Browsing by Author "Mulenga B"

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    Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) care in nine lower-income countries.
    (2025) Drown L; Adler AJ; Salvi D; Boudreaux C; Gupta N; Ali Z; Bay N; Chisunka M; Mulenga B; Koirala B; Maharjan B; Marro G; Mengistu Z; Mtumbuka E; Nabadda M; Ruckstuhl L; Wurie I; Thapa A; Mocumbi A; Bukhman G; Wroe EB; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Department of Global Health and Social Medicine, Program in Global Noncommunicable Disease and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America.; Kathmandu Institute of Child Health, Kathmandu, Nepal.; SolidarMed, Harare, Zimbabwe.; Universidade Eduardo Mondlane, Maputo, Mozambique.; Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.; Pujehun Hospital, Ministry of Health, Pujehun, Sierra Leone.; Partners In Health, Boston, Massachusetts, United States of America.; Department of Medicine, Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Doctors With Africa CUAMM, Padova, Italy.; Mathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, Ethiopia.; Clinton Health Access Initiative, Dar es Salaam, Tanzania.; Noncommunicable Diseases Alliance Kenya, Nairobi, Kenya.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    Severe chronic noncommunicable diseases (SC-NCDs) are important causes of avoidable disease burden in low- and lower-middle income countries (LLMICs) where care is often available only at tertiary, urban facilities. The Package of Essential Noncommunicable Disease Interventions - Plus (PEN-Plus) strategy aims to address gaps in access to care for SC-NCDs by integrating and decentralizing care. This study aims to assess baseline readiness of 16 facilities in nine LLMICs to provide care for SC-NCDs as part of a mixed-methods evaluation of PEN-Plus implementation. Cross-sectional surveys were utilized to collect baseline data from 16 facilities initiating new PEN-Plus programs. These surveys assessed the state of facility infrastructure and the availability of equipment and medicines for three priority conditions (type 1 diabetes (T1D), sickle cell disease (SCD), severe cardiac conditions (SCC)). Analysis consisted of descriptive statistics and summary index scores based on availability of key items. Facilities reported a high baseline availability of basic infrastructure. Readiness to provide care for priority SC-NCDs varied. Availability of functional diagnostic and management equipment and supplies for T1D was especially low in many facilities but higher for SCD. Medicine availability was overall highest for T1D (75%) but lower for SCD (39%) and SCC (49%), with significant gaps in essential medicines including hydroxyurea, anticoagulants, and medium- or long-lasting insulins.These findings highlight the need for tailored, context-driven implementation approaches to address gaps in readiness for SC-NCD care in LLMICs. Baseline results will guide ongoing implementation and evaluation of the PEN-Plus clinics.
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    Organization of services for severe chronic Noncommunicable diseases at first-level hospitals in nine lower-income countries: Results from a Baseline assessment of PEN-Plus initiation.
    (2025) Boudreaux C; Wroe EB; Thapa A; Abebe NA; Akiteng AR; Drown L; Gadewar A; Karmacharya BM; Karki S; Mansoor M; Mutagaywa R; Mulenga B; Mutengerere A; Nollino L; Salvi D; Dagnaw WW; Bukhman G; Mocumbi AO; Adler A; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Doctors with Africa CUAMM, Padua, Italy.; Division of Global Health Equity, Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Kathmandu Institute of Child Health (KIOCH), Kathmandu, Nepal.; SolidarMed, Masvingo, Zimbabwe.; Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania.; Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.; Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America.; Universidade Eduardo Mondlane, Campus Universitário, Maputo, Mozambique.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Instituto Nacional de Saúde, Maputo, Mozambique.; Sangwari - People's Association for Equity and Health, Ambikapur, Chhattisgarh, India.; Department of Medicine, Endocrine Metabolism and Nutrition Diseases Unit, AULSS 2 Marca Trevigiana, Treviso, Italy.; Uganda, Initiative for Integrated Management of Non communicable Diseases (UINCD), Kampala, Uganda.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    Severe chronic noncommunicable diseases pose a significant health burden and challenges for health systems globally. This study aims to advance our understanding of the current organization of care for these conditions in low and lower-middle-income countries. The study was conducted as part of a baseline assessment of facilities prior to the initiation of the Package of Essential NCD Interventions -Plus (PEN-Plus) strategy, which is designed to enhance outpatient care for conditions including rheumatic and congenital heart disease, sickle cell disease, type 1 diabetes, severe asthma, and advanced chronic kidney disease. We employed a cross-sectional survey methodology to collect baseline data from 16 hospitals in nine LLMICs. The survey assessed the organization of common and severe NCD services, focusing on the availability and management of severe NCDs, organized into domains of integrated services. Data were analyzed using summary statistics and heatmaps to evaluate care patterns. We document gaps in the availability of services for both common and severe NCDs. We find that the majority of NCD care occurs in the general outpatient settings, with a smaller proportion provided in specialized internal medicine wards. Despite some hospitals implementing specialized clinics and teams, limitations in specialist access, variability in service fees, and inconsistent definitions of patient follow-up were prominent issues affecting patient care access and continuity. Despite the spectrum of strategies employed by these hospitals to cater to chronically and severely ill patients, notable gaps in care persist, particularly for diagnostic and treatment options that require specialist training or equipment. The sustainable decentralization of effective care for individuals with severe chronic NCDs will require integrated teams and customized systems to ensure seamless and comprehensive care through the entire care continuum-from screening and diagnosis to care linkage, ongoing management, handling of complications, uninterrupted supply of medicines and commodities and maintaining patient retention.
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    Superimposed Pulmonary Tuberculosis (PTB) in a 26-Year-Old Female with No Underlying Co-Morbidities Recovering from COVID-19-Case Report.
    (2023-May-08) Njekwa K; Muyoyeta M; Mulenga B; Chisenga CC; Simuyandi M; Chilengi R; Center for Infectious Disease Research in Zambia (CIDRZ), P.O. Box 34681, Lusaka 10101, Zambia.; Enteric Diseases and Vaccine Research Unit (EDVRU)-Director, P.O. Box 34681, Lusaka 10101, Zambia.; Zambia National Public Health Institute (ZNPHI)-Director, H9M2+WGX, Lusaka 10101, Zambia.; Tuberculosis Programs-Director, Centre for Infectious Disease Research, P.O. Box 34681, Lusaka 10101, Zambia.
    Tuberculosis before the COVID-19 pandemic is said to have killed more people globally than any other communicable disease and is ranked the 13th cause of death, according to the WHO. Tuberculosis also still remains highly endemic, especially in LIMCs with a high burden of people living with HIV/AIDS, in which it is the leading cause of mortality. Given the risk factors associated with COVID-19, the cross similarities between tuberculosis and COVID-19 symptoms, and the paucity of data on how both diseases impact each other, there is a need to generate more information on COVID-19-TB co-infection. In this case report, we present a young female patient of reproductive age with no underlying comorbidities recovering from COVID-19, who later presented with pulmonary tuberculosis. It describes the series of investigations performed and treatments given during the follow-up. There is a need for more surveillance for possible COVID-19-TB co-infection cases and further research to understand the impact of COVID-19 on tuberculosis and vice versa, especially in LMICs.
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    The Incidence and Risk Factors for Enterotoxigenic
    (2024-Mar-29) Sukwa N; Bosomprah S; Somwe P; Muyoyeta M; Mwape K; Chibesa K; Luchen CC; Silwamba S; Mulenga B; Munyinda M; Muzazu S; Chirwa M; Chibuye M; Simuyandi M; Chilengi R; Svennerholm AM; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka P.O. Box 34681, Zambia.; Department of Microbiology and Immunology, University of Gothenburg, 40530 Gothenburg, Sweden.; Department of Biostatistics, School of Public Health, University of Ghana, Accra P.O. Box LG13, Ghana.
    This study aimed to estimate the incidence and risk factors for Enterotoxigenic