). Though 41 (17.5%) of respondents who used mosquito-nets never suffered malaria, usage of mosquito-nets was not significantly associated with absence of malaria infection (p = 0.83). The same applied for other interventions except timely testing and treatment (p = 0.02). Most frequently mentioned risk factors were; improper use of mosquito nets (214, 84%), inappropriate depositing of garbage (196, 77%), and “staying out late” (133, 52%). Key barriers to malaria prevention observed were; usage of damaged bed nets (38, 19% of 198), clogged trenches with liquid wastes, and perforated wire meshes in ventilators. Conclusion: The overall prevalence of malaria in IUIU community was 12.7%; and was significantly higher than Uganda’s national prevalence (7%). Usage of insecticide-treated bed-nets was the commonest intervention, but showed no statistically significant association with malaria non-prevalence. Awareness programs should be enhanced to address inappropriate use of malaria control methods/tools, because the widespread adoption of these interventions alone did not effectively curb the burden.
Market Vendor’s Poor Adherence to Sops for COVID-19: A Potential Source for Transmission of the Virus to the Local Communities. A Case Study of Sironko District
(Asian Journal of Medicine and Health, 2021-12-19) Kudamba, Ali; Walusansa, Abdul; Ssenku, Jamil E.; Okurut, Shaban A.; Namagembe, Habib; Nakitende, Sumayah; Wanda, Duncan; Wasangayi, Jabin; Mubajje, Muhamad Shaban; Kafero, Hussein M.
Abstract:Introduction: COVID-19 is one of the huge health burdens on the earth in the recent times. Massive campaigns on the adherence to standard operation procedures (SOPs) have been emphasized by the Government of Uganda and even the county has been put in two lockdowns to curtail the spread of this disease. Despite all these efforts, market vendors in Sironko district have seemingly not complied with these SOPs and this makes them potential hotspot for disease transmission, but no qualitative study has so far been documented. Therefore, the current study investigated the adherence of SOPs for COVID-19 amongst market vendors in this area. Methodology: A qualitative survey research design was adopted and a total of 53 participants, selected by both purposeful and simple random were involved. Interview, focus group discussion and observations techniques were used in data collection. The date was analyzed by the statistical software called MedCalc, version 20.0008 Results: The result showed that 65 % were females, most were aged between 29 females aged between 31-40 year took part in the study contributing 55% to the total subjects and married and of which 37 (70 %) were married. The market experienced challenges of inadequate & inappropriate facilities for SOPs but water was abundant (45, 85 %). All the SOPs for COVID-19 were flouted in these markets. Conclusions: Market vendor rarely adhered to SOPs for COVID-19 and this makes them a potential source for transmission of COVID-19 to the local communities in the entire sub-regions. Therefore, there is need for department of production in Sironko district to re-enforce observance to SOPs guidelines for COVID-19 in this area.
Prevalence and dynamics of clinically significant bacterial contaminants in herbal medicines sold in East Africa from 2000 to 2020: a systematic review and meta analysis
(Tropical Medicine and Health, 2021-01-28) Kafeero, Hussein. M.; Walusansa, Abdul; Asiimwe, Savina; Iramiot, Stanley . J; Ssenku, Jamilu. E.; Nakavuma, Jesca. L.; Kakudidi, Esezah. K.
Background: Infectious diseases remain a leading cause of mortality and morbidity around the world, and those caused by bacteria are common in the East African region. In this region, trade and consumption of herbal medicine has been expanding in the recent decades. Herbal medicines may be contaminated with pathogenic bacteria; however, there is limited information due to fragmented studies in East Africa. In this meta-analysis, we critically analyzed original research related to the incidence of pathogenic bacterial contaminants of HM in the East African region since 2000. The aim was to create a comprehensive understanding of the extent and dynamics of bacterial contamination in HM, to guide future research and concerted public health protection in the region. Methodology: The study was conducted according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched and evaluated published articles from eleven electronic databases (Google Scholar, PubMed, HerbMed, MEDLINE, Science Direct, Scifinder Scholar, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, Biological Abstracts and Commonwealth Agricultural Bureau Abstracts). Prevalences of different bacterial species, Cochran’s Q test, and the I2 statistic for heterogeneity were evaluated using a software called MedCalcs. Random and fixed effects models were used to determine the pooled prevalence of clinically significant bacteria from studies which were included in this meta-analysis. The potential sources of heterogeneity were examined through sensitivity analysis, sub-group analysis, and meta-regression at 95% level of significance. Results: Fourteen studies met our inclusion criteria. Overall, the studies were highly heterogeneous (I2 = 98.48%) and there was no evidence of publication bias. Escherichia coli was the most prevalent contaminant. Salmonella spp. and Shigella spp. were the most frequently reported primary pathogens with pooled prevalence of 10.4% and 6.3%, respectively. Our findings are in tandem with recent systematic reviews conducted in Europe and Asia, but are in discrepancy with the reviews recently conducted in southern Africa. Conclusion and recommendations: The East African herbal medicine industry poses considerable health risks to communities through dissemination of clinically significant bacteria. Presence of enteric bacterial contaminants indicates possible fecal pollution of herbal medicine region-wide. Adequate research pertaining to microbial safety of herbal medicine in the East African countries remains highly desired. The latter will enable establishment of strong, region-wide herbal safety mechanisms in order to support comprehensive public health protection in East Africa.
Sero‑prevalence of human immunodeficiency virus–hepatitis B virus (HIV– HBV) co‑infection among pregnant women attending antenatal care (ANC) in sub‑Saharan Africa (SSA) and the associated risk factors: a systematic review and meta‑analysis
(BMC, 2020-10-27) kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Walusansa, Abdul; Sendagire, Hakim
Background: There is plenitude of information on HIV infection among pregnant mothers attending antenatal care (ANC) in sub-Saharan Africa. However, the epidemiology of HBV–HIV co-infections in the same cohort is not clear despite the common route of transmission of both viruses. The aim of our study was to synthesize data on the prevalence of HBV–HIV co-infection among pregnant women attending ANC in Sub-Saharan Africa to assist in the design of public health interventions to mitigate the challenge. Methods: The study was done in tandem with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards and the Cochran’s Q test, I2 statistics for heterogeneity and the prevalence were calculated using commercially available software called MedCalcs (https ://www.medca lc.org). A random effect model was used to pool the prevalence since all the heterogeneities were high (≥ 78%) and Phet< 0.05 indicated significant heterogeneities. The risk factors and risk differences for HBV–HIV co-infection were analyzed. Any likely sources of heterogeneity were analyzed through sensitivity analysis, meta-regression and sub-group analysis. All analyses were done at 95% level of significance and a P < 0.05 was considered significant. Results: The overall pooled prevalence of HBV–HIV co-infection among pregnant mothers in sub-Saharan Africa was low 3.302% (95%CI = 2.285 to 4.4498%) with heterogeneities ( I2) of 97.59% (P > 0.0001). Within regional sub group meta-analyses, West Africa had significantly higher prevalence of 5.155% (95% = 2.671 to 8.392%) with heterogeneity (I2) of 92.25% (P < 0.0001) than any other region (P < 0.001). Articles published from 2004–2010 had significantly higher prevalence of 6.356% (95% = 3.611 to 9.811%) with heterogeneity (I2) 91.15% (P < 0.0001) compared to those published from 2011 to 2019 (P < 0.001). The HIV positive cohort had significantly higher prevalence of HBV–HIV co-infection of 8.312% (95% CI = 5.806 to 11.22%) with heterogeneity (I2)94.90% (P < 0.0001) than the mothers sampled from the general population with a prevalence of 2.152% (95% CI = 1.358 to 3.125%) (P < 0.001). The overall and sub group analyses had high heterogeneities ( I2 > 89%, P < 0.0001) but was reduced for South Africa (I2) = 78.4% (P = 0.0314). Age, marital status and employment were independent factors significantly associated with risk of HBV–HIV co-infection (P < 0.001) but not extent of gravidity and education level (P > 0.05). After meta-regression for year of publication and sample size for HBsAg positivity, the results were not significantly associated with HBV pooled prevalence for sample size (P = 0.146) and year of publication (P = 0.560). Following sensitivity analysis, the HBsAg pooled prevalence slightly increased to 3.429% (95% CI = 2.459 to 4.554%) with heterogeneity I2 = 96.59% (95% CI = 95.93 to 97.14%), P < 0.0001 Conclusion: There is an urgent need for routine HBV screening among HIV positive pregnant mothers attending antenatal care in sub-Saharan Africa to establish the extent of HBV–HIV co-infection in this cohort. Future studies need to investigate the putative risk factors for HBV–HIV co-infection and prioritize plausible control strategies.
TREAT-B Algorithm for Treatment Eligibility Among Chronically Infected Hepatitis B Virus Persons in a Low and a High Endemic Region: A Potential Strategy Towards Virus Elimination by 2030
(Frontiers in Virology, 2022-04-11) Kafeero, Hussein Mukasa; Ndagire, Dorothy; Ocama, Ponsiano; Drago, Charles; Wampande, Eddie; Kajumbula, Henry; Kateete, David Patrick; Walusansa, Abdul; Kudamba, Ali; Ssenku, Jamilu E.; Sendagire, Hakim
Background: Little is known about treatment eligibility in Africa for the hepatitis B virus (TREAT-B) algorithm. We investigated the treatment eligibility among the HBV chronically infected patients in a low and a high endemic region using the TREAT-B algorithm. Methods: We recruited 227 treatment-naïve HBV-infected hospital attendees from the low and high HBV endemic regions. We assessed the treatment eligibility by testing for HBeAg serostatus and ALT levels. Socio-demographic data were collected with a structured questionnaire. The accessory correlates of treatment eligibility (AST, ALP, ALB, GGT, and TBIL) and the socio-demographic factors were analyzed by both univariate and multinomial logistic regression using the SPSS and Medcalc. The analysis was done at 95% CI and a p < 0.05 was considered statistically significant. Results: Overall, 56.8% of the participants qualified for treatment at TREAT-B cutoffs of ≥2, with those from the low endemic region (90, 69.8%) having significantly higher treatment eligibility indication than those from the high endemic region (p < 0.05). Alcohol use and household contact with an HBV-infected person were independent socio-demographic factors significantly associated with treatment eligibility for both low and high endemic regions (p < 0.05). However, birth place was only indicated for treatment eligibility among the high endemic participants (p < 0.05). AST, GGT, and total bilirubin were the liver-related parameters significantly associated with treatment eligibility (p < 0.05), with GGT and AST being significantly elevated among the eligible low endemic dwellers compared to high endemic dwellers (p < 0.05). Conclusion: Using TREAT-B algorithm can be a plausible alternative to the orthodox methods to specify treatment eligibility with the potential to scale up interventions targeting HBV management and elimination.
Tumor Necrosis Factor-α-863C/A and 1031 T/C Single nucleotide polymorphic sites (SNPs) may be putative markers of HBV disease prognosis among Caucasoids: Evidence from a systematic review with meta-analysis
(Elsevier, 2022-01-19) Mukasa Kafeero, Hussein; Ndagire, Dorothy; Ocama, Ponsiano; Walusansa, Abdul; Sendagire, Hakim
Background: The pathogenesis and prognosis of hepatitis B virus (HBV) infection have been correlated with genetic polymorphisms in the gene loci within the promoter region of the immune system modulator molecules such as the cytokines including the tumor necrosis factor (TNF)-alpha. Besides, these polymorphisms vary at population levels but it is not conclusive whether races are involved or not. We aimed at testing the hypothesis that the SNPs in the promoter region of the TNF-alpha gene may have different effects in the Caucasoid populations by pooling the odds of association with the clearance/increased risk of the HBV infection from a large sample size obtained from many primary studies. We searched Scopus, PubMed, EMBASE, Cochrane, Willy and Google scholar databases for the published studies between January 1998 to December 2020. Studies that investigated the association between the TNF-α-238G/A, -308G/A, -857C/T, -863C/A and -1031 T/C gene promoter polymorphisms with the resolution/increased risk of HBV infection published in English and in peer reviewed journals were included. The odds ratios were used to evaluate the association of the TNF-α-gene SNPs with the risk/resolution of the disease. This study is registered on PROSPERO, number CRD42021266944. Results: A significant association was observed between the TNF-α-857 homozygous mutation TT and its allele T with reduced risk of infection or resolution of the disease among both the Caucasoids and the Mongoloids (p < 0.05, OR < 1.0). In contrast, the TNF-α-1031 wild type genotypes TT; p = 0.001, OR = 0.634, 95%CI = [0.489 to 0.822%] and its allele T; p = 0.001, OR = 0.701, 95%CI = [0.571 to 0.860%] were significantly associated with reduced risk of infection or increased chances of resolution of the disease among the Caucasoids only. However, the TNF-α-863 homozygous mutation AA or its allele A and the TNF-α-1031 heterozygous mutation CT or the allele C were significantly associated with unresolved HBV infection among the Caucasoids (p < 0.05, OR > 1.0) but not among the Mongoloids. Conclusion: Tumor Necrosis Factor-α-863C/A and 1031 T/C polymorphic sites may be putative markers of HBV disease prognosis and pathogenesis among the Caucasoid populations but not among the Mongoloid populations. Future research therefore should focus on the role of these presumed TNF-α-polymorphisms in the clinical profile of the HBV infections targeting an African or Negroid population.