Institution
Makerere University
Education•Kampala, Uganda•
About: Makerere University is a education organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Acquired immunodeficiency syndrome (AIDS). The organization has 7220 authors who have published 12405 publications receiving 366520 citations. The organization is also known as: Makerere University Kampala & MUK.
Papers published on a yearly basis
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TL;DR: The hierarchical organization of small artificial groups of captive monkeys is regarded as the expression of a continuous learning process, and only social interactions of the approach/retreat pattern can be used to determine rank.
223 citations
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TL;DR: World Health Organization (WHO) recommends the use of Xpert Ultra as the initial diagnostic test for suspected tuberculous meningitis, following an evaluation of the diagnostic performance of the new Xpert MTB/RIF Ultra (Xpert Ultra).
Abstract: Summary Background WHO recommends Xpert MTB/RIF as initial diagnostic testing for tuberculous meningitis. However, diagnosis remains difficult, with Xpert sensitivity of about 50–70% and culture sensitivity of about 60%. We evaluated the diagnostic performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis. Methods We prospectively obtained diagnostic cerebrospinal fluid (CSF) specimens during screening for a trial on the treatment of HIV-associated cryptococcal meningitis in Mbarara, Uganda. HIV-infected adults with suspected meningitis (eg, headache, nuchal rigidity, altered mental status) were screened consecutively at Mbarara Regional Referral Hospital. We centrifuged CSF, resuspended the pellet in 2 mL of CSF, and tested 0·5 mL with mycobacteria growth indicator tube culture, 1 mL with Xpert, and cryopreserved 0·5 mL, later tested with Xpert Ultra. We assessed diagnostic performance against uniform clinical case definition or a composite reference standard of any positive CSF tuberculous test. Findings From Feb 27, 2015, to Nov 7, 2016, we prospectively evaluated 129 HIV-infected adults with suspected meningitis for tuberculosis. 23 participants were classified as probable or definite tuberculous meningitis by uniform case definition, excluding Xpert Ultra results. Xpert Ultra sensitivity was 70% (95% CI 47–87; 16 of 23 cases) for probable or definite tuberculous meningitis compared with 43% (23–66; 10/23) for Xpert and 43% (23–66; 10/23) for culture. With composite standard, we detected tuberculous meningitis in 22 (17%) of 129 participants. Xpert Ultra had 95% sensitivity (95% CI 77–99; 21 of 22 cases) for tuberculous meningitis, which was higher than either Xpert (45% [24–68]; 10/22; p=0·0010) or culture (45% [24–68]; 10/22; p=0·0034). Of 21 participants positive by Xpert Ultra, 13 were positive by culture, Xpert, or both, and eight were only positive by Xpert Ultra. Of those eight, three were categorised as probable tuberculous meningitis, three as possible tuberculous meningitis, and two as not tuberculous meningitis. Testing 6 mL or more of CSF was associated with more frequent detection of tuberculosis than with less than 6 mL (26% vs 7%; p=0·014). Interpretation Xpert Ultra detected significantly more tuberculous meningitis than did either Xpert or culture. WHO now recommends the use of Xpert Ultra as the initial diagnostic test for suspected tuberculous meningitis. Funding National Institute of Neurologic Diseases and Stroke, Fogarty International Center, National Institute of Allergy and Infectious Disease, UK Medical Research Council/DfID/Wellcome Trust Global Health Trials, Doris Duke Charitable Foundation.
222 citations
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TL;DR: A paradigm shift in the relationship between medical schools in four African countries has created a culture of collaboration, overriding the history of competition, and the positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.
Abstract: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning. Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These interviews were recorded, transcribed and coded to identify common themes. All of the consortia have prioritized efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilize limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalization of collaborative activities. The consortia described in this paper demonstrate a paradigm shift in the relationship between medical schools in four African countries. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding that was leveraged to form in-country partnerships has created a culture of collaboration, overriding the history of competition. The positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.
222 citations
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Broad Institute1, Harvard University2, Delft University of Technology3, Johns Hopkins University4, National Institutes of Health5, South African Medical Research Council6, Yonsei University7, Makerere University8, Public Health Agency of Sweden9, University of the Sciences10, Shahid Beheshti University of Medical Sciences and Health Services11, Boston University12, National Taiwan University13, Rutgers University14, Yale University15
TL;DR: Molecular diagnostics that include markers for rifampicin resistance alone will be insufficient to identify pre-MDR strains, and incorporation of knowledge of polymorphisms that occur before the emergence of multidrug resistance, particularly katG p.Ser315Thr, into molecular diagnostics should enable targeted treatment of patients with pre-mDR-TB to prevent further development of MDR- TB.
Abstract: Multidrug-resistant tuberculosis (MDR-TB), caused by drug-resistant strains of Mycobacterium tuberculosis, is an increasingly serious problem worldwide. Here we examined a data set of whole-genome sequences from 5,310 M. tuberculosis isolates from five continents. Despite the great diversity of these isolates with respect to geographical point of isolation, genetic background and drug resistance, the patterns for the emergence of drug resistance were conserved globally. We have identified harbinger mutations that often precede multidrug resistance. In particular, the katG mutation encoding p.Ser315Thr, which confers resistance to isoniazid, overwhelmingly arose before mutations that conferred rifampicin resistance across all of the lineages, geographical regions and time periods. Therefore, molecular diagnostics that include markers for rifampicin resistance alone will be insufficient to identify pre-MDR strains. Incorporating knowledge of polymorphisms that occur before the emergence of multidrug resistance, particularly katG p.Ser315Thr, into molecular diagnostics should enable targeted treatment of patients with pre-MDR-TB to prevent further development of MDR-TB.
222 citations
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TL;DR: The urban population is at a higher risk than the rural population, and the patterns of injury differ, and interventions to control injuries should be a priority in Uganda.
Abstract: Objectives—To describe and contrast injury patterns in rural and urban Uganda. Settings—One rural and one urban community in Uganda. Methods—Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. Results—In the rural setting, 1673 households, with 7427 persons, were surveyed. Injuries had an annual mortality rate of 92/100 000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2322 households, with 10 982 people, were surveyed. Injuries had an annual mortality rate of 217/100 000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1000/year. Leading causes of death were drowning in the rural setting, and road traffic in the city. Conclusion—Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.
221 citations
Authors
Showing all 7286 results
Name | H-index | Papers | Citations |
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Pete Smith | 156 | 2464 | 138819 |
Joy E Lawn | 108 | 330 | 55168 |
Philip J. Rosenthal | 104 | 824 | 39175 |
William M. Lee | 101 | 464 | 46052 |
David R. Bangsberg | 97 | 463 | 39251 |
Daniel O. Stram | 95 | 445 | 35983 |
Richard W. Wrangham | 93 | 288 | 29564 |
Colin A. Chapman | 92 | 491 | 28217 |
Ronald H. Gray | 92 | 529 | 34982 |
Donald Maxwell Parkin | 87 | 259 | 71469 |
Larry B. Goldstein | 85 | 434 | 36840 |
Paul Gepts | 78 | 263 | 19745 |
Maria J. Wawer | 77 | 357 | 27375 |
Robert M. Grant | 76 | 437 | 26835 |
Jerrold J. Ellner | 76 | 347 | 17893 |