Hospital In Uganda Research Articles

The optimal duration of continuous respiratory rate monitoring to predict in-hospital mortality within seven days of admission – A pilot study in a low resource setting

BackgroundCurrently there are no established benefits from the continuous monitoring of vital signs, and the optimal time period for respiratory rate measurement is unknown. SettingLow resource Ugandan hospital, MethodsProspective observational study. Respiratory rates of acutely ill patients were continuously measured by a piezoelectric device for up to seven hours after admission to hospital. Results22 (5.5%) out of 402 patients died within 7 days of hospital admission. The highest c-statistic of discrimination for 7-day mortality (0.737 SE 0.078) was obtained after four hours of continuously measured respiratory rates transformed into a weighted respiratory rate score (wRRS). After seven hours of measurement the c-statistic of the wRRS fell to 0.535 SE 0.078. 20% the patients who died within seven days did not have an elevated National Early Warning Score (NEWS) on admission but were identified by the 4-hour wRRS. None of the 88 patients whose average respiratory rate remained between 12 and 20 bpm throughout four hours of observation died within 7 days of admission. A simple predictive model that included the four-hour wRRS, Shock Index and altered mental status had a c-statistic for 7-day in-hospital mortality of 0.843 SE. 0.057. ConclusionFour hours of continuously measured respiratory rates was the observation period that best predicted 7-day in-hospital mortality. After four hours the discrimination of a weighted respiratory rate score deteriorated rapidly.

Administration patterns of magnesium sulphate for women with preeclampsia and immediate newborn outcomes in Kawempe National Referral Hospital-Uganda: a cohort study.

Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates. This was an analyticalobservational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes. Overall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01-1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06-0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03-3.05) decreased the likelihood of having low Apgar scores at five minutes. Timely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery.

Active tuberculosis disease among people living with HIV on ART who completed tuberculosis preventive therapy at three public hospitals in Uganda.

Tuberculosis (TB) preventive therapy (TPT) reduces the incidence of TB among people living with the human immunodeficiency virus (PLHIV). However, despite an increase in TPT uptake, TB/HIV coinfection remains stagnant in Uganda especially in areas of increasing HIV incidence such as the Bunyoro sub-region. This study was a retrospective review records (antiretroviral therapy [ART] files) of PLHIV who were active on ART and completed TPT in 2019/2020 at three major hospitals in the Bunyoro sub-region, Uganda: Masindi General Hospital, Hoima Regional Referral Hospital, and Kiryandongo General Hospital. The sample size (987) for each facility was determined using a proportionate sampling method to ensure the study's power and precision. Factors independently associated with acquiring TB disease post TPT were determined using modified Poisson regression analysis. An adjusted prevalence risk ratio (aPRR) with corresponding 95% confidence intervals were reported. The participants' mean age was 38.23 (±11.70) and the majority were female (64.94%). Overall, 9.63% developed active TB disease post TPT completion. In the adjusted analysis, factors associated with active TB disease were a history of an unsuppressed viral load after TPT (aPRR 4.64 (2.85-7.56), p<0.001), opportunistic infections after TPT completion (aPRR 4.31 (aPRR 2.58-7.2), p<0.001), a history of TB active TB disease (aPRR 1.60 (1.06-2.41), p = 0.026), and chronic illness during or after TPT (aPRR 1.68 (1.03-2.73), p = 0.038). To reduce the development of TB disease post TPT thereby improving the effectiveness of TPT, ART adherence should be emphasized to resolve viral suppression and active management of chronic and opportunistic infections. Further clinical management consideration and research is needed for PLHIV who receive TPT but have a previous history of TB disease.

Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study.

It is projected that drug-resistant infections will lead to 10 million deaths annually by 2050 if left unabated. Despite this threat, surveillance data from resource-limited settings are scarce and often lack antimicrobial resistance (AMR)-related clinical outcomes and economic burden. We aim to build an AMR and antimicrobial use (AMU) data warehouse, describe the trends of resistance and antibiotic use, determine the economic burden of AMR in Uganda, and develop a machine learning algorithm to predict AMR-related clinical outcomes. The overall objective of the study is to use data-driven approaches to optimize antibiotic use and combat antimicrobial-resistant infections in Uganda. We aim to (1) build a dynamic AMR and antimicrobial use and consumption (AMUC) data warehouse to support research in AMR and AMUC to inform AMR-related interventions and public health policy, (2) evaluate the trends in AMR and antibiotic use based on annual antibiotic and point prevalence survey data collected at 9 regional referral hospitals over a 5-year period, (3) develop a machine learning model to predict the clinical outcomes of patients with bacterial infectious syndromes due to drug-resistant pathogens, and (4) estimate the annual economic burden of AMR in Uganda using the cost-of-illness approach. We will conduct a study involving data curation, machine learning-based modeling, and cost-of-illness analysis using AMR and AMU data abstracted from procurement, human resources, and clinical records of patients with bacterial infectious syndromes at 9 regional referral hospitals in Uganda collected between 2018 and 2026. We will use data curation procedures, FLAIR (Findable, Linkable, Accessible, Interactable and Repeatable) principles, and role-based access control to build a robust and dynamic AMR and AMU data warehouse. We will also apply machine learning algorithms to model AMR-related clinical outcomes, advanced statistical analysis to study AMR and AMU trends, and cost-of-illness analysis to determine the AMR-related economic burden. The study received funding from the Wellcome Trust through the Centers for Antimicrobial Optimisation Network (CAMO-Net) in April 2023. As of October 28, 2024, we completed data warehouse development, which is now under testing; completed data curation of the historical Fleming Fund surveillance data (2020-2023); and collected retrospective AMR records for 599 patients that contained clinical outcomes and cost-of-illness economic burden data across 9 surveillance sites for objectives 3 and 4, respectively. The data warehouse will promote access to rich and interlinked AMR and AMU data sets to answer AMR program and research questions using a wide evidence base. The AMR-related clinical outcomes model and cost data will facilitate improvement in the clinical management of AMR patients and guide resource allocation to support AMR surveillance and interventions. PRR1-10.2196/58116.

Assessment of Facility Readiness for Pediatric Emergency and Critical Care Utilizing a 2-Phase Survey Conducted in Six Hospitals in Uganda and Cameroon: A Quality Improvement Study.

Each year, 5.3 million children under 5 years of age die in low-resource settings, often due to delayed recognition of disease severity, inadequate treatment, or a lack of supplies. We describe the use of a comprehensive digital facility-readiness survey tool, recently developed by the Pediatric Sepsis Data CoLaboratory, which aims to identify target areas for quality improvement related to pediatric emergency and critical care. Facility-readiness surveys were conducted at six sub-Saharan African hospitals providing pediatric emergency and critical care in Uganda (n = 4) and Cameroon (n = 2). The tool is a 2-phase survey to assess readiness to provide pediatric essential emergency and critical care: (1) an "environmental scan," focusing on infrastructure, availability, and functionality of resources, and (2) an "observational scan" assessing the quality and safety of care through direct observation of patients receiving treatment for common diseases. Data were captured in a mobile application and the findings analyzed descriptively. Varying levels of facility readiness to provide pediatric emergency care were observed. Only 1 of 6 facilities had a qualified staff member to assess children for danger signs upon arrival, and only 2 of 6 had staff with skills to manage emergency conditions. Only 21% of essential medicines required for pediatric emergency and critical care were available at all six facilities. Most facilities had clean running water and soap or disinfectants, but most also experienced interruptions to their electricity supply. Less than half of patients received an appropriate discharge note and fewer received counseling on postdischarge care; follow-up was arranged in less than a quarter of cases. These pilot findings indicate that facilities are partially equipped and ready to provide pediatric emergency and critical care. This facility-readiness tool can be utilized in low-resource settings to assist hospital administrators and policymakers to determine priority areas to improve quality of care for the critically ill child.

Isoniazid Preventive Therapy Adherence and Its Predictors Among Soldiers on HIV Antiretroviral Therapy at a General Military Hospital in Uganda.

Uganda faces a significant dual challenge with tuberculosis (TB), ranking among these countries most affected by the disease worldwide. The World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for managing latent TB. However, the adherence to IPT in military settings remains under-explored in Uganda. This study aims to assess IPT adherence and identify its predictors among soldiers undergoing HIV antiretroviral therapy at a General Military Hospital in Uganda. We conducted a cross-sectional study involving 300HIV-positive soldiers receiving antiretroviral therapy (ART) at the General Military Hospital in Uganda. Due to the small sample size, we employed a consecutive sampling method. We utilized descriptive statistics and modified Poisson regression model for prevalence of IPT adherence and associated factors respectively. Among the 300 clients, the prevalence of isoniazid preventive therapy (IPT) was 94.7%, 95% CI: 92.1-97.2; adherence to IPT was associated with being aged ≥ 50 years, with a prevalence ratio (PR) of 1.061 and 95% CI: 1.01-1.12; being married, with a PR of 1.438, 95% CI:1.12-1.84; having social support, with a PR of 1.498, 95% CI:1.17-1.92; and having social support played a significant role in IPT adherence among married participants, with a PR of 0.817,95% CI:0.72-0.93. To enhance adherence to isoniazid preventive therapy among young soldiers with HIV, targeted interventions are crucial, as older individuals tend to adhere better. Implementing marital support programs and strengthening community engagement can bolster adherence through social support networks. Educational campaigns should focus on the importance of IPT, while regular follow-ups will ensure effective monitoring and support. Further research is needed to explore how social support can mitigate stigma associated with HIV. The findings highlight the importance of improving IPT adherence among married soldiers and suggest that this approach could be effective in other low-resource settings.

Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study

BackgroundHigh rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.Materials and methodsThis was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.ResultsOf the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001).ConclusionsThe study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

The Universal Vital Assessment (UVA) score at 6 hours post-resuscitation predicts mortality in hospitalized adults with severe sepsis in Mbarara, Uganda.

Sepsis is the leading cause of global death with the highest burden found in sub-Saharan Africa (sSA). The Universal Vital Assessment (UVA) score is a validated resource-appropriate clinical tool to identify hospitalized patients in sSA who are at risk of in-hospital mortality. Whether a decrease in the UVA score over 6 hours of resuscitation from sepsis is associated with improved outcomes is unknown. We aimed to determine (1) the association between 6-hour UVA score and in-hospital mortality, and (2) if a decrease in UVA score from admission to 6 hours was associated with improved in-hospital mortality. We analyzed data from participants with severe sepsis aged ≥14 years enrolled at the Mbarara Regional Referral Hospital in Uganda from October 2014 through May 2015. Among 197 participants, the median (interquartile range) age was 34 (27-47) years, 99 (50%) were female and 116 (59%) were living with HIV. At 6 hours, of the 65 participants in the high-risk group, 28 (43%) died compared to 28 (30%) of 94 in the medium-risk group (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.29,1.08, p = 0.086) and 3 (9%) of 33 in the low-risk group (OR 0.13, 95% CI 0.03, 0.42, p = 0.002). In a univariate analysis of the 85 participants who improved their UVA risk group at 6 hours, 20 (23%) died compared to 39 (36%) of 107 participants who did not improve (OR 0.54, 95% CI 0.27-1.06, p = 0.055). In the multivariable analysis, the UVA score at 6 hours (adjusted OR [aOR] 1.26, 95%CI 1.10-1.45, p<0.001) was associated with in-hospital mortality. When adjusted for age and sex, improvement in the UVA risk group over 6 hours was associated with a non-statistically significant 43% decrease in odds of mortality (aOR 0.57, 95%CI 0.29-1.07, p = 0.08). Targeting a decrease in UVA score over 6 hours from admission may be a useful clinical endpoint for sepsis resuscitation in sSA, but this would need to be proven in a clinical trial.

Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches.

Hand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed. We implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO's infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO's Five Moments of HH. By the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs' HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO's HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF b = -0.0004 (95% CI -0.093, 0.93) p = 0.990, HHSAF b = 0.009 (95% CI -.0127, 0.145) p = 0.842 and HCW knowledge on HH/IPC b = -0.165 (95% CI 0.815, 0.485) p = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda. Implementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.

Associations Between Non-communicable Diseases and Obstetric Complications: A Retrospective Records Review at a Tertiary Referral Hospital in Uganda.

Non-communicable diseases (NCDs) increasingly contribute to maternal morbidity and mortality. We determined the association between NCDs and obstetric complications at Mbarara Regional Referral Hospital(MRRH) in southwestern Uganda. In this retrospectiverecords review, we randomly selected records of women admitted for delivery at MRRH each month from January to December 2022,and extracted their socio-demographicand clinical histories. We defined a history of NCDs aschronic hypertension, pre-gestational diabetes, cardiac disease, anemia, or asthma. We performeda multivariaterobust Poisson regression analysis to assess the association between NCDs and obstetric complications, including preeclampsia, gestational diabetes, venous thromboembolic disease, obstetric hemorrhage, and preterm labor. Models were adjusted for maternal age, gravidity, referral status, employment status, andhumanimmunodeficiencyvirus (HIV) serostatus. Weextracteddata for 2,336 women with a mean age of 26±5.9 years. At least one NCD was present in 6.4% (n=149) of the patients,includinganemia (n=77, 3.3%), chronic hypertension (n=35, 1.5%), pre-gestational diabetes (n=16, 0.7%), asthma (n=9, 0.4%), and cardiac disease (n=6, 0.3%). Overall, 542 (23.2%) women had obstetric complications, including preeclampsia (n=265, 11.3%), preterm labor (n=67, 2.9%), placental abruption (n=29, 1.2%), postpartum hemorrhage (PPH) (n=54, 2.3%), and gestational diabetes (n=5, 0.2%). Women with NCDs had an increased likelihood of having an obstetric complication compared to women without (overall proportion 33.6% vs 22.5% respectively); adjusted prevalence ratio (aPR) was 1.8 (95% CI: 1.4-2.3) overall, 1.8 (95%CI: 1.2-2.8) for preeclampsia, 12.0 (95%CI: 2.0-72.7) for gestational diabetes, 6.0 (95%CI: 1.3-27.1) for deep venous thrombosis, 4.4 (95%CI: 1.5-12.6) for placenta abruption, and 4.3 (95%CI: 2.2-8.3) for PPH. We found that NCDs were associated with a nearly two-fold increase in the risk of obstetric complications. Our findings highlight the need for further research to understand the impact of this risk, particularly on maternal and fetal outcomes. Additionally, these findings suggest strengthened NCD surveillance, as a means of increasing preparedness, and management of potential obstetric complications among pregnant women in Uganda.

Low prevalence of soil transmitted helminth infection in Ugandan children hospitalized with severe malaria.

Co-infection by intestinal helminths and Plasmodium spp. may be common in endemic communities. Several studies have identified a relationship between helminth infection, Plasmodium spp. infection and malaria severity. However, the relationship is not well defined, and results are inconclusive. We analyzed 202 stool samples from a cohort of children with severe malaria enrolled in two hospitals in Uganda from 2014-2017 and asymptomatic community children from the same household or neighborhood and enrolled at the same time, all 6 months to 48 months of age. We investigated if intestinal helminth infection modified risk of severe malaria. We extracted nucleic acids from stool and tested them for six helminth species ( Anyclostoma duodenale, Ascaris lumbricoides, Necator americanus, Strongyloides stercolaris, Trichuris trichiura, Shistosoma mansoni ) using highly sensitive quantitative PCR. We found a low prevalence of infection by ≥1 intestinal helminth species in children with severe malaria (5.1%, n=9/177) and community control children (4.0%, n=1/25). Infection by ≥1 of the helminths assessed was not associated with severe malaria (aRR = 1.0, 95% Confidence Interval = 0.82, 1.3, p = 0.78). In 2003 Uganda instituted a national deworming program, with anti-helminth medication provided twice annually to children 6 months to 5 years of age. In these areas of Uganda, the national deworming campaign has been highly successful, as stool-based helminth infection was rare even when using highly sensitive methods of detection and was not a major contributor to risk of severe malaria.

Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study.

Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.

OTHR-04 PATIENT SATISIFACTION WITH NURSING CARE AMONG PEDIATRIC CANCER PATIENTS ATTENDING UGANDA CANCER INSTITUTE MULAGO KAMPALA UGANDA

Abstract PURPOSE To assess the level of patients’ satisfaction with nursing care among pediatric cancer patients attending Uganda Cancer Institute in order to improve the quality of oncology services provided by the nurses to the pediatric patients at UCI. INTRODUCTION Patient satisfaction is significant and usually used as an indicator for measuring the degree of excellence in health care. Patient satisfaction is the patient’s perception of care received compared with the care expected. A survey carried out by the Ministry of Health (MoH) in 2020 showed that more than half of the patients who visit Ugandan hospitals have to wait for more than an hour before they can see a health worker only to be told there’s no medicine or equipment to assist in their diagnosis. A number of studies have been conducted, however, there was little information on patients’ satisfaction with nursing care among pediatric cancer patients attending Uganda Cancer Institute and this left grey area for the researcher to conduct the study in this health facility. METHODS The study was done among sample size of fifty-six (56) respondents who were the caregivers of children between 0-17 years getting treatment at UCI. A cross sectional study design was used for this research, quantitative method of data collection using a questionnaire. RESULTS The study findings showed the respondents largely were satisfied with nursing care but problems of accessing clean water for drinking (52%), failure to give diagnostic talk (68%), no comfortable rooms for privacy (52%), nurse patient ratio at (63%) and nurses’ failure to give follow up calls (84%) were among the dissatisfactions. CONCLUSION The researcher concluded majority of respondents were satisfied with nursing care at UCI pediatrics nursing care. However, they expressed dissatisfactions in some crucial areas that need immediate attention of the hospital management.

Uncovering patient dissatisfaction with Healthcare Services at a tertiary hospital in Uganda: Patient perspective in a descriptive cross-sectional study

Introduction: Patient satisfaction is a widely recognized standard for assessing the effectiveness of healthcare services in hospitals. This study aimed to discover factors associated with patient dissatisfaction with healthcare services offered at Masaka Regional Referral Hospital, Masaka District-Uganda. Methods: A descriptive cross-sectional study that employed quantitative data collection methods was conducted between February and March 2024. Using Systematic random sampling, 384 study participants were included. Data was collected using an interviewer-administered questionnaire analyzed and presented using Microsoft Excel 2019 Version. Results: Most respondents 120 (31.25%) were aged between 31-40 years, 56.77% were females, 67.71 were married or cohabiting with the majority of respondents in low-income class and, 194(50.53%) having a monthly income of less than 100,000Ug. Shs. As (53.13%) were unemployed, 221 (57.55%) were rural residents, and the majority 248(65%) traveled long distances of greater than 10 kilometers to reach the Hospital. The majority of respondents 298(77.61%) disagreed that there was an adequate seating area, the majority of respondents 304(79.17%) waited for long hours before getting services and 204(53.12%) disagreed upon being given adequate time and information regarding their health and 174(45.31%) reported that HCWs were rude to them. Conclusions: Majority of respondents were dissatisfied with the services they had received at the hospital as most of them 208(54.17%) rated the services provided as poor. Therefore, there should be Implementation of targeted Interventions to address socio-demographic disparities, Enhance Patient-Centered Care and Communication Practices, optimization of health institutional practices to improve service delivery, and further research studies are recommended to better understand the gaps in patient satisfaction with healthcare services in Uganda.

Factors associated with completion of intensive adherence counseling among people living with HIV at a large referral hospital in Uganda: a retrospective analysis

BackgroundAmong people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda.MethodsIn this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI).ResultsWe studied 420 participants of whom 204 (48.6%) were aged 20–39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64–0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67–0.87), malnutrition (aRR 0.65, 95% CI 0.43–0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01–1.49) was associated with a higher likelihood of IAC completion.ConclusionsWe found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

HIV and body mass index are associated with prolonged corrected QT interval among people with drug-resistant tuberculosis on bedaquiline-containing regimen in Uganda

ObjectivesPeople with drug-resistant tuberculosis (DR-TB) on bedaquiline-containing regimens are at risk for a prolonged corrected QT (QTc) interval but this problem is understudied in low-resource countries. We determined the magnitude and risk factors for QTc interval prolongation among people with DR-TB on bedaquiline-containing regimens at three referral hospitals in Uganda. MethodsUsing retrospectively collected data, we designed a matched case-control study, with cases as participants with prolonged QTc interval and controls as those with normal QTc interval in 1:1. QTc interval prolongation was defined as an increase in QTc interval by 60 milliseconds in electrocardiogram from the baseline or ≥500 milliseconds during follow-up for men and women. Factors associated with cases compared with controls were identified using a multivariable conditional regression analysis at a 5% significance level, reported using odds ratio (OR) and the 95% confidence interval (CI). ResultsOf 153 participants, 39 (25.5%) had a prolonged QTc interval. We matched 30 participants with prolonged QTc interval (cases) with 30 participants with normal QTc interval (controls). Cases and controls were similar in several sociodemographic and clinical characteristics but different regarding the baseline body mass index (BMI), baseline weight, and HIV infection. Increasing BMI (adjusted OR 1.29, 95% CI 1.02-1.63) and HIV infection (adjusted OR 0.27, 95% CI 0.08-0.96) were associated with the cases compared with the controls. ConclusionsWe found a relatively high prevalence of QTc interval prolongation among people with DR-TB on a bedaquiline-containing regimen compared with the prevalence in healthy individuals, with a higher likelihood in those with increasing BMI and a lower likelihood in those with HIV. We recommend routine anthropometric measurements to identify individuals with DR-TB at a high risk for QTc interval prolongation. In addition, tuberculosis/HIV treatment guidelines for people with DR-TB on bedaquiline-containing regimens should include risk assessment for prolonged QTc intervals.

Improving effective coverage of medical-oxygen services for neonates and children in health facilities in Uganda: a before–after intervention study

Medical oxygen services are essential for the care of acutely unwell patients. We aimed to assess the effects of a multilevel, multicomponent health-system intervention on hypoxaemia detection, oxygen therapy, and mortality among neonates and children attending level IV health centres and hospitals in Uganda. For this before-after intervention study, we included children who attended paediatric or neonatal wards of 24 level IV health centres and seven general or regional referral hospitals in the Busoga and North Buganda regions of Uganda between June 1, 2020, and June 30, 2022. All neonates younger than 1 month and children aged 1 month to 14 years were eligible for inclusion. We excluded neonates who were not sick but stayed in the maternity ward for routine postnatal care. The intervention involved clinical training, mentorship, and supportive supervision; provision of pulse oximeters and cylinder-based oxygen sources; biomedical-capacity support; and support to develop and disseminate oxygen supply strategies, oxygen therapy guidelines, and lists of essential oxygen supplies. Trained research assistants extracted individual patient data from case notes using a standardised electronic data collection form. Data were collected on health-facility details, age, sex, clinical signs and symptoms, admission diagnoses, pulse oximetry readings, oxygen therapy details, and final patient outcome. The primary outcome was the proportion of admitted neonates and children with a pulse oximetry oxygen saturation reading documented in their patient case notes on day 1 of health-facility admission (ie, pulse oximetry coverage). We used mixed-effects logistic regression to evaluate the effect of the intervention. We obtained data on 71 997 eligible neonates and children admitted to 31 participating health facilities; the primary analysis included 10 001 patients in the pre-intervention period (ie, June 1 to Oct 30, 2020) and 51 329 patients in the post-intervention period (ie, March 1, 2021, to June 30, 2022). Because 1356 patients had missing data for sex, 4365 (46·7%) of 9347 in the pre-intervention group and 22 831 (46·2%) of 49 410 in the post-intervention group were female; 4982 (53·3%) in the pre-intervention group and 26 579 (53·8%) in the post-intervention group were male. The proportion of neonates and children with pulse oximetry at admission increased from 2365 (23·7%) of 10 001 in the pre-intervention period to 45 029 (87·7%) of 51 328 in the post-intervention period. Adjusted analysis indicated greater likelihood of a patient receiving pulse oximetry during the post-intervention period compared with the pre-intervention period (adjusted odds ratio 40·10, 95% CI 37·38-42·93; p<0·0001). Large-scale improvements in hospital oxygen services are achievable and have the potential to improve clinical outcomes. Governments should be encouraged to develop national oxygen plans and focus investment on interventions that have been shown to be effective, including the introduction of pulse oximetry into routine hospital care and clinical and biomedical mentoring and support. Bill & Melinda Gates Foundation and ELMA Philanthropies. For the Luganda and Lusoga translations of the abstract see Supplementary Materials section.

Impact of postpartum maternal fever or hypothermia on newborn and early infant illness and death in Southwestern Uganda

BackgroundDeaths occurring during the neonatal period contribute close to half of under-five mortality rate (U5MR); over 80% of these deaths occur in low- and middle-income countries (LMICs). Poor maternal antepartum and perinatal health predisposes newborns to low birth weight (LBW), birth asphyxia, and infections which increase the newborn’s risk of death.MethodsThe objective of the study was to assess the association between abnormal postpartum maternal temperature and early infant outcomes, specifically illness requiring hospitalisation or leading to death between birth and six weeks’ age. We prospectively studied a cohort of neonates born at Mbarara Regional Referral Hospital in Uganda to mothers with abnormal postpartum temperature and followed them longitudinally through early infancy. We performed a logistic regression of the relationship between maternal abnormal temperature and six-week infant hospitalization, adjusting for gestational age and 10-minute APGAR score at birth.ResultsOf the 648 postpartum participants from the parent study who agreed to enrol their neonates in the sub-study, 100 (15%) mothers had abnormal temperature. The mean maternal age was 24.6 (SD 5.3) years, and the mean parity was 2.3 (SD 1.5). There were more preterm babies born to mothers with abnormal maternal temperature (10%) compared to 1.1% to mothers with normal temperature (p=˂0.001). While the majority of newborns (92%) had a 10-minute APGAR score > 7, 14% of newborns whose mothers had abnormal temperatures had APGAR score ˂7 compared to 7% of those born to mothers with normal postpartum temperatures (P = 0.02). Six-week outcome data was available for 545 women and their infants. In the logistic regression model adjusted for gestational age at birth and 10-minute APGAR score, maternal abnormal temperature was not significantly associated with the composite adverse infant health outcome (being unwell or dead) between birth and six weeks’ age (aOR = 0.35, 95% CI 0.07–1.79, P = 0.21). The 10-minute APGAR score was significantly associated with adverse six-week outcome (P < 0.01).ConclusionsWhile our results do not demonstrate an association between abnormal maternal temperature and newborn and early infant outcomes, good routine neonate care should be emphasized, and the infants should be observed for any abnormal findings that may warrant further assessment.Target journalBMC Pregnancy and Childbirth (https://bmcpregnancychildbirth.biomedcentral.com/).

Draft genome sequence of Acinetobacter haemolyticus strain MUWRP1017 isolated from the pus of a female inpatient at Bwera General Hospital in Uganda.

The bacterium Acinetobacter haemolyticus, with a genome size of 3.4 Mb, was isolated from a pus swab of a wound on the left lower limb above the ankle joint of a female patient. This strain carries the antimicrobial resistance genes cephalosporinase blaADC-25, oxallinase blaOXA-264, floR, and sul2 and other resistance and virulence genes.