A development study to examine feasibility and acceptability of pulmonary rehabilitation in Uganda for adults with chronic respiratory disease

Lead Research Organisation: University of Plymouth
Department Name: Centre for Clinincal Trials & Health Res

Abstract

Arising from respiratory infections such as TB and HIV, tobacco smoking and nutritional impairment, chronic lung disease (CLD) affects around one in five adults in Africa, and is a major threat to health. Patients with breathlessness related to CLD create large but silent burden of human suffering, damage to the economy through lost productivity and disability, and direct health service costs with frequent and prolonged hospital admissions. People with CLD are prone to breathlessness, inactivity, de-conditioning, declining health status and prognosis. CLDs are disproportionately prevalent in deprived populations and many sufferers can neither afford the drugs nor transport to medical clinics. While non-communicable diseases are now recognised as a major public health problem in Africa, CLDs are neglected as a health priority.

While medication may improve lung function and symptoms they do not change prognosis or rate of decline in lung function or health status. However these important systemic effects of CLDs are amenable to treatment with pulmonary rehabilitation (PR) which is a programme of exercise, and education and self management. There is strong evidence that PR improves health status, exercise capacity, social functioning and is recommended in international guidelines. PR involves existing local resources such as nurses, doctors, physiotherapists and clinic staff. PR allows patients to help each other and themselves, without major capital outlay or equipment. PR offers a major and radical new approach to CLDs, an important neglected group for whom no effective therapy is available. A literature review found no evidence of pulmonary rehabilitation being used in Sub Saharan Africa.

In a pilot PR study we set up and ran a programme in Mulago Hospital, Kampala. A multidisciplinary team of doctors, nurses, physiotherapist and others have run 2 groups with 23 patients with chronic lung damage secondary to pulmonary TB. Results confirm that the programme is feasible and acceptable to patients and to the hospital staff at all levels. Major improvements were seen in exercise capacity and health status. In many patients the experience was life changing, allowing severely incapacitated patients who were entirely dependent on others to now function normally in work and social activities. The patients in this pilot so far have been post tuberculosis patients, but we are now able to include patients with other CLDs.

The objective of this application is to develop PR to a point where it may be deployed widely in East Africa and assessed in a large trial. The main research questions are:

- What is the optimal design of the PR programme?
- What are the patient recruitment and retention strategies?
- What are the optimal assessment strategies and outcome measures?
- How can the training and roll-out be best achieved?

The study has quantitative and qualitative elements. We will continue the pilot PR programme at Mulago hospital for 3 more cohorts, totalling 30-40 people. Quantitative data will be recorded on recruitment, uptake and completion of PR. We will assess a range of measures including exercise capacity and quality of life, satisfaction, and evaluation of chest pains. In the qualitative study, detailed interviews will be held with 25 participants who have completed the programme and 5 interviews will be conducted with people who did not take part or complete PR, focusing on barriers to attending or completing PR. A focus group and up to 5 in depth interviews with stakeholders will explore practical issues of running and extending PR in Africa. Thematic analysis will be performed by Ugandan researchers in local languages initially with further framework analysis in collaboration with the UK team. To inform the development of a full grant application we will host a meeting of all stakeholders to disseminate the findings of this work and develop the strategy for rolling out PR in East Africa.

Technical Summary

DESIGN- pre and post observational cohort study - a continuation of existing pilot Pulmonary rehabilitation (PR) programme with collection of quantitative data and detailed qualitative study on the optimisation of the programme contents, deployment and evaluation to inform the development of a large trial.

PARTICIPANTS: Three cohorts yielding 30-40 people who have completed the PR programme.

QUANTITATIVE: Details of those identified, invited, accepted and completed will be recorded. For all participants, we will record demographics, medical history and clinical features as before with new detailed evaluation of chest pains and haemoptysis. Outcome measures include incremental shuttle walking test, Clinical COPD questionnaire, MRC dyspnoea scale, spirometry and biometrics. Descriptive statistical analysis will assess the performance of the outcome measures

QUALITATIVE: Semi-structured interviews with 25 participants who have completed the programme will be conducted by experienced qualitative researchers. They will be recorded in native languages, fully transcribed and translated to English. The interviews will be flexibly guided by a list of topics including: (i) facilitators and barriers to attending the programme (ii) the impact of their respiratory disease on their lives before and after the programme (iii) problems caused by attending PR (iv) improvements in the PR or its assessment (v) maintenance after PR. Five semi-structured interviews will be conducted with people who did not take part or complete PR, focusing on barriers to attending or completing PR. A focus group and upto 5 in-depth interviews with stakeholders (clinicians, administrators, community representatives and the PR team) will explore practical issues of running and extending PR in Africa.
Thematic analysis will be performed by Ugandan researchers in local languages initially with further framework analysis of the translated transcripts in collaboration with the UK team.

Planned Impact

The outcomes of this development trial and the potential large scale trial will help various beneficiaries. In addition to the benefits to the research team in developing large scale trials, the research team is part of a new centre in Kampala consisting of international researchers who have recently been successful in other academic research bids (around £300,000) and are creating the International Lung Investigation Unit. This development trial will help the centre build capacity as a centre of research excellence in Uganda to continue to develop and run important new studies related to CLDs. The wider beneficiaries and impacts are:

1. Patients with CLDs are common, COPD may affect 1 in 5 adults, and predominate in the lower socioeconomic groups who have few resources and are unable to pay for conventional medicines (which in any case are often not very effective). For the majority, there is no treatment and no hope. The patients stand to gain by improved symptoms, exercise capacity, mood and ability to be economically active. Their families will benefit if the patients make improvements and are no longer dependent on others for limited resources. This research will give a huge silent population of people with CLDs a voice and hope.

2. Patients with other chronic diseases such as heart failure may benefit from the lessons learned that rehabilitation without drugs can empower patients to dramatically improve their symptoms, disability and dependency.

3. Clinicians may benefit from having a new way to treat peoples' unremitting symptoms, they will gain from better awareness of CLDs and the importance of patients improving their health behaviours not just relying on drugs.

4. The health services in many countries struggle to manage the acute exacerbations of diseases like COPD which causes a large number of admissions. In the UK, COPD exacerbations are the second most common cause of emergency medical admissions, and the Director of Mulago Hospital states tha prolonged and repeated admissions are a major burden to overstretched resources, creating a bed crisis that urgently needs addressing. The duration of admission and time to readmission may be improved by PR.

5. Society will benefit directly if PR allows more patients to be able to work and reduce dependence on others. By educating people about CLDs, their cause, and availability of treatment, and preventative measures such as reducing exposure to tobacco and cooking fire smoke may have profound public health benefits.

6. Policy makers in Uganda are already engaged in this work, through clinical contacts with the Ministry of Health and through our international links at WHO. We have an opportunity to influence commissioning of services to address an unmet need. This study represents a major silent and neglected health problem, using novel sustainable and scalable methods, which are applicable to a range of NCDs. The development trial will build on the work of the Fresh Air Uganda teams and as such this development trial has the support of the WHO's Global Alliance against Respiratory disease (GARD).

The research builds bridges across countries and continents, across disciplines and puts the patient at the centre of their own care which will enhancing cultural enrichment, quality of life, health and well-being and reduce social isolation and stigma.

Publications

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Jones R (2017) A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda. in International journal of chronic obstructive pulmonary disease

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Jones R (2018) Does pulmonary rehabilitation alter patients' experiences of living with chronic respiratory disease? A qualitative study. in International journal of chronic obstructive pulmonary disease

 
Title Film: 'Preventing Lung Disease in Rural Uganda - A Train the Trainer Programme' 
Description Film on the pulmonary rehabilitation programme (13 mins). 
Type Of Art Film/Video/Animation 
Year Produced 2016 
Impact This has been downloaded over 500 times and been seen by many influential people. 
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air
 
Title Film: 'Pulmonary rehabilitation in Kyrgyzstan' 
Description 'Pulmonary rehabilitation in Kyrgyzstan' - a 12-minute film. 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact Shown locally and internationally at conference. 
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air/project-videos
 
Title Film: 'The Breathe Again Africa Project' 
Description Film to publicise our crowdfunding project to raise money to build a pulmonary rehabilitation centre at the Makerere Lung Institute, Kampala, Uganda. 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact This film helped us to raise over £10,000 to achieve our goal. The centre is now open and is providing PR support to those with lung diseases. 
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air/project-videos
 
Title Film: IPCRG's tobacco dependence treatment education in Uganda 
Description This short video describes a lung health awareness programme including tobacco dependency treatment in rural Uganda using low level community health care workers. 
Type Of Art Film/Video/Animation 
Year Produced 2016 
Impact Widely seen at conferences and educational meetings. many downloads. 
URL https://www.globalbridges.org/news/blog/2016/10/18/video-ipcrgs-tobacco-dependence-treatment-educati...
 
Title Film: pulmonary rehabilitation in Uganda 
Description "Pulmonary Rehabilitation in Uganda - a life-giving programme for people with chronic lung disease" a 6 minute video 
Type Of Art Film/Video/Animation 
Year Produced 2016 
Impact Widely presented at conferences and meeting and seen on web, also used for training people to do pulmonary rehabilitation in Vietnam and Greece 
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air
 
Title Illustration 
Description Collaborative work with Year 2 and 3 Illustration student at the University of Plymouth to produce educational art materials on lung health. Posters, comics and calendars have been developed. Additionally, a Year 3 student has recently visited Uganda and will be producing an short animated film. 
Type Of Art Artwork 
Year Produced 2019 
Impact Student development and increased patient education. 
 
Title Photojournalism 
Description Photojournalism exhibition of pulmonary rehabilitation in Kyrgyzstan. 
Type Of Art Artistic/Creative Exhibition 
Year Produced 2018 
Impact Exhibited online and in Plymouth and London, raising awareness across the country. 
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air/project-videos
 
Description The PR programme has been adopted for implementation studies in Kyrgyzstan, Uganda, Greece and Vietnam funded by EU.
There are formal trials of efficacy in Uganda, Sri Lanka, India and Kyrgyzstan funded by NIHR through Global RECHARGE led by Leicester University.
Exploitation Route PR is is being consider as a standard treatment for COPD and post-TB lung disease in several countries as evidence of benefit emerges.
Sectors Healthcare

URL https://www.plymouth.ac.uk/research/primarycare/fresh-air
 
Description PR is being talked about as a key potential benefit for people with chronic lung disease in several LMICs and discussions are ongoing with several organisations without clear commitment yet.
First Year Of Impact 2020
Sector Healthcare
Impact Types Policy & public services

 
Description Fresh Air Horizon 2020
Amount £168,080 (GBP)
Organisation European Commission 
Department Horizon 2020
Sector Public
Country European Union (EU)
Start 10/2015 
End 09/2018
 
Description Global Challenges Research Fund - Kupumua Project
Amount £62,600 (GBP)
Organisation Government of the UK 
Sector Public
Country United Kingdom
Start 11/2018 
End 07/2021
 
Description RECHARGE
Amount £1,854,655 (GBP)
Funding ID 17/63/20 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2018 
End 04/2021
 
Title Plymouth international pulmonary rehab database 
Description we have a database that has taken the data from the pre-pilot and development study data and will be added to when rehab is run in Crete and Vietnam in 2016 and Kyrgystan planned for 2017. Other countries may follow if we are successful in the bid for the MRC/Wellcome/DFID main trial application- Zambia, Tanzania and Kenya and other centres in Uganda. There have been expressions of interest from Ethiopia and other European countries if we can establish a successful model. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact at this stage it is a way to get people to develop rehab to one model with shared outcome measures, so there is great potential, but little impact yet. 
 
Description FreshAir partnership With IPCRG 
Organisation International Primary Care Respiratory Group
Country United Kingdom 
Sector Public 
PI Contribution The IPCRG is an organisation that we established approximately 10 years ago. Researchers from the Universities of Leiden, Groningen and Plymouth collaborated to form a research team which applied successfully for Horizon 2020 money to run projects on respiratory disease in four countries- Greece, Kyrgyzstan, Vietnam and Uganda. The experience of recruiting and establishing pulmonary rehabilitation in Uganda as part of the development project was directly helpful in writing this bid for Horizon 2020. The pulmonary rehab programme in work package 5 is a key component of the research programme and was based in the development study funded by JGHR bid.
Collaborator Contribution A series of projects are being undertaken in the four countries involving understanding the burden of chronic respiratory disease, its prevalence and risk factors; work on prevention in relation to education on lung health particularly biomass smoke exposure and smoking cessation projects. There are components which include training in spirometry and diagnosis of COPD, and pulmonary rehabilitation is being established in Crete and explored in other countries.
Impact There is a knowledge base and a range of conference abstracts and papers.
Start Year 2016
 
Description John Hopkins University and UCL funding application partnership 
Organisation Johns Hopkins University
Department Pulmonary and Critical Care
Country United States 
Sector Academic/University 
PI Contribution RJ was approached by Researchers at John Hopkins to join a MRC and GACD research funding application for chronic lung disease in Uganda , Nepal and Peru. RJ was approached after they had heard about our chronic lung disease and rehab work in Uganda. The request was at very short notice and the proposal needed, in our opinion, some changes. RJ did not join the initial bid as a co-app but supported Dr John Hurst from UCL in his successful application to MRC. RJ is on the steering board for this £1.1m project.
Collaborator Contribution John Hopkins and UCL have related projects in Uganda and we are now sharing ideas and logistics to better operate internationally
Impact A paper has been written in 2017 and published in the American Journal of Respiratory and Critical care medicine 3. (Siddharthan T, Grigsby M, Goodman D, Chowdhury M, Rubenstein A, Irazola V, Gutierrez L, Miranda J, Bernabe-Ortiz A, Alam D, Kirenga B, Jones R, van Gemerert F Wise R, Checkley W. Association between household air pollution exposure and chronic obstructive pulmonary disease in 13 low- and middle-income country settings. AJRCCM 2018 in press (Impact Factor 13)
Start Year 2015
 
Description Leicester University, UK 
Organisation University of Leicester
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Rupert Jones led an MRC Wellcome DFID Joint Global Health Trials funded development study to examine feasibility and acceptability of pulmonary rehabilitation in Uganda for adults with chronic respiratory disease which was successfully completed. In 2015 with Leicester and other sites we were awarded a Horizon 2020 grant for E3,000,000 and Dr Jones led a work-package on implementing pulmonary rehabilitation based on the MRC development bid in 3 countries- Vietnam, Greece and Kyrgyzstan which was jointly implemented with Leicester. Further joint work includes a bid for a main trial in joint global health awards in 2016 (not funded.) In 2018 we were successful in a bid to have a global health research group funded by NIHR (£2m) led by Leicester but with wit Dr Jones as co-director of the programme, and Prof Andy Barton, a research methodologist also a funded co-applicant, both from Plymouth. It is called the RECHARGE programme
Collaborator Contribution Professor Sally Singh has provided expert advice and access to the SPACE for COPD manual which is a standardised self management manual for patients with chronic obstructive pulmonary disease (COPD) and on which the pulmonary rehabilitation programme is based. Prof Singh has visited Vietnam twice, Kyrgyzstan once, Uganda once to establish pulmonary rehabilitation research programmes. These training visits involve establishing training materials and formats and directly teaching health workers to conduct and assess pulmonary rehab to international standards. Leicester now leads the RECHARGE project including (i) research capacity building in host countries (ii) establishing RCTs in 4 countries of pulmonary rehab (iii) establishing a large international dataset, defining core and optional variables.
Impact This collaboration began in March 2015 and the outputs include successful grant application to EU for H2020 see above with various partners. the implementation of pulmonary rehab in Crete led to a plan for 2 PhD students to be supervised by Leicester on rehab in Crete. The rehab programme completed 3 groups and an ongoing programme is set to run from the University Medical centre in Heraklion. The rehab in Vietnam has been successfully implemented and will be spread throughout the region from Ho Chi Minh City with plans for a national service to be run in every District in Vietnam. Quality assurance to be provided by this collaboration, supported by Prof Singh and Dr Jones in the long term. in Kyrgyzstan the primary research groups of pulmonary rehabilitation have been established in 5 centres and again this research has provided the model of a national pulmonary rehab service which the Ministry of Health have agreed to develop.
Start Year 2015
 
Description Makerere Lung Institute 
Organisation Makerere University College of Health Sciences
Country Uganda 
Sector Academic/University 
PI Contribution The Lung institute is academic institution established in 2015 by dr Bruce Kirenga, Prof Thys van der Molen, and Dr Jones along with several members of the Mulago Hospital respiratory staff, Ministry of health, and the Makerere University College of Health Sciences. It was formally inaugurated in November 2015. The institution and has a remit to promote education, health services and research aiming to improve patient health in relation to lung disease. Dr Jones is co-Director, the MLI has several million in research grants and employs around 50 people housed in a new purpose built 20 room building. Plans are made to double the size of the premises. The Institute runs conferences and is autonomous financially. Services now available include pulmonary rehabilitation in a purpose built centre which was recently completed. Kupumua House was entirely funded and equipped by crowdfunding run by DR Jones in Plymouth University. There is a full time staff for the rehab centre for the next 2-3 years
Collaborator Contribution Dr Bruce Kirenga is a senior respiratory researcher with approximately £7 million worth of funding. Prof Van der Molen and Dr Frederick van Gemert are both members of the Groningen University Medical Centre where there is a large respiratory institution which provides academic support and supervision of PhD's to researchers in the Makerere Lung Institute. As well as running a range of major research projects the Institute is establishing both short and long course education for post graduates in respiratory disease. There are joint PhD's with Groningen University and at least one jointly supervised PhD is planned using funding from sources including the RECHARGE NIHR funded programme
Impact The existence of the highly successful Makerere Lung Institute complete with buildings, conferences education programmes and multiple research grants. For example the MaKNCD conference in 2018 was attended by over 300 people and Drs Kirenga, Jones and van Gemert were all speakers. the MLI has raised the profile of chronic lung disease - in completing a range of major studies including the FRESH AIR Horizon2020 programme, and the results of this implementation programme demonstrated the value of implementing, spirometry, smoking cessation and education programme for awareness raising of biomass smoke in general communities and in pregnant women and children. Meetings with Ministry of Health and others have happenned in Sept 2018 and a further symoposium attended by policy makers will be held in April 2019
Start Year 2015
 
Title Pulmonary Rehabilitation Programme 
Description Working with physicians and physiotherapists in the UK and Uganda, we have developed a pulmonary rehabilitation programme suitable for use in resource poor countries and undertaken initial pilot work for a large trial in Uganda. Apart from an exercise programme, we have developed culturally appropriate educational materials and both will be used in the future trial. 
Type Management of Diseases and Conditions
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2015
Development Status Under active development/distribution
Clinical Trial? Yes
Impact We shall shortly be applying for funding to roll out our initial feasibility work in a much larger trial in Africa but have also secured 2020 funding to adapt the PR programme for use in Vietnam, Crete, and Kyrgyzstan. 
URL http://medicalxpress.com/news/2015-01-funding-pulmonary-east-africa.html
 
Description "LUNGEREHABILITERINGSKONFERANSEN", Oslo 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Rehabilitation in primary care - criteria for success and failure
Awareness of rehab to leading respiratory people to establish PR in Scandinavia
Year(s) Of Engagement Activity 2015
 
Description "LUNGEREHABILITERINGSKONFERANSEN", Oslo 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Why do we need quality indicators in pulmonary rehabilitation?
Awareness of rehab to leading respiratory people to establish PR in Scandinavia. A lot of further correspondence rehab is now being set up across Norway following the methods I espoused (and designed)
Year(s) Of Engagement Activity 2015
 
Description British Lung Foundation South West regional meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Research in COPD in UK and Africa
Regional meeting for the Lung Foundation patient group
Year(s) Of Engagement Activity 2015
 
Description Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Implementing Pulmonary Rehabilitation presentation given at the International Primary Care Respiratory Group conference, Sri Lanka
Year(s) Of Engagement Activity 2017
 
Description Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 'Experience of Pulmonary Rehabilitation Programmes' talk given at the 9th IPCRG Worl Conference, Porto, Portugal.
Year(s) Of Engagement Activity 2018
 
Description Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk given on 'What is pulmonary rehabilitation, who benefits, and how to implement PR?' at the Euro-Asian Respiratory Congress.
Year(s) Of Engagement Activity 2017
 
Description Derriford Hospital Research Day 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Silent killer on the rise - addressing the causes and treatment of lung disease in Africa
Important presentation before the Vice Chancellor and CEO of Derriford Hospital, went down well.
Year(s) Of Engagement Activity 2016
 
Description European Respiratory Society conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Poster presentation at the ERS meeting :
2 posters on te Development study funded by MRC / Wellcome Trust / DFID:
An e-poster on the quantitative outcomes of our study of pulmonary rehabilitation for patients with chronic lung disease in Uganda
An e-poster on the qualitative outcomes of our development study of pulmonary rehabilitation for patients with chronic lung disease in Uganda
Year(s) Of Engagement Activity 2016
URL https://www.plymouth.ac.uk/research/primarycare/fresh-air
 
Description Global Health MSc, Plymouth University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Intercultural communication
MSc teaching.
Year(s) Of Engagement Activity 2015
 
Description Global Health MSc, Plymouth University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Research and fundraising in Global Health
MSc teaching.
Year(s) Of Engagement Activity 2015
 
Description IPCRG 3rd Scientific Meeting, Sweden 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prevalence of COPD in a rural area of a sub-Saharan country: FRESH AIR Uganda
Academic presentation for clinical academics.
Year(s) Of Engagement Activity 2013
 
Description IPCRG 4th Scientific Meeting, Singapore 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact An exploratory trial to test the impact of training midwives to deliver biomass smoke reduction on exposures, pregnancy outcome and infant health
Academic presentation for clinical academics.
Year(s) Of Engagement Activity 2015
 
Description IPCRG 7th World Conference, Athens 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A PILOT STUDY OF PULMONARY REHABILITATION IN POST TUBERCULOSIS PATIENTS IN UGANDA
Academic presentation for clinicians and policy makers.
Year(s) Of Engagement Activity 2014
 
Description IPCRG 8th World Conference, Amsterdam 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Lessons from designing and implementing pulmonary rehabilitation in Kampala
Oral presentation of our research, very well-attended.
Year(s) Of Engagement Activity 2016
 
Description IPCRG 8th World Conference, Amsterdam 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Rapid Assessment of the Demand and Supply of Tobacco Dependence Pharmacotherapy in Uganda
Oral research presentation.
Year(s) Of Engagement Activity 2016
 
Description IPCRG 8th World Conference, Amsterdam 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Implementing Pulmonary Rehabilitation in Low Resource Settings
Invited lecture including film on rehab in Africa and Asia.
Year(s) Of Engagement Activity 2016
 
Description International union TB lung disease conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact oral presentation on Lung health awareness raising programme in Uganda
Year(s) Of Engagement Activity 2016
 
Description Invited speaker 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Talk given on 'Chronic Lung Disease in Africa' at the University of Plymouth's Sustainable Earth Institute conference 2017
Year(s) Of Engagement Activity 2017
 
Description Junior Doctors' respiratory training, Derriford Hospital 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact COPD in Africa
Education seminar for junior doctors.
Year(s) Of Engagement Activity 2016
 
Description Pan African Thoracic Society, Kenya 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The development and implementation of a Lung Health programme for rural Uganda addressing biomass and tobacco smoke
Academic abstract presentation for academic / clinical audience in Africa.
Year(s) Of Engagement Activity 2016
 
Description Pan African Thoracic Society, Kenya 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Qualitative findings on the implementation of pulmonary rehabilitation in Kampala
Academic abstract presentation for academic / clinical audience in Africa.
Year(s) Of Engagement Activity 2016
 
Description Primary Care Seminar, Plymouth University 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Chronic respiratory disease in Africa: a neglected problem
University seminar.
Year(s) Of Engagement Activity 2015
 
Description Tobacco Dependence Treatment Summit, USA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Training Community Health Workers in Rural Uganda to Introduce Stop Smoking Interventions in a Context of a Lung Health Awareness Campaign
Large Global Bridges meeting in USA, our project was highlighted of of the whole conference as showing the way to use grass roots health workers, not doctors, to deliver an innovative lung health programme.
Year(s) Of Engagement Activity 2016
 
Description Using Qualitative Research in Health Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This seminar provided an opportunity for participants to consider mixed methodological approaches to health research by using the current MRC funded development study as an exemplar.
Year(s) Of Engagement Activity 2015