Hospital In Uganda Research Articles

Health Care Workers' Perceived Self-Efficacy to Manage COVID-19 Patients in Central Uganda: A Cross-Sectional Study.

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic placed health workers at the frontline of the emergency task force response; a duty that requires professional expertise and confidence to rapidly identify and treat patients with COVID-19. This study explored perceived self-efficacy (PSE) of health care workers (HCWs) in the management of patients with COVID-19 and associated factors in central Uganda.MethodsWe recruited 418 HCWs from four national referral hospitals in Uganda. Multivariate linear regression analysis was utilized to determine factors associated with PSE. A p-value > 0.05 was considered statistically significant.ResultsMajority of the participants were female, about half were nurses/midwives, and had 10 years of work experience on average. Overall, HCWs reported moderate PSE in managing COVID-19 patients which reduced with increasing severity of the COVID-19 illness. Having a PhD, being a medical doctor, agreeing or completely agreeing that one has knowledge about COVID-19 management, and having COVID-19 management training were significantly associated with increase in one’s level of PSE.ConclusionThis study highlights an unsatisfactory, moderate level of PSE among HCWs in the management of patients with COVID-19 in central Uganda. The health sector should focus on improving HCWs’ self-efficacy through continuous training of all HCWs in the clinical management of especially the severe and critically ill cases of COVID-19. Non-doctor HCWs should be given priority as they scored lower levels of PSE; yet they are the corner stone of the primary health care system and make majority of the health human resource in low- and middle-income countries. Interventions towards creating a safe working environment for HCWs through provision of adequate infection prevention and control strategies are essential in boosting HCWs confidence to manage COVID-19 patients.

Job Satisfaction and Turnover Intentions in Faith-Based Hospitals in Uganda: The Mediation Role of Organizational Commitment

This paper examines job satisfaction, organizational commitment and turnover intentions among health workers in faith-based hospitals in Uganda. The study surveyed 125 nurses from three catholic faith-based hospitals. Hierarchical regression analysis confirmed that job satisfaction has a negative effect on turnover intentions, while affective and normative commitments partially mediate the relationship between job satisfaction and turnover intentions. Female gender, and organizational tenure— 3-9 years, each negatively contributes to turnover intentions, while Registered Comprehensive Nursing positively predicts turnover intentions. The importance of job satisfaction, emotional attachment, and a sense of obligation is emphasised, but the ambiguity and thus negative effect of Registered Comprehensive Nursing is noted.

Unexpected Huge Prevalence of Intracardiac Extension of Wilms Tumor-A Single Center Experience from a Ugandan Hospital.

Wilms tumor (WT) is the most common primary renal malignancy in young children. WT vascular extension to the inferior vena cava (IVC) occurs in 4–10% of cases and can reach the right atrium (RA) in 1%. Data on WT clinical presentation and outcome in developing countries are limited. The aim of the present study is to describe the prevalence of intracardiac extension in a consecutive population of WT patients observed in a large non-profit Ugandan hospital. A total of 16 patients with a histological diagnosis of 29 WT were screened in a 6-month period. Patient n°2, a 3 y/o child, presented with a 3-week history of abdominal distension, difficulty in breathing, and swelling of the lower limbs. A cardiovascular system exam showed rhythmic heart sounds, a heart rate of 110 beats per minute, and a pansystolic murmur on the tricuspid area; the abdomen was grossly distended with a palpable mass in the right flank, hepatomegaly, and splenomegaly. An abdomen ultrasound showed an intra-abdominal tumor, involving the right kidney and the liver and extended to the IVC. An ultrasound guided biopsy showed a picture consistent with WT. Cardiac echo showed a huge, mobile, cardiac mass attached to the right side of the interatrial septum, involving the tricuspid valve annulus, causing a “functional” tricuspid stenosis. The patient died of cardiogenic shock 7 days after admission. Patient n°3, a 3 y/o child, presented with analogue symptoms and the same diagnosis. The cardiac echo showed a round mass in the RA. Thirteen more patients were screened with cardiac echo, showing a normal heart picture. In our limited series, we found WT cardiac extension in three patients over 16 (19%). Cardiac echo performed routinely can lead to a better staging, prognostic, and therapeutic assessment. In our setting, the intra-cardiac extension could be more frequent than previously reported and might have prognostic implications.

Characteristics of antimicrobial stewardship programmes in hospitals of Uganda.

While interest in antimicrobial stewardship programmes (ASPs) is growing in most low- and middle-income countries (LMICs), there is a paucity of information on their adoption or implementation in Africa, particularly Uganda. The study assessed the presence and characteristics of ASPs, implemented antimicrobial stewardship (AMS) strategies and the challenges to their implementation in hospitals in Uganda. We conducted a cross-sectional study among heads of infection prevention committees (IPCs) in regional referral hospitals, general hospitals, and private-not-for-profit (PNFP) hospitals from November 2019 to February 2020. An interviewer-administered questionnaire was used to collect data. We analysed data using descriptive statistics. A total of 32 heads of IPCs were enrolled in the study. Of these, eight were from regional referral hospitals, 21 were from general hospitals, and three were from PNFPs. Most heads of IPC were pharmacists (17/32, 53.1%) with a mean age and standard deviation (sd) of 36.1 (±1.1) years. A formal ASP was adopted or implemented in 14 out of the 32 (44%, 95% CI 26-62) studied hospitals. Thirty out of 32 hospitals implemented at least one type of AMS strategy. Sixty-eight percent (22/32) of the hospitals implemented pre-authorisation and approval as their primary AMS core strategy to optimise antibacterial use. The most commonly reported challenges to the implementation of ASP across all 32 hospitals (with or without ASP) were lack of time for the ASP team (29/32, 90.6%) and lack of allocated funding for antimicrobial stewardship team (29/32, 90.6%). In this study, most hospitals in Uganda implemented at least one AMS strategy despite the low implementation of ASPs in hospitals. The ministry of health needs to sensitise and support the establishment of ASP in hospitals across the country.

Perceptions of Lecturers, Administrators, and Students About the Workplace as Learning Environment for Undergraduate Medical Students at a National Referral and Teaching Hospital in Uganda.

PurposeThe workplace is an important element of the learning ecosystem for medical students during their competence development. It offers engagement opportunities that enable students to participate in clinical activities as part of learning in their preparation for future clinical practice. The purpose of this study was to explore the perceptions and experiences of lecturers, administrators, and students of Makerere University College of Health Sciences about the workplace, at Mulago National Referral and Teaching Hospital, as a learning environment for the undergraduate medical students with the ultimate aim of identifying opportunities and challenges to learner competence development in the learning environment for purposes of improvement.MethodsThe study design was cross-sectional descriptive with a qualitative approach using key informant interviews for the lecturers and administrators and focus group discussions for the students. The framework method was used to perform thematic data analysis.ResultsThe workplace was perceived to be well endowed with adequate patient numbers, a suitable case mix and unrestricted access to patients which enhanced competence development. The challenges reported included inadequate resources, such as infrastructure, equipment and supplies and overcrowding, which compromised competence development. The resource challenge appeared insurmountable in the context of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care.ConclusionThere were mixed perceptions about the learning environment at the hospital with both enabling and challenging factors on the backdrop of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care. In order to improve the workplace as a learning environment, it is imperative that the two institutions find common ground in terms of clinical care, students’ teaching and provision of supplies that are essential not only for patient care but competence development of the learners who are the clinicians of tomorrow.

Investigation on Radiation Protection Status in Hospitals: A case study of selected hospitals in Kampala Uganda

This article discusses a study into the radiation protection status of Ugandan hospitals. Four hospitals with diagnostic radiological capabilities were selected for this inquiry. This study used a questionnaire. The secondary objective was to increase staff awareness of potential radiation health hazards and concerns. Additionally, it was determined important to ascertain radiation workers' level of understanding on radiation protection in order to initiate the process of drafting Ugandan radiological laws, regulations, and codes of practice in this field. The study consists of 92 radiation workers. The study found an acceptable level of occupational radiation monitoring knowledge among radio-diagnostic staff in Kampala Uganda, as well as an acceptable level of radiation monitoring among radio-diagnostic staff in Kampala Uganda, though much work remains to be done on radiation protection practice, as some radiation workers' attitudes toward wearing personnel monitoring devices (dosimeters) were found to be insufficient. Several participants mentioned that their unit lacked personnel monitoring devices. The current study reveals that radiographer' current strategies for reducing radiation exposure to patients and to themselves are ineffective. As a result, corrective measures should be implemented in a systematic and consistent manner to ensure that radiation safety procedures and standards are followed appropriately in radiology departments.

Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children’s education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients’ homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Acute kidney injury in hospitalized children with sickle cell anemia

BackgroundChildren with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifications to the Kidney Disease: Improving Global Outcomes (KDIGO) definition would influence clinical outcomes of AKI in children with SCA hospitalized with a VOC.MethodsWe prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital in Uganda. Kidney function was assessed on admission, 24–48 h of hospitalization, and day 7 or discharge. Creatinine was measured enzymatically using an isotype-dilution mass spectrometry traceable method. AKI was defined using the original-KDIGO definition as ≥ 1.5-fold change in creatinine within seven days or an absolute change of ≥ 0.3 mg/dl within 48 h. The SCA modified-KDIGO (sKDIGO) definition excluded children with a 1.5-fold change in creatinine from 0.2 mg/dL to 0.3 mg/dL.ResultsUsing KDIGO, 90/185 (48.7%) children had AKI with 61/185 (33.0%) AKI cases present on admission, and 29/124 (23.4%) cases of incident AKI. Overall, 23 children with AKI had a 1.5-fold increase in creatinine from 0.2 mg/dL to 0.3 m/dL. Using the sKDIGO-definition, 67/185 (36.2%) children had AKI with 43/185 (23.2%) cases on admission, and 24/142 (16.9%) cases of incident AKI. The sKDIGO definition, but not the original-KDIGO definition, was associated with increased mortality (0.9% vs. 7.5%, p = 0.024). Using logistic regression, AKI risk factors included age (aOR, 1.10, 95% CI 1.10, 1.20), hypovolemia (aOR, 2.98, 95% CI 1.08, 8.23), tender hepatomegaly (aOR, 2.46, 95% CI 1.05, 5.81), and infection (aOR, 2.63, 95% CI 1.19, 5.81) (p < 0.05).ConclusionThese results demonstrate that AKI is a common complication in children with SCA admitted with VOC. The sKDIGO definition of AKI in children with SCA was a better predictor of clinical outcomes in children. There is need for promotion of targeted interventions to ensure early identification and treatment of AKI in children with SCA.

Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial

SummaryBackgroundThe TRACT trial established the timing of transfusion in children with uncomplicated anaemia (haemoglobin 4–6 g/dL) and the optimal volume (20 vs 30 mL/kg whole blood or 10 vs 15 mL/kg red cell concentrates) for transfusion in children admitted to hospital with severe anaemia (haemoglobin <6 g/dL) on day 28 mortality (primary endpoint). Because data on the safety of blood components are scarce, we conducted a secondary analysis to examine the safety and efficacy of different pack types (whole blood vs red cell concentrates) on clinical outcomes.MethodsThis study is a secondary analysis of the TRACT trial data restricted to those who received an immediate transfusion (using whole blood or red cell concentrates). TRACT was an open-label, multicentre, factorial, randomised trial conducted in three hospitals in Uganda (Soroti, Mbale, and Mulago) and one hospital in Malawi (Blantyre). The trial enrolled children aged between 2 months and 12 years admitted to hospital with severe anaemia (haemoglobin <6 g/dL). The pack type used (supplied by blood banks) was based only on availability at the time. The outcomes were haemoglobin recovery at 8 h and 180 days, requirement for retransfusion, length of hospital stay, changes in heart and respiratory rates until day 180, and the main clinical endpoints (mortality until day 28 and day 180, and readmission until day 180), measured using multivariate regression models.FindingsBetween Sept 17, 2014, and May 15, 2017, 3199 children with severe anaemia were enrolled into the TRACT trial. 3188 children were considered in our secondary analysis. The median age was 37 months (IQR 18–64). Whole blood was the first pack provided for 1632 (41%) of 3992 transfusions. Haemoglobin recovery at 8 h was significantly lower in those who received packed cells or settled cells than those who received whole blood, with a mean of 1·4 g/dL (95% CI –1·6 to –1·1) in children who received 30 mL/kg and –1·3 g/dL (–1·5 to –1·0) in those who received 20 mL/kg packed cells versus whole blood, and –1·5 g/dL (–1·7 to –1·3) in those who received 30 mL/kg and –1·0 g/dL (–1·2 to –0·9) in those who received 20 mL/kg settled cells versus whole blood (overall p<0·0001). Compared to whole blood, children who received blood as packed or settled cells in their first transfusion had higher odds of receiving a second transfusion (odds ratio 2·32 [95% CI 1·30 to 4·12] for packed cells and 2·97 [2·18 to 4·05] for settled cells; p<0·001) and longer hospital stays (hazard ratio 0·94 [95% CI 0·81 to 1·10] for packed cells and 0·86 [0·79 to 0·94] for settled cells; p=0·0024). There was no association between the type of blood supplied for the first transfusion and mortality at 28 days or 180 days, or readmission to hospital for any cause. 823 (26%) of 3188 children presented with severe tachycardia and 2077 (65%) with tachypnoea, but these complications resolved over time. No child developed features of confirmed cardiopulmonary overload.InterpretationOur study suggests that the use of packed or settled cells rather than whole blood leads to additional transfusions, increasing the use of a scarce resource in most of sub-Saharan Africa. These findings have substantial cost implications for blood transfusion and health services. Nevertheless, a clinical trial comparing whole blood transfusion with red cell concentrates might be needed to inform policy makers.FundingUK Medical Research Council (MRC) and the Department for International Development.TranslationFor the French translation of the abstract see Supplementary Materials section.

Norepinephrine may improve survival of septic shock patients in a low-resource setting: a proof-of-concept study on feasibility and efficacy outside the Intensive Care Unit

ABSTRACT Septic shock treatment in sub-Saharan African hospitals is challenging due to limited availability of ICUs, central venous catheters, vasopressors, and trained staff. We designed this proof-of-concept study to determine efficacy, safety, and feasibility of norepinephrine (NE) use in a non-intensive setting in a low-resource country, consisting in a peripheral infusion via a mechanical drop counter. Septic shock patients accessing a rural hospital in Uganda were included: the 2020 group (N = 12) was prospectively enrolled (Jan–Mar 2020) when NE was available; the 2019 group (N = 11) was retrospectively enrolled (Oct–Dec 2019). Enrollment was continuous to reduce selection bias. Basic clinical endpoints (noninvasive blood pressure, tissue perfusion, diuresis) defined shock control and the prognostic endpoint was survival at hospital discharge. Shock control at 6 and 12 hours was higher in the 2020 group (p = 0.012 for both). Survival at hospital discharge was 75% and 27.3%, respectively (p = 0.039). NE infusion was associated with a Hazard Ratio of 0.23 (p = 0.041) in a multivariate Cox model. No NE-induced adverse effects were detected. These preliminary results suggest that implementing NE infusion in a low-resource setting without ICU could be a safe and effective strategy in managing septic shock and that this approach could lead to a lower mortality rate.

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda.

Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

High Burden of Adverse Drug Reactions to Isoniazid Preventive Therapy in People Living With HIV at 3 Tertiary Hospitals in Uganda: Associated Factors.

HIV is one of the most important risk factors of tuberculosis (TB)-related morbidity and mortality. Isoniazid preventive therapy (IPT) is recommended to prevent latent TB reactivation in patients with HIV. However, due to multiple therapies and comorbidities, these patients are predisposed to adverse drug reactions (ADRs) that lead to increased morbidity and mortality. The aim of this study was to determine the prevalence and associated factors of suspected IPT-linked ADRs in HIV-positive patients using IPT. A cross-sectional study was conducted between February and March 2020 at 3 regional referral hospitals (RRHs) in central Uganda. We sampled 660 HIV-positive patients aged 10 years or older who received IPT between July and December 2019 inclusive. Patients were interviewed using a pretested structured questionnaire, and their treatment records were reviewed. A modified Poisson regression model with clustered robust standard errors was used to identify factors associated with suspected IPT-linked ADRs. The prevalence of the suspected ADRs was 51% (334 of the 660; 95% confidence interval [CI]: 18% to 83%). Patients self-reported 7-fold the number of suspected ADRs documented in the clinical files by the health care workers. Musculoskeletal symptoms were the most frequently experienced reaction (14%), followed by dizziness (13%) and peripheral neuropathy (11%). Serious suspected ADRs were experienced by 12% of the study participants; the most common were hepatotoxicity (26%), dizziness (23%), and neuropathy (17%). Female sex (aPR [adjusted prevalence ratio]: 0.92, 95% CI: = 0.88 to 0.95), study site (aPR: 1.09, 95% CI: = 1.09 to 1.18), level of education (aPR: 0.94, 95% CI: = 0.94 to 0.99), history of TB (aPR: 0.93, 95% CI: = 0.87 to 0.99), good IPT adherence (aPR: 1.16, 95% CI: = 1.05 to 1.29), and use of protease inhibitor (PI)-based antiretroviral therapy (aPR: 1.01, 95% CI: = 1.00 to 1.02) were significantly associated with suspected IPT-linked ADRs. The prevalence of suspected IPT-linked ADRs is high, and hepatotoxicity is the most commonly reported serious suspected ADR. Patients self-reported more suspected ADRs than those documented in clinical files by health care workers. Patient engagement could improve ADR detection and potentially strengthen the pharmacovigilance system. Patients with a high risk of ADR ought to be monitored regularly to enable early detection and management.

POS-732 QUALITY OF LIFE AND ONE-YEAR SURVIVAL OF PATIENTS WITH KIDNEY FAILURE IN A RESOURCE LIMITED SETTING

In 2017, 1.2million people died due to kidney failure making it the 12th leading cause of death globally. This position has risen from 17th over the past three decades. The global burden of kidney failure is most felt in Resource Limited Settings (RLS) such as Uganda in Sub-Saharan Africa (SSA). In most of SSA, patients never receive renal replacement therapy due to limited accessibility or proximity to these services and of those initiated onto dialysis, 85% will discontinue it due to cost limitations to maintain healthcare expenditure thus leading to premature death. The objective of this study was to determine the survival and changes in Quality of Life (QOL) of kidney failure patients receiving care in a tertiary hospital in Uganda over a one-year period. Patients aged ≥18 years with kidney failure were recruited from the renal outpatients’ clinic, hemodialysis unit and inpatient ward of tertiary hospital in Uganda, and followed up for 12months. Survival rates were calculated using the Kaplan Meier method and factors associated with survival analysed with the log rank test. Quality of life was calculated using the Kidney Disease and Quality of Life-Short Form (KDQOL-SF™) version 1.3 questionnaire. Scores less than 50 were considered to be indicative of poor QOL. Data was analysed for 335 patients recruited into the study. 216 (64%) patients were on Conservative Management (CM) while 119 (34%) were on Hemodialysis (HD). Overall, one-year survival was 26.6%; 95%CI (21.8 – 31.2). There was no statistically significant difference in median survival of patients on CM (7.6 months) in comparison to those on HD (8 months) (p-value 0.3984). Male sex and distance from the hospital were significantly associated with shorter survival HR 1.38 (CI 1.04-1.83) while belonging to a protestant faith improved survival HR 0.64 (CI 0.48-0.88). Quality of life scores changed significantly for 13 out of 19 subdomains of the KDQOL-SF™. Subdomain scores that changed the most included- Social support; 75.6 ±29.2 at baseline to 27.7 ±19.4 at one year (p-value <0.001), and Effects of kidney disease 54± 20 to 70± 23 (p-value <0.001). All three composite summary scores; -mental health, physical health and kidney disease specific, showed statistically significant increases but remained less than 50 throughout the one-year follow up. Survival is dismal for patients with kidney failure with no survival or QOL advantage offered by HD in comparison to CM in this setting. Male sex and residence far from the hospital were associated with reduced survival and protestant faith improved survival despite poor QOL scores and a marked decline in social support over the one-year period. To improve patient outcomes in RLS, health systems need to increase accessibility and affordability of specialist renal services including; trained human resources and renal replacement therapy options, as well as integrate spiritual support, financial literacy and social support services into existing care practices.

Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda.

BackgroundIn Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.MethodsThis was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients’ demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival.ResultsA total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8–70.9), 42.0% (95% CI:35.6–48.3) and 33.3% (95% CI:27.3–39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10–5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31–5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40–12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39–1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32–0.88, p=0.015) were associated with a better survival.ConclusionThe survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.

Interleukin-18 binding protein in infants and children hospitalized with pneumonia in low-resource settings.

Pneumonia is the leading infectious cause of death in children, with especially high mortality in low- and middle-income countries. Interleukin-18 binding protein (IL-18BP) is a natural antagonist of the pro-inflammatory cytokine interleukin-18 and is elevated in numerous autoimmune conditions and infectious diseases. We conducted a prospective cohort study to determine the association between admission IL-18BP levels and clinical severity among children admitted to two hospitals in Uganda for hypoxemic pneumonia. A total of 42 children (median age of 1.2years) were included. IL-18BP levels were higher in patients with respiratory distress, including chest indrawing (median 15ng/mL (IQR 9.8-18) versus 4.5ng/mL (IQR 3.8-11) without chest indrawing, P=0.0064) and nasal flaring (median 15ng/mL (IQR 9.7-19) versus 11ng/mL (IQR 5.4-14) without nasal flaring, P=0.034). IL-18BP levels were positively correlated with the composite clinical severity score, Pediatric Early Death Index for Africa (PEDIA-e, ρ=0.46, P=0.0020). Patients with IL-18BP>14ng/mL also had slower recovery times, including time to sit (median 0.69days (IQR 0.25-1) versus 0.15days (IQR 0.076-0.36) with IL-18BP<14ng/mL, P=0.036) and time to fever resolution (median 0.63days (IQR 0.16-2) versus 0.13days (IQR 0-0.42), P=0.016). In summary, higher IL-18BP levels were associated with increased disease severity and prolonged recovery times in Ugandan children with pneumonia.

Bacterial contamination of healthcare worker’s mobile phones: a case study at two referral hospitals in Uganda

ABSTRACT Hospital and community-acquired infections are escalating and pose significant public health unhealthiness worldwide. The advancements of telemedicine and automation of healthcare records are supported by cellphones, laptops and wearable devices. This study focused on the incidence of healthcare workers’ mobile phones becoming contaminated with pathogenic bacteria and their possible roles as vehicles of transmission of antimicrobial-resistant bacteria. A case study at two referral hospitals in Uganda between May and October 2020. Self-administered questionnaires were administered to participants after informed consent. Mobile phones of the participants in different departments of the hospitals were swabbed and samples were collected and transported to the microbiology laboratory for bacterial culture and antimicrobial susceptibility tests. The point prevalence of Healthcare workers’ mobile phone bacterial contamination with one or more species was 93%. Organisms isolated were E. coli 5.6% (1), Micrococcus spp 11.1% (2), Coagulase-negative staphylococci, CoNS, 61.1% (11) and Bacillus spp 22.2% (4). About 45% of the organisms were multidrug-resistant. Resistance was major to penicillin, cotrimoxazole, ciprofloxacin and Gentamicin, respectively. The isolated E. coli was resistant to all antibiotics used in the study. Only 15% (2) of the participants disinfected their phones at least once a week and 8% cleaned their hands after using a mobile phone. Healthcare Workers’ mobile phones can act as fomites for the transmission of multidrug-resistant microorganisms. This study provides strong evidence for developing and strengthening disinfection protocols for mobile phones and does not underscore the importance of hand hygiene in the middle of a patient encounter especially when the HCW grabs a phone but doesn’t re-clean their hands before patient contact. Abbreviations: MDR, Multidrug-resistant; WHO, World Health Organization; IPC, infection prevention and control; HHC, hand hygiene compliance; JMEDICC, Joint Mobile Emerging Disease Intervention Clinical Capability

Chronic wound isolates and their minimum inhibitory concentrations against third generation cephalosporins at a tertiary hospital in Uganda

Globally, the burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics. In the United States of America alone, more than 6.5 million chronic wounds with evidence of bacterial infection are diagnosed every year. In addition, the polymicrobial environment in chronic wound infections has been observed from several studies as a risk factor for development of resistance to many antibiotics including the third generation cephalosporins currently used in Mbarara Regional Referral Hospital for treatment of chronic wound infections. Therefore the main objective of this study was to determine the prevalence of chronic wound isolates and their minimum inhibitory concentrations (MIC) against third generation cephalosporins. This study was a cross-sectional descriptive and analytical survey of bacterial isolates from chronic wound infection among 75 study participants admitted in the surgical ward of Mbarara Regional Referral Hospital (MRRH), a tertiary Hospital in Western Uganda. Standard laboratory bacterial culture and identification techniques as well as broth microdilution method were used to isolate, identify pathogens and test for MIC respectively. We found that 69/75 study participants had samples with bacterial growth and the most prevalent pathogens isolated were staphylococcus aureus (40.6%) and Klebsiella spp. (29%). Generally, most isolates were susceptible to cefoperazone + sulbactum 2 g (Sulcef) and ceftriaxone 1 g (Epicephin). The overall prevalence of isolates in chronic wound infection among patients admitted in the surgical ward of MRRH was 92% and the most prevalent isolates were Staphylococcus aureus, Klebsiella species and proteus species respectively. The observed MIC values were higher than the CLSI clinical breakpoint, implying a decreasing trend in susceptibility of chronic wound isolates to third generation cephalosporins.

HIV Infection Is an Independent Predictor of Mortality Among Adults with Reduced Level of Consciousness in Uganda.

ABSTRACT.The clinical epidemiology of adults admitted with reduced level of consciousness (LOC) in sub-Saharan Africa (SSA) and the impact of HIV infection on the risk of mortality in this population is unknown. We secondarily analyzed data from a cohort study that enrolled 359 consecutive adults with reduced LOC presenting to Mbarara Regional Hospital in Uganda with the aim of comparing the prognostic utility of the Full Outline of Unresponsiveness (FOUR) score to the Glasgow Coma Scale (GCS) Score. For this analysis, we included 336 individuals with known HIV serostatus, obtaining clinical, laboratory, and follow-up data. We recorded investigations and treatments deemed critical by clinicians for patient care but were unavailable. We computed mortality rates and used logistic regression to determine predictors of 30-day mortality. The median GCS was 10. Persons living with HIV infection (PLWH) accounted for 97 of 336 (29%) of the cohort. The 30-day mortality rate in the total cohort was 148 of 329 (45%), and this was significantly higher in PLWH (57% versus 40%, adjusted odds ratio [aOR] 2.39: 95% confidence interval [CI]: 1.31–4.35, P = 0.0046). Other predictors of mortality were presence of any unmet clinical need (aOR 1.72; 95% CIL 1.04–2.84, P = 0.0346), anemia (aOR 1.68; 95% CI: 1.01–2.81, P = 0.047), and admission FOUR score < 12 [aOR 4.26; 95% CI: 2.36–7.7, P < 0.0001). Presentation with reduced LOC in Uganda is associated with high mortality rates, with worse outcomes in PLWH. Improvement of existing acute care services is likely to improve outcomes.

Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC.

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

Soluble T cell immunoglobulin and mucin-domain containing protein 3 in children hospitalized with pneumonia in resource-limited settings

In a prospective cohort study of 77 children with severe pneumonia from two hospitals in Uganda, we assessed soluble T cell immunoglobulin and mucin-domain containing protein 3 (sTIM-3) levels at hospital admission and their association with pneumonia severity and subsequent mortality. sTIM-3 levels were positively correlated with the Respiratory Index of Severity in Children (RISC) (ρ = 0.35, p = 0.0017), sTIM-3 levels were higher in children who required transfer to a tertiary hospital (p = 0.014) and in fatal cases (p = 0.011). In summary, sTIM-3 is associated with disease severity and predictive of mortality in childhood pneumonia in resource-limited settings.