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 aims to understand 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.
- Diabetes
Type 2 diabetes (T2D) is among the biggest of 21st-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?
- Mental health
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.
- Violence
The research in this group focuses on adolescent health and well-being. In particular, our work includes the health impacts of violence, and determining how these relate to mental health outcomes, vulnerability to sexually transmitted infections and unwanted pregnancy, and adherence to ART. We examine health sector responses to violence. Our research includes studies to understand the social and structural drivers of morbidity, and to develop and evaluate appropriate interventions. The group also builds 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).
- Disability research
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.
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- NCD Genomics
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.
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