One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute.

PURPOSE: Acute leukemias are associated with substantial morbidity and mortality, particularly in the adult population. Despite an increasing burden of acute leukemia in developing countries, there are limited data on clinical outcomes and prognostic factors in this setting. In this study, we aimed to describe the clinical characteristics, survival, and prognostic factors of adults with acute leukemia at the Uganda Cancer Institute (UCI). METHODS: A retrospective cohort study was conducted between January 2009 and December 2018, reviewing data of patients 18 years or older with a cytopathologic diagnosis of acute leukemia at UCI. Data were extracted on clinical and laboratory characteristics, response to treatment, and survival. Cox-proportional hazards regression and survival analysis were performed to determine survival rates and associated factors. P < .05 was considered statistically significant. RESULTS: In total, 233 participants were enrolled. Most (59.2%. n = 138) participants were male, with a median age of 32 years (IQR, 23-48 years), and 136 (58.4%) had AML. Overall, the 1-year survival was 16.5%, with a median survival time of 47 (IQR, 21-219) days. Predictors of mortality were being a female (adjusted hazard ratio [aHR], 2.8; 95% CI, 1.2 to 6.7; P = .022) and overweight (aHR, 4.2; 95% CI, 1.3 to 13.4; P = .015). Among the patients who had AML, the predictors were poor Eastern Cooperative Oncology Group (ECOG; aHR, 3.1; 95% CI, 1.6 to 6.2; P = .001) and HIV (aHR, 6.0; 95% CI, 1.7 to 20.5; P = .004). Among the patients who had ALL, the predictors were poor ECOG (aHR, 2.3; 95% CI, 1.3 to 4.1; P = .006). CONCLUSION: Patients with acute leukemia in Uganda have poor overall survival. Prospective studies are recommended to better understand causes of early mortality.

High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit.

BACKGROUND: We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. METHODS: We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. RESULTS: Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41-65) years. More than 80% of the patients presented with severe (19%, n=91) or critical (66%, n=315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2-3.2; P=.011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91-0.95; P<.001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00-1.02; P=.042). The risk of death was 1.4-fold higher in female participants compared with their male counterparts (hazards ratio, 1.4; 95% CI, 1.0-2.0; P=.025). CONCLUSIONS: In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.

High Prevalence of Depressive Symptoms Among Ugandan Patients with Rheumatoid Arthritis.

BACKGROUND: There is a scarcity of data on the burden of depression among Ugandans with rheumatoid arthritis (RA) patients. We aimed to screen for symptoms of depression, their severity and associated factors among patients with RA in Uganda. PATIENTS AND METHODS: A descriptive, cross-sectional study was conducted between September and December 2020 at Mulago National Referral Hospital (MNRH) and Nsambya Hospital. Patients with RA were enrolled consecutively. Data on demographics, disease course and comorbidities and depression symptomatology were collected through an interviewer administered questionnaire. Symptoms of depression were screened for using the depression/anxiety dimension of the EuroQoL questionnaire. RESULTS: Forty-eight patients with a median age of 52 (IQR: 43.5-60.5) years were recruited in the study. The majority of the patients were female (91.7%, n=44). Twenty-nine patients (60.4%) had comorbidities with a median Charlson comorbidity score of 3 (IQR: 2-4). Overall, 70.8% (n=34) had depressive symptoms. Patients attending MNRH were more likely to have depressive symptoms (p=0.025). Significantly, patients with depressive symptoms were younger (p=0.027), had lower health index value (p<0.001), and lower overall self-reported health status (p=0.013). At binary logistic regression, patients at MNRH (crude odds ratio (COR): 4.32, 95% confidence interval (CI): 1.16-16.15, P=0.030), patients aged <52 years (COR: 5.24, 95% CI: 1.23-22.28, P=0.025) and those with mild RA (COR: 5.71, 95% CI: 1.15-28.35, P=0.033) were significantly more likely to have depressive symptoms. Increase in age (COR: 0.94, 95% CI: 0.89-0.99, P=0.025), and high visual analogue score (COR: 0.94, 95% CI: 0.89-0.99, P=0.013) were protective. CONCLUSION: Depressive symptoms were common among RA patients in Uganda. Routine screening, diagnosis and management of depression is recommended among young patients to improve quality of life and patient outcomes.

Patient-reported outcome measure of the quality of life in Ugandans living with autoimmune rheumatic diseases.

Aim of the work: To assess the patient reported outcome measure (PROM) of the quality of life (QoL) of patients with autoimmune rheumatic diseases (RDs) attending two tertiary care rheumatology clinics in Uganda. Patients and methods: Patients with a confirmed diagnosis of RD and receiving disease modifying anti-rheumatic drugs (DMARDs) were studied. Health index and overall self-rated health status were assessed using the EuroQol 5-dimension (ED-5D-5L) questionnaire tool. Results: 74 patients were studied: 48 (64.9%) had rheumatoid arthritis (RA), 14(18.9%) systemic lupus erythematosus (SLE), and 12(16.2%) had other RDs; spondyloarthritis (n = 5), systemic sclerosis (n = 3), juvenile idiopathic arthritis (n = 2), and idiopathic inflammatory myositis (n = 2). Their mean age was 45 ± 17 years and 69 (93.2%) were female. 14(18.9%) were on concomitant herbal medication and 26 (35.1%) self-reported at least 1 adverse drug reaction. Any level of problem was reported by 54(72.5%) participants for mobility, 47(63.5%) for self-care, 56(75.6%) for usual activity, 66(89.1%) for pain and discomfort, and 56(75.6%) for anxiety/depression. The mean health index of the patients was 0.64 ± 0.16 and the overall self-rated health status was 58.1 ± 16.7. Patients with SLE (0.74 ± 0.12) had higher health index compared to those with RA (0.60 ± 0.17) or other RDs (0.70 ± 0.1) (p < 0.007). Overall self-rated health status was comparable across clinical diagnoses (p = 0.23). Both the index and self-reported status were better for patients who received private hospital care compared to public hospital (p < 0.0001 and p = 0.01). Conclusion: There is a substantial negative impact of autoimmune rheumatic diseases on quality of life of patients, especially those receiving care from a public facility in Uganda.