Hospital In Uganda Research Articles

Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done.

Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.

Quality of individual and group level interventions for first-episode psychosis at the tertiary psychiatric hospital in Uganda.

BackgroundIndividual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear.AimTo determine the quality of the individual and group level interventions provided to first episode psychosis patients in UgandaSettingThe study was performed at the only tertiary psychiatric hospital in Uganda.MethodsA retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was performed. The proportion of participants who received different essential components for individual and group level interventions were calculated. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-episode psychosis services fidelity scale (FEPS-FS). The FEPS-FS assigns a grade of 1–5 on a Likert scale depending on the proportion of patients who received the different components of the intervention. Twelve essential components across the individual and group interventions were assessed and their quality quantified.ResultsThe final sample included 156 first-episode psychosis patients. The median age was 27 years (inter-quartile range [IQR] [24–36]) and 55% of the participants were female. All 12 essential components had poor quality with the range of scores on the FEPS-FS between one and three. Only one essential component assessed (use of single antipsychotics) had moderate quality.ConclusionAmongst current services at the Butabika National Referral Mental Hospital in Uganda, the essential components for individual and group level interventions for psychotic disorders are of poor quality. Further studies are required on how the quality of these interventions can be improved.

Quality of care for adult in-patients with malaria in a tertiary hospital in Uganda

BackgroundPrompt detection and appropriate treatment of malaria prevents severe disease and death. The quality of care for adult malaria in-patients is not well documented in sub-Saharan Africa, particularly in Uganda. The study sought to describe the patterns of malaria diagnosis and treatment among adult in-patients admitted to the medical and gynaecological wards of Uganda’s 1790-bed Mulago National Referral Hospital from December 2013 to April 2014.MethodsA prospective cohort of 762 consented in-patients aged ≥ 18 years was assembled. Proportions of in-patients who received preadmission and in-hospital anti-malarials, missed Day 1 dosing of hospital-initiated anti-malarials and/or had malaria microscopy done were determined. Multivariable logistic regression was used to identify risk-factors for missed Day 1 dosing of anti-malarials.ResultsOne in five (19%, 146/762) in-patients had an admission or discharge malaria diagnosis or both; with median age of 29 years (IQR, 22–42 years). Microscopy was requested in 77% (108/141) of in-patients with an admission malaria diagnosis; results were available for 46% (50/108), of whom 42% (21/50) tested positive for Plasmodium falciparum malaria parasitaemia. Only 13% (11/83) of in-patients who received in-hospital injectable artesunate (AS) or quinine (Q) received follow-up oral artemether-lumefantrine (AL); 2 of 18 severe malaria cases received follow-up oral AL. Injectable AS only (47%, 47/100) was the most frequent hospital-initiated anti-malarial treatment followed by injectable Q only (23%, 23/100) amongst in-patients who received in-hospital anti-malarials. A quarter (25%, 25/100; 95% CI: 17–35%) of in-patients missed Day 1 dosing of hospital-initiated anti-malarials. Each additional admission diagnosis was more than two-fold likely to increase the odds of missed Day 1 dosing of in-hospital anti-malarials (aOR = 2.6, 95% CI: 1.52–4.56; P-value = 0.001).ConclusionsHalf the malaria microscopy results were not available; yet, the rate of testing was high. The majority of in-patients initiated on injectable AS or Q did not receive the recommended follow-up oral AL. One in four in-patients delayed to initiate hospital anti-malarials by at least one calendar day. The hospital should encourage prompt availability of malaria test-results to promote the timely initiation and completion of anti-malarial treatment, thereby improving the quality of care for hospitalized malaria patients in Uganda.

A randomised trial of laryngeal mask airway in neonatal resuscitation.

Birth asphyxia is the leading cause of neonatal mortality in low-income countries.1 Improving resuscitation and outcomes from neonatal resuscitation at birth are crucial.2 Asphyxiated newborns often require bag-mask ventilation (BMV) as part of their initial resuscitation. When this fails, intubation is necessary. However, intubation is a difficult skill to practice especially for non-doctor staff present at delivery in low-income countries.2 Thus, improving the effectiveness of initial efforts to provide ventilation in asphyxiated newborn may decrease the need for extensive resuscitation and improve neonatal outcomes. Previous studies have shown an LMA is effective in providing positive pressure ventilation (PPV) ventilation at delivery,3 while other benefits of an LMA include ease of placement, minimal trauma, less air leak and improved seal.4 In this study, Pejovic et al. tested whether PPV provided in low-income countries by midwives using an LMA was superior to BMV. This large, RCT demonstrated that using an LMA to provide PPV at birth by midwives in neonates with asphyxia did not decrease mortality and morbidity when compared with facemask ventilation at birth. Although the current study did not show a benefit of using an LMA for initial resuscitative efforts when compared with facemask ventilation, it still may have a role in providing PPV at birth in low-income countries. The current phase three trial was done at a high volume delivery hospital in Uganda. Whether conducting the study in a hospital with low volume where midwives are less familiar with traditional BMV would have a different result is unknown. Furthermore, access to foetal monitoring would have increased the pre-test probability of birth asphyxia and potentially increased the ability of the study to detect a therapeutic effect. Previous studies have shown an LMA can be used in place of intubation for advanced airway management; it would be interesting to know if the transition from initial resuscitation to advanced resuscitation was improved with use of an LMA. Additional studies are needed to determine effectiveness of an LMA ventilation in infants with asphyxia with different study design, including foetal monitoring, patient selection, resuscitative steps and selection of hospital. This study shows an LMA can be used safely by midwives for providing ventilation at birth as measured by these short-term in-hospital experience. Along with these short-term morbidity and mortality data, assessment of long-term outcomes is needed. Furthermore, it would be interesting to know whether additional studies of an LMA vs facemask ventilation at birth would demonstrate a beneficial role for an LMA in neonatal resuscitation. Finally, although an LMA ventilation provided by midwives at birth in neonates with asphyxia while not superior to facemask ventilation with regard to in-hospital morbidity and mortality in low-income countries, it was shown to be safe, which opens the door to future study of an LMA in neonatal resuscitation in low-income countries. https://ebneo.org/laryngeal-mask-airway None.

POS-173 ACUTE KIDNEY INJURY AND RENAL RECOVERY IN UGANDAN CHILDREN WITH SEVERE MALARIA

Acute kidney injury (AKI) is increasingly recognized as an important clinical complication in children with severe malaria associated with increased morbidity and mortality, including long-term neurocognitive and behavioral problems in surviving children. The objective of this study was to evaluate AKI and renal recovery in a prospective cohort study of children with severe malaria admitted to two hospitals in Uganda: Mulago National Referral Hospital in Kampala in Central Uganda and Jinja Regional Referral Hospital in Eastern Uganda.

Prevalence of pathogenic Klebsiella pneumoniae based on PCR capsular typing harbouring carbapenemases encoding genes in Uganda tertiary hospitals

BackgroundKlebsiella pneumoniae is an opportunistic pathogen that has been implicated as one of commonest cause of hospital and community acquired infections. The K. pneumoniae infections have considerably contributed to morbidity and mortality in patients with protracted ailments. The capacity of K. pneumoniae to cause diseases depends on the presence of an array virulence factors. Coexistence and expression of virulence factors and genetic determinants of antibiotic resistance complicates treatment outcomes. Thus, emergence of pathogenic MDR K. pneumoniae poses a great threat to the healthcare system. However, the carriage of antibiotic resistance among pathogenic K. pneumoniae is yet to be investigated in Uganda. We sought to investigate the carbapenem resistance profiles and pathogenic potential based on capsular serotypes of K. pneumoniae clinical isolates.MethodsThis was a cross sectional study involving use of archived Klebsiella pneumoniae isolates collected between January and December, 2019 at four tertiary hospitals in Uganda. All isolates were subject to antimicrobial susceptibility assays to determine phenotypic antibiotic resistance, pentaplex PCR to detect carbapenemases encoding genes and heptaplex PCR to identify capsular serotypes K1, K2, K3, K5, K20, K54 and K57.ResultsThe study found an overall phenotypic carbapenem resistance of 23.3% (53/227) and significantly higher genotypic resistance prevalence of 43.1% (98/227). Over all, the most prevalent gene was blaOXA-48-like (36.4%), followed by blaIMP-type (19.4%), blaVIM-type (17.1%), blaKPC-type (14.0%) and blaNDM-type (13.2%). blaVIM-type and blaOXA-48-like conferred phenotypic resistance in all isolates and 38.3% of isolates that harbored them respectively. Capsular multiplex PCR revealed that 46.7% (106/227) isolates were pathogenic and the predominantly prevalent pathotype was K5 (18.5%) followed by K20 (15.1%), K3 (7.1%), K2 (3.1%) and K1 (2.2%). Of the 106 capsular serotypes, 37 expressed phenotypic resistance; thus, 37 of the 53 carbapenem resistant K. pneumoniae were pathogenic.ConclusionThe high prevalence of virulent and antibiotic resistant K. pneumoniae among clinical isolates obtained from the four tertiary hospital as revealed by this study pose a great threat to healthcare. Our findings underline the epidemiological and public health risks and implications of this pathogen.

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

BackgroundUganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.MethodsA direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.ResultsEight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05).ConclusionThis study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study

BackgroundPostpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda.ObjectiveWe aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion.ResultsWe enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9–15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26–51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47–48.47, p = 0.017).ConclusionThe cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.

P0273 / #740: POST-DISCHARGE MORTALITY AMONG YOUNG INFANTS IN UGANDA ADMITTED WITH SUSPECTED INFECTIONS

Aims & Objectives: Mortality of infants after hospitalization for infections is high and innovative solutions to improve outcomes are urgently needed. Our objective was to better understand the burden and risks of death in this population. Methods: We collected clinical, anthropometric, social and demographic indicators prospectively on admission from children 0-6 months old admitted with a proven or suspected infection from 6 hospitals in Uganda. We followed children for 6 months after discharge. Vital status was the primary outcome of interest. Results: We enrolled 1224 children between April 2018 and March 2019. The mean age was 1.86 months (SD=1.83). 180(14.7%) of children had experienced at least 1 admission previously; 46 within 7 days, 66 within 7 days to 1 month and 68 over 1 month. The median duration of admission was 5 days (IQR = [3,7]). 95(7.8%) children died during admission, 932(82.5%) received a routine discharge, 59(5.2%) were referred to a higher level of care, and 137(12.1%) left against medical advice. 100(8.9%) died within 6 months of discharge; 50(50.0%) died at home, 15(15.0%) in transit to seeking care and 33(33.0%) during a subsequent readmission. The median time to death after discharge was 35.5 days (IQR=[14.0,82.5]). Key admission risk factors for post-discharge mortality were abnormal tone (OR=2.42,95%CI=(1.43,3.93)), prior care seeking (OR=2.34,95%CI=(1.48,3.84)), if admission was a referral (OR=2.27,95%CI=(1.50,3.44)) and not sucking during breastfeeding (OR=1.94,95%CI=(1.29,2.94)). Dehydration was also a risk factor for children 1-6 months old (OR=1.96,95%CI=(1.13,3.25)). Conclusions: Death after discharge is high in young infants. Key risk factors identified will inform prediction models to improve post-discharge outcomes.

Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study

BackgroundAnemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda.MethodsWe conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda.ResultsThe prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37).ConclusionsDespite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.

Incidence and predictors of COPD mortality in Uganda: A 2-year prospective cohort study.

BackgroundData is lacking on outcomes among COPD patients in sub-Saharan Africa. The objective of the study was to assess the incidence and predictors of mortality among COPD patients enrolled in the Uganda Registry for Asthma and COPD.Research questionWhat is the Incidence and predictors of mortality among COPD patients in Uganda?Study design and methodsIndividuals with a diagnosis of COPD at six hospitals in Uganda were enrolled into the registry, and followed every six months. Mortality was ascertained through post-mortem reports and verbal autopsies. Mortality rates (MR), mortality rate ratios (MRR), and hazard ratios (HR) were computed to assess associations between socio-demographic, behavioural, and clinical characteristics at enrolment into the registry and mortality up to two years after.ResultsWe enrolled 296 COPD patients. Median age was 60 years, and 51·3% were male. The overall mortality rate was 95·90 deaths/1000 person-years. COPD severity by post-bronchodilator FEV1 was the strongest risk factor for mortality. Compared to stage 1, adjusted hazard ratios were as follows for stage 4: 9·86 (95%CI: 1·70–57·14, p = 0·011), stage 3: 6·16 (95%CI: 1·25–30·32, p = 0·025), and stage 2: 1·76 (95%CI: 0·33–9·48, p = 0·51). Underweight patients had a higher incidence of mortality compared to normal weight patients (MRR: 3·47 (95%CI: 1·45–8·31, p = 0·0026).ConclusionAmong COPD patients in Uganda, two-year mortality is high, and disease severity at baseline was the strongest risk factor for mortality. Our findings suggest the need for early, accurate, diagnosis and management of COPD, to potentially improve survival.

Comparing Banana Leaf Dressing and Vaseline Gauze Dressing for Split-Thickness Skin Graft Donor Sites in a Ugandan Hospital

Introduction: This study compared the effectiveness of banana leaf dressing (BLD) with the commonly used Vaseline gauze dressing (VGD) on split-thickness skin graft (SSG) donor sites. VGD is not completely nonadherent and is associated with pain on removal. BLD is smooth, non-adherent, pain-free and available.&#x0D; Methods: In this prospective study, consecutive patients were dressed with either BLD or VGD. Ease of applying and removing the dressings was scored. Pain scores were taken on postoperative days 3, 5, 7, 9 and 10. On day 10, the dressing was changed, epithelialization recorded and a swab taken for microbial culture. Average cost of each dressing was calculated.&#x0D; Results: There was no significant difference between postoperative pain scores with either dressing (p=0.992). BLD patients had less pain on dressing change (p=0.006). Both dressings were easy to apply; BLD was easier to remove (p=0.000). Wounds with BLD re-epithelialized faster (p=0.0158). 40% of wounds grew no organism on microbial culture, 25% grew Staphylococcus aureus and 35% grew unusual organisms (p=0.482). VGD was 4 times more expensive than BLD (p=0.000).&#x0D; Conclusion: Banana leaf dressing is effective and highly recommended for dressing SSG donor sites.Keywords: Split-thickness skin graft, Donor sites, Banana leaf dressing, Vaseline gauze dressing

Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade.

ObjectiveWe aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women’s opinions on their overall experience of PPH care.MethodsThis prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0–10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported.ResultsAmong women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45–3.35). A high postpartum pain score of 8–10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30–10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable.ConclusionUBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women’s satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.

Women’s Perspectives of Childbirth in Kiboga, Uganda

ObjectiveTo gain a deeper understanding of the experiences of women who gave birth at the Kiboga District Hospital in Uganda through analysis of their childbirth stories. DesignQualitative interpretive description. SettingThe maternity ward of the Kiboga District Hospital in Uganda. ParticipantsTwenty women, ages 19 to 43 years, within 24 hours of childbirth. MethodI conducted in-depth interviews with the help of a local professional translator to capture the unique experiences of the participants regarding their birth experiences, perceptions, and personal feelings. ResultsQualitative interpretive and descriptive analysis revealed two main themes that each consisted of a number of subthemes: Cultural Norms of Childbirth (Women’s Status, Submissiveness, and Silence/Acceptance) and the Childbirth Process and Its Impact (Loss, Coping and Overcoming Difficulties, and Physical Well-Being). ConclusionWomen need to feel supported and valued to deal with their childbirth experiences. Incorporating the professional support of experienced midwives in an enabling environment and providing access to a sufficiently equipped health care facility may improve the mental and physical state of women who give birth in Uganda and help them return to optimal functioning.

Prevalence of autism spectrum disorder symptoms in a paediatric neurology clinic at a tertiary hospital in Uganda.

BackgroundChildren with neurological disorders are more likely to present with autism spectrum disorder (ASD) symptoms and get an ASD diagnosis. Despite the large burden of childhood neurological disorders in Uganda, there is limited information on ASD amongst children with neurological disorders in Uganda.AimThe aim of this study was to determine the prevalence and factors associated with ASD symptoms amongst children attending the paediatric neurology clinic.SettingThe study was conducted at the paediatric neurology clinic of Mulago National Referral Hospital in Uganda.MethodsThis was a cross-sectional study of 318 children aged 2–9 years. After obtaining consent, a socio-demographic questionnaire and the Social Communication Questionnaire were administered to the caregivers of the children. Additional questions were administered to assess the prenatal, birth and postnatal characteristics of the children. Sample characteristics were described using frequencies and means. Bivariate analysis was carried out using chi-square test and Fisher’s exact test. Multiple logistic regression models were used to assess which factors were independently associated with ASD symptoms.ResultsThe mean age of the children was 5 years and 58.2% were males. The prevalence of significant ASD symptoms was found to be 45%. Factors negatively associated with significant ASD symptoms were female sex (odds ratio [OR] 0.48 [95% CI 0.24, 0.98]) and ability to speak (OR 0.09 [95% CI 0.04, 0.2]). The history of delayed developmental milestones was positively associated with significant ASD symptoms (OR 3.3 [95% CI 1.59, 6.84]).ConclusionThe prevalence of ASD symptoms is high in children with neurological disorders. Children, especially those with delayed developmental milestones, should routinely be screened for ASD.

Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

BackgroundTraumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda.ObjectiveWe aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda.MethodsWe consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without.ResultsMost patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality.ConclusionHypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.

Comparison of antipsychotic naïve first‐episode psychosis patients and healthy controls in Uganda

The risk factors for a first episode of psychosis in low and middle-income countries (LMICs) are not well described. The study compared the association of different risk factors in patients with first-episode psychosis patients and healthy controls from an LMIC context. A comparative, descriptive, cross-sectional study was performed in antipsychotic naïve first-episode psychosis patients and healthy controls at the National referral hospital in Uganda. Standardized tools were used to assess sociodemographic (e.g., age, sex, socioeconomic status) and clinical (e.g., childhood trauma, quality of life) variables. First episode psychosis participants were compared to healthy controls in terms of sociodemographic and clinical variables, and logistic regression was used to determine predictors of FEP. Our final sample included 198 antipsychotic naïve first-episode psychosis participants and 82 controls. Most participants were female (68.5%) with a mean age of 29.4 years. After adjusting for age and sex, FEP patients when compared to controls were less likely to be female [AOR 0.18 (95%CI 0.03-0.85; p= .031)], more likely to have experienced emotional abuse [AOR 1.30 (95%CI 1.02-1.65; p= .032)] and more likely to have a poor quality of life [AOR 0.93 (95%CI 0.89-0.97; p= .002)]. The risk factors for a first episode of psychosis in this low and middle-income population were like those described in high-income countries. Further studies on interventions to prevent the transition to psychotic disorders in this sub-groups of patients are recommended. Also, the use of specialized early intervention services in improving the quality of life needs to be evaluated.

Risk factors for early and late failures following repair of urogenital fistulas.

In Sub-Saharan Africa, obstetric fistulas are a health crisis of extensive proportions. Although risk factors for failure are described, little data exist regarding differences in risk factors for early and late recurrences. A retrospective cohort study was conducted to evaluate risk factors for fistula recurrence. Inclusion criteria included women who underwent repair of urogenital fistula at a Fistula Hospital in Uganda between 2013 and 2019. Our primary objective was to determine the incidence of both early and late failures and to identify and compare risk factors for each. Logistic regression was used to calculate crude odds ratios (ORs) and 95% confidence intervals (CIs) representing the association between each risk factor for early and late failures. Covariates significantly associated with early or late failure in univariate analyses were included in multivariate logistic regression models. A total of 541 patients were included. The incidence of early failure was 10.9%. Risk factors for early failure included stillbirth (aOR = 3.71, 95% CI: 1.38-9.96), fistula larger than 3cm, (aOR = 3.12 95% CI: 1.40-6.93), presence of foot drop (aOR = 4.74, 95% CI:1.88-11.97), and perioperative blood transfusion (aOR = 3.10, 95% CI: 1.11-8.66). Risk factors for late failures included stillbirth (aOR = 4.63, 95% CI:1.04-20.51), and previous fistula repairs (aOR = 3.13, 95% CI:1.30-7.56). Both early and late failures can occur and risk factors for each may be different. Identifying patients at risk for late failures is important for improved counseling and highlights the importance of developing risk-reducing strategies to improve patient outcomes after discharge.

Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement.

Introductionvital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting.Methodsretrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests.Resultsamong 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication.Conclusionvery few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.

The Relationship Between Market Environment Dimensions and Availability of Malaria Pills in Uganda.

IntroductionThis study sought to examine the contribution of relationship building (in terms of collaboration, information sharing and supply chain interdependence) on the availability of malaria treatment pills in public hospitals in Sub-Saharan Africa using data from Uganda.MethodsBy means of a cross-sectional survey research design, the study used a questionnaire strategy to collect quantitative data. Out of the 320 questionnaires that were distributed in 40 public hospitals, 283 were answered and returned, which yielded an 88% response rate. Structural equation modelling (SEM) was used to establish the relationship between measured variables and latent constructs.ResultsDrawing on the survey results, the confirmatory factor analysist and the Structural Equation Modelling clearly demonstrate that relationship building (in terms of collaboration, information sharing and supply chain interdependence) significantly influences the availability of Artemisinin-based combination therapies in public general hospitals in Uganda.ConclusionPolicy-makers should focus on developing cheaper information technology tools to exchange information regarding stock levels, forecasting, quantification, orders, and dispensing. This study developed a measurement model for an inter-hospital relationship, using relational view theory, and it employs dimensions in terms of information sharing and supply chain interdependence to predict and explain the availability of malaria pills in government hospitals.