Browsing by Author "Kandala, Ngianga-Bakwin"

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    Predictors of frailty and multimorbidity in adults aged 40 to 65 years in a rural population cohort in Burkina Faso
    (University of the Witwatersrand, Johannesburg, 2024) Georges, Some; Kandala, Ngianga-Bakwin
    Background: Frailty and multimorbidity are vulnerable geriatric syndromes that pose a disability problem among the elderly in Sub-Saharan Africa (SSA). Assessment of factors associated with frailty and multimorbidity in middle-aged adults has remained limited despite the prevalence established in previous studies. We determined factors associated with frailty and multimorbidity among middle-aged adults in rural areas from 2015 to 2022 in Burkina Faso. Methods: This study utilized data from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) sub-study, a retrospective cohort study of 1500 participants aged 40-65 residing in Nanoro and Yako in Burkina Faso between 2015-2022. Each participant was asked to complete a standardized and structured questionnaire on socio-demographic, lifestyle, and clinical information. In addition, measures of Fried's phenotypic frailty components, and twelve chronic diseases were assessed for derivation into frailty and multimorbidity score variants respectively. To determine the risk factors associated with frailty and multimorbidity, we performed an ordinal and multinomial logistic regression analysis respectively with a significance level of 5%. Results: The prevalence of pre-frailty and frailty was 59.3% and 8.5% respectively while that of multimorbidity was 38.3%, where the multimorbidity prevalence rate stratified by existing chronic diseases was 13.0%. Half of the participants who had multimorbidity were frail (47.2%) while 10.4% of frail participants had multimorbidity. Weight loss (23.9%) and self-reported exhaustion (23.1%) were the most frequent phenotypic components. Dyslipidemia (63.9%), hypertension (26.4%) and rheumatic arthritis (15.0%) were the most frequent chronic diseases. On the one hand, age (≥50 years, aOR 1.4[1.0-1.9]), being widowed (aOR 1.5[1.1-2.1]), being unemployed (aOR 2.5[1.1-5.8]), smokeless tobacco use (aOR 2.5[1.1-5.7]), being underweight (aOR 26.2[17.1-40.2]) and multimorbidity (aOR 1.4[1.0-2.1]) were independently associated with increased odds of frailty. However, fruits (aOR 0.9[0.8-1.0]) and vegetables consumption (aOR 0.9[0.8-1.0]), and being highly active in weekly activities (aOR 0.1[0.0-0.2]) significantly reduced the odds of frailty. On the other hand, age (≥60 years, RRR 1.8[1.1-2.8]), being a woman (RRR 2.6[1.7-3.9]), being widowed (RRR 1.6[1.0-2.7]), being unemployed (RRR 4.5[1.1-18.0]), overweight (RRR 5.0[2.8- 9.1]), obesity (RRR 3.4[1.1-11.0]), pre-frailty (RRR 1.8[1.2-2.6]) and frailty (RRR 2.1[1.0-4.2]) were strongly associated with an increased risk of multimorbidity. Nevertheless, the consumption of alcohol (RRR 0.4[0.3-0.6]) and fruit (RRR 0.9[0.8-1.0]) significantly reduced the risk of multimorbidity. There was no significant association with determinants such as gender, level of education, smoking status. Conclusion: These findings provide additional evidence on the determinants of frailty and multimorbidity in Burkina Faso. Community awareness initiatives should be strengthened to influence lifestyle on tobacco consumption, alcoholism, physical activity, and vitamin supplementation associated with the consumption of fruits and vegetables
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    Private retail drug shops: what they are, how they operate, and implications for health care delivery in rural Uganda
    (BioMed Central, 2018-07) Mayora, Chrispus; Kandala, Ngianga-Bakwin; Kitutu, Freddy Eric; Ekirapa-Kiracho, Elizabeth; Peterson, Stefan Swartling; Wamani, Henry
    Background: Retail drug shops play a significant role in managing pediatric fevers in rural areas in Uganda. Targeted interventions to improve drug seller practices require understanding of the retail drug shop market and motivations that influence practices. This study aimed at describing the operational environment in relation to the Uganda National Drug Authority guidelines for setup of drug shops; characteristics, and dispensing practices of private retail drug shops in managing febrile conditions among under-five children in rural western Uganda. Methods: Cross sectional survey of 74 registered drug shops, observation checklist, and 428 exit interviews using a semi-structured questionnaire with care-seekers of children under five years of age, who sought care at drug shops during the survey period. The survey was conducted in Mbarara and Bushenyi districts, South Western Uganda, in May 2013. Results: Up to 90 and 79% of surveyed drug shops in Mbarara and Bushenyi, largely operate in premises that meet National Drug Authority requirements for operational suitability and ensuring medicines safety and quality. Drug shop attendants had some health or medical related training with 60% in Mbarara and 59% in Bushenyi being nurses or midwives. The rest were clinical officers, pharmacists. The most commonly stocked medicines at drug shops were Paracetamol, Quinine, Cough syrup, ORS/Zinc, Amoxicillin syrup, Septrin® syrup, Artemisinin-based combination therapies, and multivitamins, among others. Decisions on what medicines to stock were influenced by among others: recommended medicines from Ministry of Health, consumer demand, most profitable medicines, and seasonal disease patterns. Dispensing decisions were influenced by: prescriptions presented by client, patients’ finances, and patient preferences, among others. Most drug shops surveyed had clinical guidelines, iCCM guidelines, malaria and diarrhea treatment algorithms and charts as recommended by the Ministry of Health. Some drug shops offered additional services such as immunization and sold non-medical goods, as a mechanism for diversification. Conclusion: Most drug shops premises adhered to the recommended guidelines. Market factors, including client demand and preferences, pricing and profitability, and seasonality largely influenced dispensing and stocking practices. Improving retail drug shop practices and quality of services, requires designing and implementing both supply-side and demand side strategies.