The burden of bladder outlet obstruction in men in rural Uganda
Bibliographic record
Abstract
A patient with indwelling suprapubic catheter drainage due to late diagnosis of advanced BOO in Uganda. The realities of daily living in much of the developing world make maintenance of hygiene a challenge due to limited access to clean water and sanitation. Drugs available in a rural Ugandan medical clinic recommended for treatment of BOO. Investigators meet participants wanting to enroll in the Ugandan burden of disease survey. Men recruited at a rural community site. A participant recruited when attending a local medical clinic. Broadcasting information about the community-based survey via a radio talk show. Recruitment at remote rural sites involved extensive travel. A participant reporting his symptoms using the picture-based visual score (left), after completing the IPSS (right) by interview. Health education related to BOO was consistently sought during debriefing sessions for survey participants. Participants liked the visual symptom score and provided input on clarity of the pictures used. A considerable decrease in mortality from BOO has been achieved in the developed world through improvements in surgical and medical management. This decrease in mortality was reported as ‘A major unheralded health triumph’ in 1996, and the statement was made that high mortality rates in low-resource environments could be lowered by (i) education and (ii) ‘widespread availability’ of modern treatment.5 At the time, ‘modern treatment’ primarily meant surgery, but today international guidelines recommend drug therapy which can reduce morbidity in BOO by > 2-fold.6,7 Importantly, the drugs recommended are available and inexpensive in the developing world. However, educational barriers and limited knowledge that treatment is effective early in the disease restrict access to therapy, preventing meaningful impact on morbidity and mortality. We conducted the first community-based quantitative assessment of the burden of BOO in Africa as a first step in increasing awareness, facilitating early diagnosis and enabling patients to access effective but under-utilized medical therapy. The objective of this cross-sectional survey in rural Uganda was to compare the burden of disease due to LUTS in men > 50 years of age living in the community (N = 238) with a second cohort seeking treatment at a medical clinic (N = 177). We used two recruitment strategies: radio phone-in talk shows to promote clinic attendance, and community outreach travel to survey patients in rural areas. The WHO-endorsed International Prostate Symptom Score (IPSS), which quantifies symptoms and quality of life, was administered via interview.8 Usually the IPSS is self-administered, but literacy and language are barriers to completion this way. So with clinic participants we compared the IPSS to a newer visual score9 where pictures illustrating urinary tract symptoms allow quantification of four of the eight IPSS questions. Our data show that the frequency and negative impact of LUTS are high in the community, in keeping with WHO estimates, but that the burden of disease is greater than previously recognized, as by the time patients ultimately seek care their symptoms are severe due to advanced disease. Health education about BOO was welcomed at workshops to debrief participants. The visual symptom score was popular, showed validity and warrants further development. The people (identifiable) photographed have given their consent for their pictures to be used in the dissemination and publication of this research. This work was supported in part by a Stars in Global Health award from Grand Challenges Canada. Conflict of interest: All authors declare no conflict of interest. We acknowledge the contributions made by the participants in this community-based survey and the assistance provided by local clinic staff in the interview and data collection process, especially by Henry and Isaac.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".