Referral Hospital In Uganda Research Articles

Drug sensitivity patterns of bacterial isolates from septic post-operative wounds in a regional referral hospital in Uganda.

Wound infections have been a problem in the field of surgery for a long time. Advances in control of infections have not completely eradicated this problem because of development of drug resistance. Antimicrobial resistance can increase complications and costs associated with procedures and treatment. A study was carried out on drug sensitivity patterns of bacterial isolates from septic postoperative wounds in Jinja hospital, Uganda. This study was designed to determine the distribution of bacterial pathogens isolated from septic post-operative wounds and their antimicrobial susceptibility patterns. Specimens of pus swabs were collected aseptically and analysed in the laboratory. Colony characteristics and Grams technique were used to differentiate the organisms. Biochemical tests were done to confirm the species of the organisms. Sensitivity testing was done on the isolates using the disk diffusion method. Pathogenic bacteria were recovered from 58.5% of the specimens. The isolates were: S.aureus (45.1%), Coliforms (16.9%), Proteus mirabilis (11.3%), P.aeruginosa (9.9%), Klebsiella pneumoniae (7.0%) and Enterobacter spp (2.82%). Most of the organisms were sensitive to gentamicin, ciprofloxacin and ceftazidime. There was resistance to ampicillin, amoxycillin and chloramphenicol. Staphylococcus aureus was generally sensitive to gentamicin (87.5%), ciprofloxacin (68.7%) and methicillin (75%), but resistant to erythromycin (56.2%) and ampicillin (97%). Most of the gram-negative bacteria isolated (Coliforms, P.aeruginosa, E.coli, Proteus mirabilis, and Klebsiella pneumoniae) were sensitive to Ciprofloxacin, Gentamicin and Ceftazidime but resistant to Ampicillin, Amoxycillin and Chloramphenicol. Methicillin-resistant Staphylococcus aureus (MRSA) strains formed 25% of this species. Pseudomonas aeruginosa was sensitive to gentamicin (87.5%) and ceftazidime (85.7%) but showed resistance to ciprofloxacin (57.2%). Some organisms e.g. S.aureus, Pseudomonas aeruginosa and Proteus mirabilis exhibited multi-drug resistance to the antibiotics tested. Since a high proportion of samples had positive cultures, infection control is recommended as a strategy to minimise spread of resistant organisms. It is recommended that gentamicin, ciprofloxacin and ceftazidime be used in preference to ampicillin and amoxycillin for treatment of septic wounds. There is need to develop national surveillance of antibiotic- resistant organisms.

The challenge of re-treatment pulmonary tuberculosis at two teaching and referral hospitals in Uganda.

With an annual tuberculosis (TB) incidence of about 350 cases per 100,000 of the population, Uganda is a high burden country. Moreover, it is evident that some TB patients have been treated for a previous episode of the disease. To highlight the burden of re-treatment pulmonary TB and examine patient factors associated with re-treatment among adults at two teaching and referral hospitals, Mbarara and Mulago. A descriptive cross sectional study with data collection between September 2004 and March 2005; we calculated the prevalence and used logistic regression to explore factors associated with re-treatment. The prevalence of re-treatment pulmonary TB at Mbarara based on medical records was 30.0% (95%CI: 21.2 to 40.0), and 21.3% (95%CI: 12.9 to 31.8) from exit interviews. The corresponding estimates at Mulago hospital were 12.0% (95% CI: 6.4 to 20.0) and 43.9% (33.0 to 55.3). Compared to the 18-26 year age category, the prevalence odds ratio (POR) for a seven-year increase in age was 1.54 (95%CI: 1.04-2.28; p = 0.027), while female patients were 0.39 (95%CI: 0.17-0.90; p = 0.025) times less likely to report re-treatment disease than males, in this facility-based study. Re-treatment pulmonary TB is frequent at the two teaching and referral hospitals. A contribution to re-treatment prevention should entail more rigorous management of new TB cases, particularly at lower levels of care.

Audit of severe maternal morbidity in Uganda – implications for quality of obstetric care

For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. A systemic analysis found substandard care and records, and patient-related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non-threatening stimulus for improving the quality of obstetric care.