The FRESH AIR project in Uganda is led by Dr Bruce Kirenga of the Makerere University College of Health Sciences.
Uganda is a low income country which shares characteristics with other Sub-Saharan African countries. Only 12% of Uganda’s population have access to electricity – falling to 2-6% in rural areas. Biomass fuel which is used extensively: wood fuel in rural areas and charcoal in urban. Rates of tobacco consumption are high amongst men. There is very low public awareness of the health dangers of smoke. There is an organised healthcare structure from the village health team to the District Health Officer but the health infrastructure is poor. Many people have limited access to health care professionals and medicines.
IPCRG has been working in Uganda since 2010, developing the original FRESH AIR protocols and concepts. Find out more here, including the original "letters home" from the Principle Investigator of the prevalence survey Frederik van Gemert.
Update March 2017: The Government of Uganda has launched the latest Demographics and Health Survey Report 2016. This complements the Health Sector Development Plan 2015/2016 - 2019/2020. Read more
Dr Bruce Kirenga - Makerere University College of Health Sciences
Dr Kirenga is a respiratory physician with formal training in epidemiology and project planning and management. He has over 10 years’ experience of initiating and coordinating programmatic, training and research health projects.
See the original video of the IPCRG FRESH AIR study here
Summary - for clinicians and researchers
Project Administrator- Shamim Buteme
We talk about Turning the World Upside Down where low income countries have something to reach high income countries about the delivery of health care. But is it real?
Well, here's an illustration.
In the UK we struggle to "sell" the benefits of Pulmonary Rehabilitation to payors or patients. We struggle to provide services that match the evidence because PR is often provided in church halls and community centres with very limited equipment and fewer staff. A group of 12 breathless people with COPD, each with a different body mass index, strength and knowledge in a church hall with some chairs, one set of weights and a few traffic cones. Sound familiar?
But in Uganda there's a unique project underway that may help. Having started with people who have survived TB, a PR programme is being rolled out to people with chronic lung disease in Uganda and then Vietnam, Kyrgyz Republic and Crete.
Applying the principles of implementation science, it is adapting the evidence to the local resource-poor context.
There are two main differences. Here patients do not have access to any inhaled medicines. So, we can see if PR alone can make a difference to their lives. Here, where there is no government safety net, we can also count the benefits of economic productivity and social capital.
Physiotherapist colleagues in the UK may be inspired seeing how patients can benefit and also how adaptations are made to the local context. See a link to a new film here.
For now, the key questions for me are:
- What makes people turn up?
- What makes people complete the programme?
- What elements are transferable anywhere in the world such as endurance exercises?
- What about strength exercises: the ones that train muscles to use less oxygen so more is available for breathing - how can these be calibrated to individuals with very different starting points?
For a practical background to PR see IMPRESS guide to pulmonary rehabilitation
Executive Officer, IPCRG
FRESH AIR WP7 lead