By Esther Nakkazi
Uganda could host the first Non-Communicable Diseases (NCD) Centre of Excellence in Africa that will close the knowledge gap of the burden of disease.
Although there is a growing burden of NCDs in sub-Saharan African, there is lack of matched knowledge about how the risk for each individual evolves over their lifespan.
An ongoing project, supported through a Makerere University and Sweden bilateral research collaboration that helped establish the Iganga-Mayuge Health Demographic Surveillance Systems (HDSS) is exploring the feasibility of an NCD population cohort to facilitate long-term studies on risk factors for NCDs in Uganda.
The project is a collaborative research effort between Sweden’s Karolinska Institutet, Makerere College of Health Sciences (MakCHS) and the Makerere University Centre for Health and Population research (MUCHAP)
Dr. Roy Mayega the local principal investigator says the cohort at MUCHAP/Iganga-Mayuge HDSS is the first step of a long term population-based research. It provides for a detailed understanding of the phenotypes related to key NCDs, their relationship to key biomarkers and trends in a context where the prevalence of cardiovascular diseases and diabetes is still relatively low.
Mayega says the project will also provide a platform assessing preventive interventions, early identification of undetected disease, the calibration of risk point-of-care screening and diagnostic tools for use in sub-Saharan Africa.
Dr. Dan Kajungu, MUCHAP Executive Director says the project is important as quality data paucity remains a key development bottleneck in low and middle-income countries (LMICs) like Uganda and the situation is worse regarding longitudinal data to inform policy effectively.
Available longitudinal studies have been conducted in developed countries and only a few in sub-Saharan Africa because of their complex logistics and requirements of a clear understanding of their feasibility and contextual stability amidst resource constraints.
“Continuity of such project is key,” says Kajungu as the project has already provided the local burden of disease data showing that more deaths are occurring in adult population 15 years and above due to NCDs than the communicable and infectious disease in rural Uganda.
The Makerere project is collecting electrocardiogram (ECG) and spirometry data, in addition to biological samples in form of blood, urine and saliva swab from a consenting population and transferring it to the molecular biology and the biorepository laboratories at MakCHS for analysis.
A system is also in place for continuously registering all births and deaths in the HDSS community. Once a birth or death occurs, community-based scouts report it to HDSS and details of how the death occurred are documented. This verbal autopsy is conducted using the World Health Organisation (WHO) tools to establish the cause of death as determined by a trained physician (medical doctor).
More morbidity or disease data are collected electronically where population cohort members’ health facility data are linked to their household and community data using the HDSS unique identifiers.
The HDSS has the capacity to provide accurate information that facilitates the proper allocation of health resources and generate data on different health and health-related problems.
Dr. David Muwanguzi, the Iganga District Health Officer says the Iganga Mayuge HDSS has assisted the district particularly the health department in providing demographic statistics vital for evidence-based planning and budgeting for not only health care but also other services such as education, agriculture among others.
As a result of the project high impact research that influenced policy has been done in the Iganga-Mayuge HDSS platform, for example, the Kangaroo mother care (KMC) in the field of maternal, child and newborn care was piloted in this population cohort, as well as the Integrated Community Case Management (iCCM) for home-based malaria and pneumonia management.
Research done here has impacted on low-cost hernia surgery in the study that estimated hernia prevalence and unmet need for surgery, management of diabetes in adults, injury and disability surveillance and support for cerebral palsy in children studies.
“The Iganga-Mayuge HDSS has always sensitized community members on health-related issues and has encouraged people to utilize government programmes like immunization says Ismail Kezaala Ismail, a resident of Kabira village, Kabira parish in Nakigo Sub-county, Iganga District.
Kezaala says the HDSS has benefited the community through free hernia surgery, epileptic drugs to children, wheelchairs for children affected by cerebral palsy, and treatment to children with Tuberculosis.
NCD Research and training for students in a rural setting:
The MUCHAP platform further continues to support research training of graduate students (Masters and PhDs) from Makerere University, and collaborators like Karolinska Institutet of Sweden, John Hopkins School of Public Health and New York University in USA, Hasselt University in Belgium through provision of data for secondary analysis and utilizing the population-based cohort for research and provides mentorship and internship placements to students.
The center hosts the Maternal and Newborn research Working Group for the worldwide network of health and demographic surveillance sites and collaborates with researchers to develop research protocols, implementation, and evidence to facilitate evidence-based planning and budgeting.
Dr. Muwanguzi says the organization brings in partners within Uganda and abroad to conduct research studies and many of them have informed policies and benefited the community members like malaria and pneumonia studies, non-communicable disease epidemiology, hernia surgery, cerebral palsy and epilepsy surveillance among others.
The Centre has the capacity and mechanism of monitoring the global Sustainable Development Goals (SDGs) and universal health coverage (UHC) targets at the subnational level. “This is especially done for indicators that are measured at the individual and household levels as well as those that can be measured at the community level,” says Dr. Kajungu.
The platform has measured various indicators about coverage and uptake of national interventions like the coverage and utilization of immunization and vaccines, mosquito nets for malaria vector control, household income improvement, family planning, and other behavior change interventions at community level.
“This has strengthened the evaluation of burden of disease at the subnational level in that community,” says Edward Galiwango, a project official.
Dr. Kajungu says that measuring the progress of SDG and UHC indicators is possible at the subnational level and will complement the national estimates to improve population estimates validity.