{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:59Z","timestamp":1787022179032,"version":"build-2736575974"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS118544"],"award-info":[{"award-number":["R01NS118544"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS118544"],"award-info":[{"award-number":["R01NS118544"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Among low and middle-income countries, especially in Sub-Saharan Africa, the stroke burden is severe, with increasing trends in stroke incidence, prevalence, and mortality.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n This 6-month, prospective randomized controlled trial (RCT) compared a novel stroke risk reduction approach (TargetEd manAgeMent Intervention (TEAM)) vs. Enhanced Treatment as Usual (ETAU) in 247 Ugandans at risk for stroke.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Participants, enrolled across 3 Ugandan sites, were adults with high stroke risk. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 6-month follow-up. Secondary outcomes included changes from baseline to 6 months on diastolic BP (DBP), serum lipids, glycosylated hemoglobin (HbA1c), self-efficacy and stress.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The mean sample age was 55.4 (\u00b1SD\u2009=\u200912.0) with majority being women (n\u2009=\u2009168, 68%). In addition to hypertension, the most common risk factors were hyperlipidemia (n\u2009=\u2009199, 80.6%) and obesity (n\u2009=\u200998, 39.7%). Overall mean SBP and DBP at baseline were 143.0 (SD\u2009=\u200919.8, range 94.5\u2013206) and 89.3 (SD\u2009=\u200914.0, range 61\u2013136) respectively. In TEAM, SBP significantly improved from 145.7 (\u00b121.5) at baseline to137.4 (\u00b118.1) at 6-months vs. change from 141.9 (\u00b118.4) to 141.1 (\u00b121.9) for ETAU (p\u2009=\u20090.031). There were similar reductions in DBP favoring TEAM (p\u2009=\u2009.012). Compared to ETAU, TEAM showed improved physical activity (p\u2009=\u2009.017), self-efficacy (p\u2009<\u2009.001) and stress (p\u2009=\u2009.014).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There is a need for effective and practical approaches to reduce stroke burden in Sub-Saharan Africa. Inclusion of the TEAM approach in primary care seems to be a pragmatic and effective way to potentially reduce stroke burden in Uganda.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n ClinicalTrials.gov identifier:\n NCT04685408<\/jats:ext-link>\n , registered on 28 December 2020.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0330606","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:25:36Z","timestamp":1755883536000},"page":"e0330606","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["A 6-month, prospective randomized controlled trial of the TargetEd MAnageMent (TEAM) intervention vs. enhanced treatment as usual among Ugandans at risk for stroke"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7390-7330","authenticated-orcid":true,"given":"Mark","family":"Kaddumukasa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kaddumukasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4945-130X","authenticated-orcid":true,"given":"Scovia 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Chukwudelunzu","year":"2024","journal-title":"AN"},{"key":"pone.0330606.ref003","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/309106","article-title":"Knowledge and perception of stroke: a population-based survey in Uganda","volume":"2014","author":"J Nakibuuka","year":"2014","journal-title":"ISRN Stroke"},{"issue":"5","key":"pone.0330606.ref004","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1161\/STROKEAHA.118.020783","article-title":"Stroke Among Young West Africans: Evidence From the SIREN (Stroke Investigative Research and Educational Network) Large Multisite Case-Control Study","volume":"49","author":"FS Sarfo","year":"2018","journal-title":"Stroke"},{"key":"pone.0330606.ref005","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2147\/JBM.S406196","article-title":"A critical review of sickle cell disease burden and challenges in Sub-Saharan Africa","volume":"14","author":"OP Adigwe","year":"2023","journal-title":"J Blood Med"},{"issue":"9","key":"pone.0330606.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0138991","article-title":"The epidemiology of hypertension in Uganda: findings from the national non-communicable diseases risk factor survey","volume":"10","author":"D Guwatudde","year":"2015","journal-title":"PLoS One"},{"issue":"11","key":"pone.0330606.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0206548","article-title":"Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action","volume":"13","author":"C Jenkins","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0330606.ref008","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1055\/s-0039-1700601","article-title":"Stroke Happens Suddenly so It Cannot Be Prevented: A Qualitative Study to Understand Knowledge, Attitudes, and Practices about Stroke in Rural Gadchiroli, Maharashtra, India","volume":"11","author":"Y Kalkonde","year":"2020","journal-title":"J Neurosci Rural Pract"},{"key":"pone.0330606.ref009","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jns.2017.12.032","article-title":"Feasibility study of a targeted self-management intervention for reducing stroke risk factors in a high-risk population in Uganda","volume":"386","author":"M Kaddumukasa","year":"2018","journal-title":"J Neurol Sci"},{"issue":"6","key":"pone.0330606.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0251662","article-title":"Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial","volume":"16","author":"M Kaddumukasa","year":"2021","journal-title":"PLoS One"},{"key":"pone.0330606.ref011","doi-asserted-by":"crossref","first-page":"74","DOI":"10.14740\/jnr830","article-title":"Demographics and clinical correlates of blood pressure among Ugandans at risk for stroke","volume":"14","author":"M Sajatovic","year":"2024","journal-title":"J Neurol Res"},{"key":"pone.0330606.ref012","doi-asserted-by":"crossref","DOI":"10.1007\/978-94-009-2792-6_2","volume-title":"Self-regulation of motivation and action through goal systems","author":"A Bandura","year":"1988"},{"key":"pone.0330606.ref013","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195325492.001.0001","volume-title":"Intervention Research. Developing Social Programs","author":"MW Fraser","year":"2009"},{"issue":"1","key":"pone.0330606.ref014","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1017\/S1368980007000146","article-title":"Development and validation of a short questionnaire to assess sodium intake","volume":"11","author":"KE Charlton","year":"2008","journal-title":"Public Health Nutr"},{"key":"pone.0330606.ref015","unstructured":"World Health Organization. Global Physical Activity Surveillance. Available from: http:\/\/www.who.int\/chp\/steps\/GPAQ\/en\/"},{"key":"pone.0330606.ref016","unstructured":"Centers for Disease Control and Prevention. The Global Tobacco Surveillance System (GTSS). Available from: http:\/\/www.cdc.gov\/tobacco\/global\/gtss\/"},{"key":"pone.0330606.ref017","volume-title":"The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care","author":"TF Babor","year":"2001"},{"key":"pone.0330606.ref018","volume-title":"Generalized self-efficacy scale","author":"R Schwarzer","year":"1995"},{"key":"pone.0330606.ref019","unstructured":"Centers for Disease Control and Prevention. Global Tobacco Surveillance System Data (GTSSData) Office of Smoking and Health: National Center for Chronic Disease Prevention and Health Promotion. [cited 2023 Apr 4]. Available from: https:\/\/www.cdc.gov\/tobacco\/global\/gtss\/gtssdata\/index.html"},{"issue":"3","key":"pone.0330606.ref020","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000381453","article-title":"Stroke-risk factors differ between rural and urban communities: population survey in central Uganda","volume":"44","author":"J Nakibuuka","year":"2015","journal-title":"Neuroepidemiology"},{"issue":"3","key":"pone.0330606.ref021","first-page":"239","article-title":"Evaluation of the accuracy of the Omron HEM-907 blood pressure device","volume":"63","author":"K Gurpreet","year":"2008","journal-title":"Med J Malaysia"},{"issue":"3","key":"pone.0330606.ref022","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0920-9964(99)00130-9","article-title":"Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses","volume":"42","author":"K Thompson","year":"2000","journal-title":"Schizophr Res"},{"issue":"3","key":"pone.0330606.ref023","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/bcp.12194","article-title":"What are validated self-report adherence scales really measuring?: a systematic review","volume":"77","author":"T-M-U Nguyen","year":"2014","journal-title":"Br J Clin Pharmacol"},{"issue":"10046","key":"pone.0330606.ref024","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0140-6736(16)30506-2","article-title":"Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study","volume":"388","author":"MJ O\u2019Donnell","year":"2016","journal-title":"Lancet"},{"key":"pone.0330606.ref025","doi-asserted-by":"crossref","DOI":"10.5830\/CVJA-2015-038","article-title":"The burden of stroke in Africa: a glance at the present and a glimpse into the future","volume":"26","author":"MO Owolabi","year":"2015","journal-title":"Cardiovasc J Afr"},{"key":"pone.0330606.ref026","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.brainresbull.2018.05.018","article-title":"Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa","volume":"145","author":"RO Akinyemi","year":"2019","journal-title":"Brain Res Bull"},{"key":"pone.0330606.ref027","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.amepre.2005.07.025","article-title":"Stroke prevention, treatment, and rehabilitation in sub-saharan Africa","volume":"29","author":"D Lemogoum","year":"2005","journal-title":"Am J Prev Med"},{"issue":"2","key":"pone.0330606.ref028","doi-asserted-by":"crossref","first-page":"335","DOI":"10.11124\/JBIES-22-00446","article-title":"Stroke prevention strategies in Africa: a scoping review protocol","volume":"22","author":"CI Umeonwuka","year":"2024","journal-title":"JBI Evid Synth"},{"issue":"4","key":"pone.0330606.ref029","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30002-0","article-title":"Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study","volume":"6","author":"MO Owolabi","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"10","key":"pone.0330606.ref030","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/s41582-021-00542-4","article-title":"Stroke in Africa: profile, progress, prospects and priorities","volume":"17","author":"RO Akinyemi","year":"2021","journal-title":"Nat Rev Neurol"},{"issue":"9798","key":"pone.0330606.ref031","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0140-6736(11)61215-4","article-title":"Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey","volume":"378","author":"S Yusuf","year":"2011","journal-title":"Lancet"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:25:42Z","timestamp":1755883542000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330606"}},"subtitle":[],"editor":[{"given":"Toshiki","family":"Maeda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330606","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}