Non-communicable diseases theme

Led by Professor Moffat Nyirenda

The prevalence of non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and mental illness, in sub-Saharan Africa is increasing rapidly, and these disorders will soon overtake infectious diseases as major causes of morbidity and mortality. It is also becoming clear that NCDs manifest differently in Africa compared to high-income countries, occurring at younger ages and displaying distinct phenotypes - perhaps shaped by the rich genetic heterogeneity and other exposures such as prevalent infections and poor nutrition. However, the region remains ill-prepared to respond to this challenge, both in terms of research and health systems readiness.

The NCD Research Theme is aimed at understanding these distinct manifestations and their drivers, as well as to develop appropriate prevention and management intervention strategies. The Theme brings together a multidisciplinary team of scientists with expertise in epidemiology, social science, clinical science and basic science, and works closely with the community, Ministry of Health and other stakeholders. Our research is currently organized in 5 key focus areas, namely Diabetes, Mental Health, Violence, Disability and NCD genomics.

By addressing these intractable local health challenges, we will support Uganda’s efforts to achieve the UN’s Sustainable Development Goals.

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Diabetes (led by Professor Moffat Nyirenda)

Type 2 diabetes (T2D) is among the biggest of 21^st-century global health challenges. In 2019, approximately 20 million adults in sub-Saharan Africa were living with diabetes, but this is expected to increase by 143% by 2045 - the largest percentage increase of all regions over that period. This poses a major threat to sustained development in the region if resources have to be found to treat the complications of this condition. Although T2D was traditionally considered a disease of old age, associated with obesity and insulin resistance, in Africa this condition occurs in relatively young and lean individuals. In our study of patients with newly diagnosed T2D in Uganda, ~50% were younger than 50 years and nearly 40% were neither overweight nor obese.

Our research is aimed at 1) better understanding the phenotypes of diabetes, including mechanisms that underlie the “thin T2D phenotype”, and to investigate the role of genetic and environmental factors that are of relevance to the African continent – for example, undernutrition, particularly in early life, can increase long term risk of diabetes or infections (such as HIV, COVID-19) which can also increase diabetes risk 2) identifying the best approaches to prevention and management of diabetes - are the lifestyle interventions to lose weight or use of metformin (as an insulin sensitizer), based on evidence in mostly obese population in high-income countries, going to be as effective in lean Africans?

Related News

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Related projects

Integrated prevention and management of HIV Infection,diabetes & hypertension

 

MENNISCUS 3

 

Controlling Chronic diseases in Africa: development and evaluation of an integrated community-based management of HIV-infection, diabetes and hypertension in Tanzania and Uganda.

 

Integrating and decentralising diabetes and hypertension services in Africa

 

Title Gestational Diabetes in Uganda and India: Design and Evaluation of Educational Films and improving screening and Self Management –GUIDES 

 

Digital Innovations and Diagnostics for Infectious Diseases in Africa

 

Causes and MEchanisms foR non-atopic Asthma in Children (CAMERA)

 

Family centred approach to enhance lifestyle change and behavioural modification for prevention of cardiovascular diseases (CVD) among adolescents and their families in Uganda (FaCe-D) study

 

Mental health (led by Dr. Eugene Kinyanda)

Our research has focused on the burden of mental health, particularly among people living with HIV. We have demonstrated that emotional mental disorders (EMD), namely anxiety and depression, are common (prevalence of 12-34%) in young people living with HIV (YPLHIV) in Uganda. However, providing mental health services in Uganda is beset by many health system challenges such as low mental health literacy, and low capacity to recognize and manage EMD. To address the challenge, we designed and evaluated an intervention that has showed that effective screening and management of depression, delivered by non-specialist healthcare workers, can be successfully integrated in HIV care in Uganda. This intervention was undertaken in adults, but we are planning a similarly innovative approach for the youth to co-design and implement a psychological intervention that will be delivered by peers. Our work includes mechanistic studies to explore the role of genetic factors, inflammation, and other environmental exposures. We work closely with policy makers, which facilitates uptake of our research findings. 

Related News

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Related projects

Integrating the management of depression into routine HIV care in Uganda ( the HIV+D trial)

 

Support to the Ministry of Health Ebola Mental Health and Psychosocial support Services (MPSS) In Mubende and five other Districts.

 

Violence (led by Dr. Nambusi Kyegombe)

The research in the Group focuses on adolescent health and well-being. In particular, our work will include the health impacts of violence, and determine how these relate to mental health outcomes, vulnerability to sexually transmitted infections and unwanted pregnancy, and adherence to ART. We will examine health sector responses to violence. Our research will include studies to understand the social and structural drivers of morbidity, and to develop and evaluate appropriate interventions.  The group will also build on existing collaborations and resources at LSHTM in London including with the Gender Violence and Health Centre – which is a WHO Collaborating Centre – and with the Centre for Maternal Adolescent and Reproductive and Child Health (MARCH).

Related News

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Related projects

Sexual harassment against women and girls in low-wage work in Uganda (SHARI-UG)

 

Disability research (led by Associate Professor Femke Mbazzi)

According to the latest National Population and Household Census, although the Government has strong commitments for inclusion of persons with disabilities, many of the nearly 14% of Ugandans living with a disability face barriers in accessing health care, and are less likely to be included in education, employment, and society. The COVID-19 pandemic has further exacerbated exclusion of persons with disabilities. Our research focuses on developing and testing interventions to improve the health, development, and quality of life of persons with disabilities in Africa, and more generally to promote equity, diversity and inclusion in research, education and employment at the Unit. We work with many local and international partners, and our ambition is to create a centre of excellence for disability inclusiveness in East Africa and to build research capacity (including among individuals with disabilities) in this important area.

Related news

• Obuntu bulamu documentary Obuntu Bulamu Documentary - YouTube
• Obuntu bulamu intervention training materials in English and French
• Young Africa Works Uganda country report
• Young Africa Works participatory video

Related projects

The Mission Billion: participatory approaches to improve access to health care for disabled people in Uganda, NIHR funded grant, aims to improve access to health care for persons with disabilities in Uganda in collaboration with ICED and Makerere University (2022 – 2025). This project is part of the larger Missing Billion Initiative of Professor Kuper at LSHTM. 

 

The Baby Ubuntu programme of early care and support for young children with developmental disability and their families funded by Saving Brains, Grand Challenges Canada and the Tropical Health Education Trust, is an early childhood intervention which aims to improve health and well-being of children with developmental disabilities and their caregivers (2019 – 2023). The programme has developed several training manuals for caregivers and health care workers.

 

The impact of COVID-19 and related public health response on vulnerable populations in Uganda study aims to understand parental and teachers perspectives on the impact of the COVID-19 pandemic on the quality of life of children with disabilities (2020 – 2023).

 

Evidence based inclusive education for children with disabilities in primary schools in Wakiso district, Uganda (EBIE), Phase II: Obuntu bulamu, a peer to peer support intervention for inclusion, funded by Norad / Atlas Alliance, and FIRAH. This randomized control trial (2020 – 2024) aims to improve inclusion and quality of life of children with disabilities at home and in school. The documentary and intervention were co-created with study participants.  Evidence Based Inclusive Education for Children with Disabilities in Wakiso district, Uganda | Vliruos

 

The Young Africa Works: Disability Inclusion Research Partnership is a Mastercard Foundation funded grant (2021 – 2023), which aims to gain an in-depth understanding of the individual, social and policy level factors influencing access to education and employment in youth with disabilities in 7 African countries, including Uganda.  Disability, Diversity & Inclusion - Mastercard Foundation (mastercardfdn.org)

 

The Disabled Youth Investigates (DIY) UKRI funded project (2023 – 2024) trains 12 youth with disabilities as co-researchers and investigates life stories and research participation of youth with disabilities. Messages to promote disability inclusion in research are developed with the youth.

 

The PENDA internship program for persons with disabilities (2022 – 2023) provides opportunities for students and recent graduates from vocational and academic programs with disabilities internship opportunities at the unit. This program is part of the larger FCDO funded PENDA programme at LSHTM of Prof Kuper and Prof Shakespeare. PENDA: Programme for Evidence to Inform Disability Action | LSHTM

 

The General Population Cohort study in Kyamulibwa included the Washington Short Set of Disability Questions and collects longitudinal data of 600 persons with disabilities

 

NCD Genomics (led by Dr. Segun Fatumo)

Africans have the most diverse genomes of all human populations, and therefore, genomic research in Africa has the potential to generate new knowledge about disease mechanisms (and inform detection and treatment options) that would benefit Africans and non-Africans.

Our work is delivered through The African Computational Genomics (TACG) Research Group and capitalizes on the Unit’s Uganda Genome Resource and regional collaborations. Our approaches include genome-wide association studies (GWAS) to determine disease associations, developing African-specific genetic risk scoring tools to accurately quantify genetic risk for common cardiometabolic disorders/traits (such hypertension, diabetes and lipid abnormalities), chronic kidney disease, and mental disorders. We also employ the Mendelian Randomization (MR) approach to determine causality. Our research includes extensive capacity building activities, both formal training and delivery of short courses, in collaboration with local institutions and regional networks.

Related projects

Assessing the impact of genetic variation on chronic kidney disease in Africa

 

Developing PRS for Cardiometabolic Disorders in African-Ancestry Populations (CARDINAL)