Dementia is the third leading cause of years lived with disability at the global level. About 47 million people globally live with Alzheimer?s disease and its related dementias (AD/ADRD) of which 58% are in low and middle income countries (LMICs). This number is expected to double every 20 years with the burden in LMICs projected to increase to 68% by 2050. AD is the most common dementia, contributing 50?70% of cases. Other dementias include vascular dementia at 20%, Lewy body dementia 15% and frontotemporal dementia 5%. Africa has fastest rate of increase of the population of older persons, and yet data on AD/ADRD is sparse. Uganda has a population estimated at 42 million people of which more than 80% live in hard to reach areas with 4.6% of the population over 60 years of age. Administrative records from the out-patient psychiatry clinic at Mbarara Regional Referral Hospital in a period of one year (2015- 2016) showed that 110 people constituting 2.6% of the patients seen had AD/ADRD. A study of Ugandans aged over 60 years admitted to non-psychiatric wards found that 6.3% had dementia; however this study did not differentiate the types of dementia. It is possible that many patients with AD/ADRD either go unrecognized or do not seek care as the condition is often regarded as part of the normal ageing process. Conducting more studies in AD/ADRD in Uganda will shade more light on the prevalence, burden of formal and informal care, and contribute towards awareness and improvement of care in Uganda. We are therefore proposing the Mbarara Alzheimer?s and related Dementia Research Initiative (MADRI) an administrative supplement to the Mbarara University Research Training Initiative, MURTI (D43TWO10128: PI Celestino Obua) to complement and expand the scope of research in neurology and the other MURTI focus areas of HIV, cardiovascular disease, and mental health to include AD/ADRD. The addition of AD/ADRD to MURTI will enable us form a basis for future research given the paucity of information in this area and its growing importance for the region. This will be achieved through the following training aims: 1) to build capacity of junior faculty to conduct epidemiological studies in AD/ADRD in rural communities, 2) to develop the capacity of junior faculty at MUST to conduct clinical and operational research in AD/ADRD within primary health center (PHC) settings, and 3) to provide educational support to PHC providers in rural southwestern Uganda to recognize, manage and refer clients with AD/ADRD. These will be achieved by adapting the Structured Operational Research and Training IniTiative (SORT IT), an innovative deliverable-driven training approach that uses learning-by-doing pedagogy with intensive hands-on mentorship to build research skills from protocol development to scientific publication. To improve care, we will avail a short course to primary healthcare providers, as public health component, to equip them with basic skills in identification, management and referral of people with AD/ADRD. The MADRI long-term goal is to build capacity of junior faculty to carry out research in AD/ADRD, generate data and improve the care for persons with AD/ADRD in southwest Uganda and the region as a whole.

Public Health Relevance

Training junior faculty at Mbarara University to conduct studies in Alzeimer?s Disease and related Dementias (AD/ADRD) will build research capacity to gather data, raise awareness and improve clinical care of people with the disease in rural southwestern Uganda.

National Institute of Health (NIH)
Fogarty International Center (FIC)
International Research Training Grants (D43)
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Special Emphasis Panel (ZRG1)
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Katz, Flora N
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Mbarara University/Science/ Technology
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