Naz, Tasmia

School of Public Health

MSPH

Uganda

COPD among Urban and Rural Populations: Assessing

Chronic Obstructive Pulmonary Disease (COPD) currently results in 3 million deaths per year globally. COPD-related mortality is expected to increase 30% over the next decade making it the third leading cause of death globally by 2030. The goal of the ongoing LiNK Study (Lung Function in Nakaseke and Kampala) is to examine the risk factors for COPD as well as coincidence with infectious diseases such as HIV and TB among urban and rural populations in Uganda. Despite the increasing prevalence, COPD remains largely undiagnosed in sub-Saharan Africa and few studies have examined risk factors for the disease in the region. While Uganda remains largely rural (88%), urbanization has increased significantly over the past decade and further investigation into the effect of this demographic transition on lung disease is needed. We are currently recruiting 1000 participants in an urban area (Kampala) and rural area (Nakeseke) respectively. The study is the first comparing these groups in an attempt to determine variability in risk factors between the two populations. Our aims are 1) to identify risk factors (tobacco smoking, biomass fuel smoke exposure, infections, urbanization) for COPD in an urban and rural sample of participants, 2) examine the co-incidence of infectious diseases (HIV and TB) among participants with COPD and 3) determine risk factors for undiagnosed COPD among urban and peri-urban samples. Lastly we will assess implementation of COPD management as well as patient and provider preferences in seeking/providing longitudinal COPD care through semi-structured interviews. This internship will involve in depth exposure in field research and quantitative and qualitative methodology. Student(s) will participate in developing questionnaires, conducting field research with established field research teams and manuscript writing.   

Global Health Mentor/PI: William Checkley, MD

For my field placement, I was based in Kampala, Uganda. This was my first time traveling to this region so I was ready and excited to immerse myself in a new setting and culture. I worked on two different studies, one on risk factors of chronic obstructive pulmonary disease among HIV positive individuals and the other on non-communicable disease prevalence and census data expansion, both based in Nakaseke which is a rural district an hour north of Kampala. My main responsibilities were to code and set up mobile data collection for both projects and manage as well as analyze incoming data. On most days I worked out of Kampala alongside the data team of the Lung Institute at Makerere University School of Medicine. About once every two weeks, I traveled to Nakaseke to collaborate and attend trainings with the field staff of African Community Center for Social Sustainability (ACCESS), a community based organization serving the population of Nakaseke.

One of the highlights from traveling to the field was holding meetings with village leaders and members to inform them about our projects and how we are working to improve the overall health status of the community. Working with ACCESS and seeing their vital role and impact in the community was a fascinating experience. Many vulnerable groups in Nakaseke, such as people living with HIV-AIDS, orphans, and children, are able to receive (otherwise unattainable) comprehensive healthcare because of ACCESS. ACCESS also offers a nursing program to address the shortage of healthcare workers in rural communities and build the next generation of providers. Comprehensive, accessible healthcare combined with capacity building are two vital tools that ACCESS provides through which Nakaseke is empowered. It was exciting to see a sustainable development model in action and flourish; I look forward to seeing the impact ACCESS has on the community in the years to come.

Kampala is a developed city where public transportation is readily available as is access to shopping malls, restaurants, art exhibits, music festivals, vibrant communities of students and development workers, etc. I was working out of Makerere University at the time of a major strike and this opened my eyes to the role of the government on the education sector of Uganda. After protests from both students and professors due to the government’s delay in paying professors their salaries, the president decided to shut down the university for an undetermined amount of time. I met several students who were forced to put their education on hold and were unable to sit for their exams while research centers were unable to operate. Ultimately, executive actions such as this have the power to slow down the progress of the country. The projects I was working on were not personally affected since they received external funding. Nevertheless, I learned the importance of adaptability that my Ugandan colleagues and peers embodied so well; all of us had to be prepared for changing deadlines and challenges meeting goals in the face of external forces such as political unrest, funding sources, etc. 

This field placement broadened my perspectives of working in global health and equipped me with some fundamental research skills. I gained coding skills for various mobile data collection platforms, improved data analysis skills, and got to participate in manuscript writing. I learned a lot about Ugandan culture, history, politics, geography, and built close relations with our field team. I highly enjoyed my field placement and would recommend it to someone looking for global health research experience!

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