| 1. |
- Aad, G., et al.
(författare)
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- 2013
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 73:1
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Kabukye, Johnblack K., et al.
(författare)
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Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda : Qualitative Study of Stakeholders' Perceptions
- 2023
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Ingår i: Journal of Medical Internet Research. - 1438-8871. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. Objective: This study aimed to describe stakeholders' perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. Methods: We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. Results: In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. Conclusions: This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation.
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| 3. |
- Kabukye, Johnblack K, et al.
(författare)
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User Requirements for an Electronic Medical Records System for Oncology in Developing Countries : A Case Study of Uganda.
- 2017
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Ingår i: AMIA ... Annual Symposium proceedings. AMIA Symposium. - 1942-597X. ; 2017, s. 1004-1013
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Konferensbidrag (refereegranskat)abstract
- Cancer is a major public health challenge in developing countries but the healthcare systems are not well prepared to deal with the epidemic. Health information technologies such as electronic medical records (EMRs) have the potential to improve cancer care yet their adoption remains low, in part due to EMR systems not meeting user requirements. This study aimed at analyzing the user requirements for an EMR for a cancer hospital in Uganda. A user-centered approach was taken, through focus group discussion and interviews with target end users to analyze workflow, challenges and wishes. Findings highlight the uniqueness of oncology in low-resource settings and the requirements including support for oncology-specific documentation, reuse of data for research and reporting, assistance with care coordination, computerized clinical decision support, and the need to meet the constraints in terms of technological infrastructure, stretched healthcare workforce and flexibility to allow variations and exceptions.
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| 4. |
- Naamala, Allen, et al.
(författare)
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Health-related quality of life among adult patients with cancer in Uganda : a cross-sectional study
- 2024
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda.MethodsThis cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue.ResultsThe mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life.ConclusionImprovement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.
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| 5. |
- Naamala, Allen, et al.
(författare)
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Psychometric properties of the EORTC QLQ-C30 in Uganda
- 2021
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Ingår i: Health and Quality of Life Outcomes. - : BioMed Central (BMC). - 1477-7525. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 in patients with cancer in Uganda. Methods Adult patients with various types of cancer (n = 385) cared for at the Uganda Cancer Institute answered the EORTC QLQ-C30 in Luganda or English language, the two most spoken languages in the country. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS). Results Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda alpha = 0.66, English alpha = 0.50) had acceptable Cronbach's alpha values (0.79-0.96). The CFA yielded good fit indices for both versions (RMSEA = 0.08, SRMR = 0.05 and CFI = 0.93). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I-II compared to those in stages III-IV. Criterion validity was supported by positive correlations between KPS and the subscales Physical function (Luganda r = 0.75, English r = 0.76) and Global quality of life (Luganda r = 0.59, English r = 0.72). Conclusion The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation.
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| 6. |
- Orem, Jackson
(författare)
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Etiological risk factors and clinical characteristics of childhood non-Hodgkin lymphoma in Uganda
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Incidence of non-Hodgkin lymphoma (NHL) has increased greatly over time, especially in children. Improved diagnostic methods alone cannot explain this increase, especially the increase observed in sub-Saharan Africa, where diagnostic capabilities are low. Objectives and aims: The objectives of this study were to better understand known risk factors for NHL, such as Epstein-Barr virus (EBV), and their impact on disease characteristics. The specific aims were: I. to understand the background role of EBV, II. to elucidate the basis for and strength of the diagnosis of childhood NHL in Uganda, III. to highlight trends in characteristics of childhood NHL, and IV. to examine the impact of human immunodeficiency virus (HIV) infection. Subject and Method: Aims I and II were studied in Papers I and II using samples and data from a case-control study carried out at the Mulago National Referral Hospital between 2004 and 2008. This study enrolled children with suspected tumours or masses referred to the Departments of Paediatrics, Paediatric surgery, Orthopaedics and to the Uganda Cancer Institute. In Paper I, EBV viral load was measured in saliva, whole blood, and white blood cells by real-time PCR, serological values for IgG-VCA, EBNA1, and EAd-IgG were measured and compared in NHL and chronic inflammatory conditions (CIC). Comparisons were also done by NHL subtypes (Burkitt lymphoma, BL and other NHL). Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. In Paper II children were diagnosed with suspected NHL based on initial clinical examination; tissue samples were then taken and examined in Uganda and sent thereafter to a pathology laboratory in The Netherlands for re-examination and additional tests. Agreement between diagnoses assigned in Uganda and The Netherlands were compared using kappa statistics. For aims III and IV a review of routine clinical records of paediatric BL patients seen at the Uganda Cancer Institute was done and reported in Papers III and IV. Information on demographic characteristics (age and sex), clinical features (symptoms, signs, disease site, and stage), treatment response and vital status information were obtained. In Paper III the frequency distribution of the clinical characteristics, treatment, and outcome of childhood BL over 20 years were summarised by means and standard deviations (SD), or proportions; differences were tested by the 2 test, t-test, z-test or analysis of variance (ANOVA) procedures. In Paper IV descriptive statistics of frequencies, means and SD were done using Student’s t-test and Chi-square test statistic and ORs, CIs and P-values were obtained. Survival analysis was performed using the Kaplan-Meier method. Results: In Paper I the most common clinical presentations were fever, night sweats and weight loss. EBV viral load in blood was elevated in BL vs other NHL (OR 6.67, 95% CI 1.32-33.69; P-value=0.04) and a significant difference in EAd-IgG was observed in NHL vs CIC (OR 0.19, 95% CI 0.07-0.51; P-value=0.001). In Paper II, the agreement between clinical and pathological diagnoses of NHL in Uganda was 91% (95% CI 84-95; kappa 0.84; P-value=0.001). The agreement between clinical diagnoses in Uganda and pathological diagnoses in The Netherlands was 49% (95% CI 40-59; kappa 0.04; P-value=0.612). The agreement between all pathological diagnoses assigned in Uganda and The Netherlands was  36% (95% CI 28-46; kappa 0.11; P-value=0.046). In Paper III, facial tumour (n=945, 77.65%) and abdominal disease (n=842, 69.19%) were the most common presentations. Significant presentation with advanced-stage disease (hepatic mass, malignant pleocytosis) was noted (P-value <0.01). Mortality was higher in older children, children with advanced- stage BL, and HIV-positive children. In Paper IV HIV-positive children presented significantly more often with disease in the lymph nodes (67%), liver (51%), and chest (10%). Response to chemotherapy was similar in HIV-positive and HIV-negative children although survival was poorer in HIV-positive children (median survival of 11.79 months, 95% CI 8.65-14.92; P-value<0.000). Conclusion: This study provides additional understanding of the role of EBV in childhood NHL, shown by the significant association between virological and serological markers and common general features, suggesting a common factor. We noted a weak basis for diagnosis of childhood NHL in Uganda with a high probability of error. The presenting features of childhood NHL have not changed with time, although more children present late, especially those with HIV. Improvements in the cancer care system in Uganda should include better diagnostic and treatment services for children as a basis for better understanding of disease and high-quality research.
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