Referral Hospital In Uganda Research Articles

Administrative Factors Affecting Employee Performance in a Regional Referral Hospital in Uganda: A Case Study of Hoima Regional Referral Hospital

This study investigates the administrative factors impacting employee performance at Hoima Regional Referral Hospital in Uganda. Employing a correlational study design, both quantitative and qualitative methodologies were utilized to comprehensively explore the dynamics at play. From a population of 394, a sample of 198 participants was selected using simple random and purposive sampling techniques. Data collection involved questionnaires and interviews, with quantitative data analyzed through descriptive and inferential statistics, and qualitative data through thematic analysis. The findings indicated a weak but significant positive relationship between funding mechanisms and employee performance (R=0.332; P=0.004). Based on these findings, the study recommends the evaluation of electronic procurement systems to mitigate delays in emergency situations. Keywords: Funding Mechanisms, Employee Performance, Hoima Regional Referral Hospital, Correlational Study Design and Administrative Factors

Administrative Factors Influencing Employee Performance in Regional Referral Hospitals: A Case Study of Hoima Regional Referral Hospital, Uganda

This study examines the administrative factors affecting employee performance at Hoima Regional Referral Hospital in Uganda. Utilizing a correlational study design, both quantitative and qualitative methods were employed to gather comprehensive data. From a population of 394, a sample size of 198 participants was selected using simple random and purposive sampling techniques. Data collection involved questionnaires and interviews, with quantitative data analyzed through descriptive and inferential statistics and qualitative data through thematic analysis. Findings revealed a moderate positive significant relationship between the availability of physical facilities and employee performance (R=0.443; P=0.000). These results underscore the importance of well-maintained physical facilities in enhancing employee performance in healthcare settings. Recommendations include regular updates to hospital equipment and continuous professional development for staff. Keywords: Employee Performance, Physical Facilities, Hoima Regional Referral Hospital, Administrative Factors and Correlational Study Design

Corneal endothelial cell density and associated factors among adults at a regional referral hospital in Uganda: a cross-sectional study.

To assess the prevalence of low corneal endothelial cell density and correlates of corneal endothelial cell density among adults attending Mbarara University and Referral Hospital Eye Centre in Uganda. In this hospital-based cross-sectional study, participants 18 years and older, were enrolled. We obtained informed consent, and basic demographic data. We also conducted visual acuity, a detailed slit lamp examination, intra-ocular pressure, corneal diameter, tear-film break-up time, keratometry, A-scan, and pachymetry on all participants. A confocal microscope Heidelberg HRT3 was used to examine the central cornea and to obtain the mean cell density (cells/mm2). To calculate the proportion of low endothelial cell density, descriptive statistics were used, whereas correlates of endothelial cell density were assessed, using linear regression analyses. We evaluated a total of 798 eyes of 404 participants aged between 18 and 90 years (males = 187, females = 217). The average endothelial cell density was 2763.6 cells/mm2, and there was a decrease in endothelial cell density with increasing age, irrespective of gender. There was no significant difference in endothelial cell density between males and females. Increasing age (adjusted coefficient - 10.1, p < 0.001), history of smoking (adjusted coefficient - 439.6, p = 0.004), history of ocular surgery (adjusted coefficient - 168.0, p = 0.023), having dry eye (adjusted coefficient - 136.0, p = 0.051), and having arcus senilis (adjusted coefficient - 132.0, p = 0.08), were correlated with lower endothelial cell density. However, increasing corneal diameter (adjusted coefficient 134.0, p = 0.006), increasing central corneal thickness (adjusted coefficient 1.2, p = 0.058), and increasing axial length (adjusted coefficient 65.8, p = 0.026), were correlated with higher endothelial cell density. We found five eyes (0.63%) from different participants with a low endothelial cell density (< 1000cells/mm2). Our study established baseline normal ranges of ECD in a predominantly black African population, and found that low ECD is rare in our population. The elderly, smokers, and those with past ocular surgery are the most vulnerable. The low prevalence could be due to a lack of reference values for the black African population.

Delivery of a post-natal neonatal jaundice education intervention improves knowledge among mothers at Jinja Regional Referral Hospital in Uganda.

Neonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge. This was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10-14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score. Of the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001). Maternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.

Predictors and Risks of Vaginal Birth after Cesarean Section: Insights from a Regional Referral Hospital in Uganda

Vaginal birth after cesarean section (VBAC) remains a topic of significant interest due to its potential benefits and associated risks. This retrospective cohort study aimed to identify predictors and risks associated with VBAC compared to elective repeat cesarean section (ERCD) among women delivering at Jinja Regional Referral Hospital in Uganda. We analyzed data from 384 women who had a previous cesareansection and delivered at the hospital between 2022 and 2023. Socio-demographic, obstetric, and medical characteristics were assessed for their association with successful VBAC using logistic regression. Risks of maternal morbidities between VBAC and ERCD groups were compared using Chi-square tests. The study found that BMI &lt;35 kg/m², birth weight &lt;3500g, spontaneous onset of labor, previous safe vaginal birth, and absence of diabetes mellitus were significant predictors of successful VBAC. Women undergoing TOLAC had a higher incidence of uterine rupture (p = 0.030), thromboembolism (p &lt; 0.001), and blood transfusion requirement (p &lt; 0.001) compared to ERCD. However, hysterectomy, hemorrhage, viscus injury, and pelvic floor trauma did not significantly differ between the two groups. Our findings highlight important predictors and risks associated with VBAC compared to ERCD in a regional referral hospital setting. Understanding these factors can aid clinicians in counseling women on their delivery options and managing potential risks associated with VBAC. Further research is warranted to explore strategies for optimizing VBAC outcomes while minimizing associated morbidities. Keywords: Maternal, Morbidity, Labor, Cesarean Section, Elective Repeat Cesarean Delivery, Jinja, Hospital

273 A Direct Domparative Analysis of Pediatric Traumatic Brain Injury Presentation and Outcomes in the United States and Uganda

INTRODUCTION: Pediatric traumatic brain injury (pTBI) is the leading cause of death and disability among children globally. However, few studies have explored pTBI in low- and middle-income countries (LMICs) compared to high-income countries (HICs). METHODS: Patient records were extracted from the Duke University Hospital subset of the National Trauma Data Bank (NTDB, n = 866) and a dataset at the Mbarara Regional Referral Hospital in Uganda (MRRH, n = 571). Descriptive statistics were performed to compare across settings. Logistic regression was used to quantify the odds of mortality in each setting given ICU utilization, admission GCS, and other factors. RESULTS: In-hospital mortality was higher in the LMIC versus the HIC (9.4% vs 2.9%, p &lt; 0.001), while ICU utilization was lower in the LMIC (9.0% vs 33.4%, p &lt; 0.001). Rates of surgical management did not differ significantly (15.8% vs 17.0%). More patients presented with moderate (27.8% vs 4.3%) and severe TBI (16.5% vs 11.8%) in the LMIC (p &lt; 0.001). No deaths were reported among patients presenting with moderate or mild TBI in the HIC setting, whereas LMIC pTBI patients died in every TBI severity category. Over 50% of LMIC ICU patients died, versus 8.1% of HIC ICU patients. In a multivariate regression model of mortality, ICU placement was associated with mortality (OR: 6.7, 95% CI: 2.1-20.9), an association not seen in the HIC setting. CONCLUSIONS: Pediatric TBI mortality is greater in the LMIC vs the HIC setting. The LMIC setting also had a high prevalence of moderate/severe TBI and low ICU availability and effectiveness. Future work should involve the implementation and evaluation of interventions to assess these gaps in the LMIC setting.

Prevalence and Socio-demographic Characteristics of Malaria in Pregnancy among Women Attending Antenatal Care in Fort Portal Regional Referral Hospital, Uganda

Malaria infection during pregnancy poses significant risks to both maternal and fetal health, particularly in regions with high transmission rates such as sub-Saharan Africa. This study, conducted at Fort Portal Regional Referral Hospital in Uganda, aimed to comprehensively investigate the prevalence and socio-demographic correlates of malaria infection among pregnant women attending the Antenatal Care (ANC) clinic. Utilizing a robust descriptive cross-sectional design, data were collected from 400 participants through structured questionnaires and subjected to rigorous statistical analysis. The findings revealed a malaria prevalence rate of 7.8% among the study population. Further analysis unveiled compelling associations between malaria infection and various socio-demographic factors. Notably, women aged 24-45 years constituted the majority of malaria-positive cases, highlighting a vulnerable age group. Additionally, lower levels of education, unemployment or self-employment status, and urban residence were significantly associated with higher rates of malaria infection. Primigravida and women in the second trimester emerged as particularly susceptible subgroups, indicating heightened risk during specific stages of pregnancy. These findings underscore the urgent need for targeted interventions aimed at reducing malaria burden among pregnant women in the study area. Effective health education programs tailored to address the needs of vulnerable demographics, particularly primigravida and women in the second trimester, are imperative. Furthermore, the sustained distribution of insecticide-treated mosquito nets remains paramount in combating malaria transmission. These interventions, informed by the socio demographic correlates identified in this study, hold the potential to mitigate the adverse impact of malaria on maternal and fetal health, contributing to improved pregnancy outcomes and overall public health in the region. Keywords: Malaria, pregnancy, antenatal care, prevalence, socio-demographic correlates, Fort Portal Regional Referral Hospital, Uganda.

Acceptance of assisted partner notification among HIV-positive adults with severe mental illness at a national referral hospital in Uganda: a cross-sectional study

BackgroundHIV mostly affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the acceptance of the APN strategy among PLHIV who had a diagnosis of SMI.MethodsThis study used a cross-sectional study design that was retrospective to determine acceptance of APN among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants’ demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined acceptance of APN as the number of PLHIV with SMI diagnoses who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the acceptance of APN.ResultsA total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age was 30 (interquartile range (IQR) (25–34)), and 41 (33%) of them accepted APN (95% CI: 25.05–41.61). Receipt of at least three counselling sessions before enrollment in APN (aPR = 1.8, 95% CI: 1.72–1.98) was the most significant factor associated with increased acceptance of APN. Poor adherence to ART (aPR = 0.62, 95% CI: 0.54–0.80), being escorted to hospital by a distant relative (aPR = 0.55, 95% CI: 0.39–0.80), being married/cohabiting (aPR = 0.65, 95% CI: 0.60–0.81), and being a Seventh Day Adventist (SDA) (aPR = 0.53, 95% CI: 0.45–0.71) or Pentecostal (aPR = 0.44, 95% CI: 0.22–0.98) by faith were associated with reduced acceptance of APN.Conclusion and recommendationThe acceptance of APN is low among PLHIV with a diagnosis of SMI. More structured counselling would facilitate earlier identification of undiagnosed HIV-positive partners. We recommend a follow-up study to compare acceptance of APN among PLHIV with SMI and those without SMI.

Mode of birth in subsequent pregnancy when first birth was vacuum extraction or second stage cesarean section at a tertiary referral hospital in Uganda

IntroductionThe trends of increasing use of cesarean section (CS) with a decrease in assisted vaginal birth (vacuum extraction or forceps) is a major concern in health care systems all over the world, particularly in low-resource settings. Studies show that a first birth by CS is associated with an increased risk of repeat CS in subsequent births. In addition, CS compared to assisted vaginal birth (AVB), attracts higher health service costs. Resource-constrained countries have low rates of AVB compared to high-income countries. The aim of this study was to compare mode of birth in the subsequent pregnancy among women who previously gave birth by vacuum extraction or second stage CS in their first pregnancy at Mulago National Referral Hospital, Uganda.MethodsThis was a retrospective cohort study that involved interviews of 81 mothers who had a vacuum extraction or second stage CS in their first pregnancy at Mulago hospital between November 2014 to July 2015. Mode of birth in the subsequent pregnancy was compared using Chi-2 square test and a Fisher’s exact test with a 0.05 level of statistical significance.ResultsHigher rates of vaginal birth were achieved among women who had a vacuum extraction (78.4%) compared to those who had a second stage CS in their first pregnancy (38.6%), p < 0.001.Conclusions and recommendationsVacuum extraction increases a woman’s chance of having a subsequent spontaneous vaginal birth compared to second stage CS. Health professionals need to continue to offer choice of vacuum extraction in the second stage of labor among laboring women that fulfill its indication. This will help curb the up-surging rates of CS.

Pregnancy Outcomes Among Teenagers at a National Referral Hospital in Uganda.

Introduction: Teenage pregnancy is a global public health challenge, and it is a major contributor to the high maternal and neonatal morbidity and mortality rates reported in sub-Saharan Africa and Uganda. However, there is a paucity of data regarding pregnancy outcomes and their associated factors among teenagers in Uganda. The purpose of this study was to determine the prevalence and factors associated with pregnancy outcomes among teenagers who delivered at a National Referral Hospital in Kampala, Uganda. Materials and Methods: This cross-sectional study was conducted among teenage mothers who delivered at a National Referral Hospital in Kampala, Uganda. Consecutive participant recruitment was done for those who fulfilled the eligibility criteria. The outcomes of interest included adverse maternal outcome with obstructed labor being used as a proxy and adverse fetal outcomes with birth asphyxia used as a proxy. Logistic regression analysis was used to determine the association between independent and dependent variables with a 5% level of statistical significance (α = 0.05). Results: Teenage pregnancy was associated with adverse maternal outcomes which included obstructed labor (18%) and preterm labor (5.5%). There were no maternal deaths during the study period. Adverse fetal outcomes observed in this study population included low birth weight (83%), birth asphyxia (18%), and stillbirth (4%). The only factor associated with adverse maternal outcome was gestational age where teenage mothers had 4 times likelihood of delivering before 37 weeks. Relatedly, teenage mothers had an 81% chance of having a preterm birth. Conclusion: Teenage pregnancy was generally not associated with adverse maternal or fetal outcomes except for preterm birth. The reasons for adverse pregnancy outcomes may reflect a combination of gynecological and biological immaturity, as well as adverse socioeconomic pressures.

Factors Influencing Folic Acid and Iron Supplement Use Among Pregnant Women at Hoima Regional Referral Hospital in Uganda

The study sought to assess adherence levels to Folic Acid and Iron supplementation among expectant women attending antenatal care at Hoima Regional Referral Hospital. Findings revealed a 58.8% adherence rate among pregnant mothers. Among adherents, the majority were younger than 30, Christians, rural residents, cohabiting, had primary education, and were homemakers. Notably, only a minority were experiencing their first pregnancy. Regarding awareness and advice, a significant percentage knew about the preventive benefits of Iron-folic acid supplements against anemia, had received advice on supplementation benefits and the necessity of not missing doses. However, awareness about the specific benefits, dosage, and sources of folic acid and iron was limited. While most attended early ANC visits, only a fraction knew about folic acid benefits and sources, the correct dosage, or foods containing folic acid. Additionally, just over half met the recommended ANC visit frequency. Factors influencing adherence were largely tied to demographics such as age, religion, residence, partnership status, education, and employment, alongside knowledge gaps about supplementation benefits and dosages. Conversely, behaviors like alcohol intake, late or infrequent ANC attendance, and negative experiences during ANC acted as barriers to adherence. Keywords: Pregnancy, Anaemia, Antenatal Care, Folic acid, Iron supplementation.

Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study

BackgroundRetinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening.MethodsWe conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis.Results331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71–37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92–31.82)].Conclusion6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.

DISP-17. BUILDING A MODEL PEDIATRIC NEURO-ONCOLOGY PROGRAM IN SUB-SAHARAN AFRICA AND ITS IMPACT

Abstract BACKGROUND Central nervous system tumors are the most common solid tumors in children and the second commonest childhood cancer globally. We describe the establishment of the first dedicated comprehensive pediatric neuro-oncology treatment center that may serve as a model for others in low-resource settings and the impact of this initiative. METHODS This is a descriptive interim report of a pediatric neuro-oncology capacity building program in the SSA setting established in March 2019 at Mulago National Referral Hospital in Uganda, including a retrospective study conducted at Mulago National referral Hospital, in patients below 18 years of age admitted with a radiological diagnosis of a brain tumor from March 2019 to March 2023, to demonstrate the impact of this program. The program is a collaboration between Makerere University, Mulago National Referral Hospital, Texas children's Hospital/Baylor College of Medicine, and other academic and philanthropy partners in North America and Europe. RESULTS A total of 14 pediatric oncologists have been trained over 6 years, with one further training in neuro-oncology. Multidisciplinary management involving local experts from Uganda and experts from Texas Children's Hospital has been strengthened. Between March 2019 and March 2023, 121 children were diagnosed radiologically with brain tumors. Majority (57%) of these patients were males. The commonest symptom at presentation was headache (42%). Most of the patients (52%) had infratentorial tumors. The commonest diagnosis was glioma (38%), craniopharyngioma (26%), medulloblastoma (11%). Fifty-two patients had surgical resection and a histological diagnosis. Ten percent of patients had no diagnosis. Radiotherapy was received by 24(20%) patients. Twenty patients received chemotherapy. Sixty-six are alive and attending clinic. The overall one-year survival was 63%(95%CI(50.3-73.4). CONCLUSION Capacity to improve the suspicion, referral, diagnosis and comprehensive care for children with central nervous system tumors in low-resource settings can be improved through innovative collaborations.

Safe and Effective Escalation of Evidence-Based Chemotherapy for Mature B Cell Non-Hodgkin's Lymphoma in a Low Resource Setting

BACKGROUND Although high intensity chemotherapy regimens result in &amp;gt;90% long term survival of children with Mature B-cell Non-Hodgkin Lymphoma (MB-NHL), low intensity chemotherapy regimens are used in most Sub-Sahara African (SSA) setting resulting in decades of less than 20% long term survival. This is in part because dose-intense chemotherapy strategies that are standard of care in high income countries (HIC) have not been widely or effectively implemented in low- and middle income countries (LMIC). We investigated the toxicity and outcomes of children with MB-NHL who were treated with a treatment regimen that includes 1g/M2 of methotrexate per dose (mini COPADM) at Mulago National Referral Hospital in Uganda. The objective of this study was to evaluate the safety and effectiveness of an incremental chemotherapy escalation strategy to control treatment-related toxicities and increase response and survival of children treated for MB-NHL at a pediatric oncology center in the SSA setting. METHODS We prospectively collected clinical outcomes on children under 18 years with MB-NHL at Mulago National Referral Hospital (MNRH) in Uganda between January 2020 and July 2023. Overall (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier method. Events in the EFS analysis were: 1) Death; 2) Relapse; or 3) Persistent or progressive disease at the end of Cycle 3. Patients were censored at the earlier of two years from presentation or their last day of follow-up. Descriptive statistics were presented. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS We identified 77 patients, among whom 16 (21%) died prior to commencement of the first cycle of chemotherapy and 6 (8%) treated with alternative therapies. The 55 patients who were treated with mini COPADM with 1g/M 2 of methotrexate and are included in this analysis had similar demographics and clinical phenotypes to the 22 that were excluded. The median age was 9.6 years (interquartile range ((IQR) 6.6 - 11.7 years) with 38 (69%) males. Patients were Stage III (53%, 29/55), stage IV (38%, 21/55); and 55%, (30/55) were high-risk. The most common presentations were abdominal mass 43 (78%) and jaw mass 14 (25%). With a median follow-up time of 9 months (IQR 6 - 24 months), the 1-year overall survival (OS) and event free survival (EFS) were 56%; 95% CI (41 - 76) and 41%; 95%CI (27 - 61) respectively. For children with high-risk disease, 1-year OS was 44%; 95%CI (28 - 72) and EFS 25%; 95% CI (12 - 51). Toxicities included febrile neutropenia (83%) and CTCAE grade ≥3 mucositis (44%). For the 12 patients whose cause of mortality was recorded, 1 case (8.3%) was treatment-related and 11 (91.7%) were due to cancer. CONCLUSION: This study establishes baseline response rates, survival, and toxicity for patients with pediatric MB-NHL in Uganda treated with 1g/M2 of methotrexate. Toxicities were consistent with treatment received, perhaps exacerbated by synergy of anthracycline (50 mg/m2) along with intermediate dose MTX. These findings suggest that mini-COPADM with 1g/M 2 of methotrexate can be safely supported with the current clinical resources at MNRH and this low dose regimen accounts for the poor survival of children with MB-NHL in our center. We plan to escalate our therapy to mini-COAPDM with 3g/M2 and addition of Rituximab, with contingent intensification of supportive care to curb treatment-related toxicities.

Pharmacokinetic-Guided Hydroxyurea to Reduce Transfusion Requirements in Ugandan Children with Sickle Cell Anemia: Baseline Data from the Alternative Dosing and Prevention of Transfusions (ADAPT) Trial

Background: Children are the primary recipients of blood transfusions in sub-Saharan Africa where the demand for safe blood far exceeds the supply. Without disease-modifying therapy, sickle cell anemia (SCA) causes excess morbidity, mortality, and healthcare resource utilization, specifically requiring a high reliance on blood transfusions. Hydroxyurea is a safe and effective medication for the treatment of SCA that decreases blood transfusion use in this population, which may offset the costs of improving hydroxyurea access. The widespread use of hydroxyurea in Africa is limited in part by challenges determining an individual's optimal dose; pharmacokinetic (PK) dosing of hydroxyurea may streamline the dosing process, maximizing the clinical benefits and minimizing toxicities. We designed the Alternative Dosing And Prevention of Transfusions (ADAPT) trial to analyze the reduction in transfusion use with hydroxyurea and as a pilot evaluation of the feasibility of PK-guided hydroxyurea dosing in Uganda. Methods: ADAPT (NCT05662098) is a prospective, single-center, open-label cohort study at Jinja Regional Referral Hospital in Uganda. Children 1-10 years old with HbSS were eligible to enroll; those already receiving hydroxyurea or scheduled blood transfusions, or with malignancy, HIV, tuberculosis, or other chronic illnesses were excluded, and those who received a transfusion within 30 days were temporarily excluded. All participants completed a 3-month screening period during which they underwent baseline evaluations and hydroxyurea PK testing. For PK testing, a 500 mg hydroxyurea test dose was administered, and serum was collected 30, 60, and 180 minutes after the dose. Hydroxyurea concentrations were determined via chemical derivatization and high-performance liquid chromatography in Uganda. Area-under-time-concentration-curves (AUC) and Bayesian estimation were then used to calculate the optimal hydroxyurea dose based on target medication exposure. Those for whom hydroxyurea PK evaluation was completed successfully with a dose recommendation between 15-35 mg/kg/day started on their PK-guided hydroxyurea dose; otherwise, participants started on the default dose of 20 mg/kg/day. All participants will be treated on hydroxyurea for a minimum of 12 months during which time both treatment groups will follow the same laboratory monitoring and dose adjustment protocol to achieve the maximum tolerated dose. The primary study endpoint is the incidence rate ratio of blood transfusion use during screening versus treatment. Secondary endpoints include characterization of blood transfusions (indications, risk factors, adverse reactions), feasibility of PK testing, and laboratory and clinical adverse events comparing children started on PK-guided versus default dosing. Results: From June 2022 to January 2023, 106 participants were enrolled, exceeding the projected enrollment pace and goal. The average age (mean ± SD) at enrollment was 4.6 ± 2.3 years, and 50% were female. Per family-reported history, most participants had previously received a blood transfusion (78%) with 15% reporting at least 6 lifetime transfusions. Five percent had a prior stroke. A majority also had a history of pain events (86%), malaria (79%), and dactylitis (74%). Only 2% had previously used hydroxyurea. At enrollment, the median weight-for-height z-score was -0.19 (interquartile range -1.03-0.32), and baseline exam demonstrated a palpable spleen in 20%. Abdominal ultrasonography was completed on all participants, and the spleen was identified in 75% of participants with a mean volume of 132 ± 99 mL. Transcranial Doppler exams were completed on 105 participants (99%) during screening with 13% conditional and 6% abnormal results. Baseline labs (mean ± SD) documented hemoglobin = 7.7 ± 1.3 g/dL and HbF = 10.3 ± 7.1 %. Of 106 children enrolled, 1 died from acute chest syndrome in screening and 2 were withdrawn after moving away from the clinic; 103 successfully initiated hydroxyurea treatment. Conclusion: ADAPT has fully completed enrollment and will prospectively evaluate the effectiveness of hydroxyurea treatment on reducing transfusion use in Ugandan children with SCA, a finding with both individual and public health implications. ADAPT will also provide pilot data regarding the feasibility of PK-guided dosing of hydroxyurea to facilitate safe, effective hydroxyurea use in Africa.

71 Examining the Psychometric Validity of NeuroScreen to Assess Neurocognition in Hospitalized Psychosis Patients in Uganda

Objective:People with psychotic disorders often experience neurocognitive deficits, such as neurocognitive impairment (NCI), which can negatively affect their daily activities (e.g., performing independent tasks) and recovery. Because of this, the American Psychology Association advocates integrating neurocognitive testing into routine care for people living with psychotic disorders, especially those in their first episode, to inform treatment and improve clinical outcomes. However, in low-and-middle income countries (LMICs), such as Uganda where the current study took place, administering neurocognitive tests in healthcare settings presents numerous challenges. In Uganda there are few resources (e.g., trained clinical staff, and culturally relevant and normed tests) to routinely offer testing in healthcare settings. NeuroScreen is a brief, highly automated, tablet-based neurocognitive testing tool that can be administered by all levels of healthcare staff and has been translated into indigenous Ugandan languages. To examine the psychometric properties of NeuroScreen, we measured convergent and criterion validity of the NeuroScreen tests by comparing performance on them to performance on a traditional battery of neurocognitive tests widely used to assess neurocognition in people with psychotic disorders, the Matric Consensus Cognitive Battery (MCCB).Participants and Methods:Sixty-five patients admitted into Butabika Mental Referral Hospital in Uganda after experiencing a psychotic episode and forty-seven demographically similar control participants completed two neurocognitive test batteries: the MCCB and NeuroScreen. Both batteries include tests measuring the neurocognitive domains of executive functioning, working memory, verbal learning, and processing speed. Prior to completing each battery, patients were medically stabilized and could not exhibit any positive symptoms on the day of testing. On the day of testing, medication dosages were scheduled so that patients would not experience sedative effects while testing. To examine convergent validity, we examined correlations between overall performance on NeuroScreen and the MCCB, as well as tests that measured the same neurocognitive domains. To examine criterion validity, an ROC curve was computed to examine the sensitivity and specificity of NeuroScreen to detect NCI as defined by the MCCB.Results:There was a large correlation between overall performance on NeuroScreen and the MCCB battery of tests, r(110) = .65, p &lt; .001. Correlations of various strengths were found among tests measuring the same neurocognitive domains in each battery: executive functioning [r(110) = .56 p &lt;.001], processing speed [r(110) = .44, p &lt;.001)], working memory [r(110) = .29, p&lt;.01], and verbal learning [r(110) = .22, p &lt; .01]. ROC analysis of the ability of NeuroScreen to detect MCCB defined NCI showed an area under curve of .798 and optimal sensitivity and specificity of 83% and 60%, respectively.Conclusions:Overall test performance between the NeuroScreen and MCCB test batteries was similar in this sample of Ugandans with and without a psychotic disorder, with the strongest correlations in tests of executive functioning and processing speed. ROC analysis provided criterion validity evidence of NeuroScreen to detect MCCB defined NCI. These results provide support for use of NeuroScreen to assess neurocognitive functioning among patients with psychotic disorders in Uganda, however more work needs to be to determine how well it can be implemented in this setting. Future directions include assessing cultural acceptability of NeuroScreen and generating normative data from a larger population of Ugandan test-takers.

PAEDIATRIC-09 DIAGNOSIS AND MANAGEMENT OF PEDIATRIC BRAIN TUMORS IN SUB-SAHARAN AFRICA; A CASE STUDY OF UGANDA

Abstract BACKGROUND Pediatric brain tumors are the commonest solid tumors in children and the 2nd commonest childhood cancer globally. In Sub-Saharan Africa, there is paucity of data on their diagnosis and management. OBJECTIVES To describe the presentation, investigations done, treatment modalities and outcome of pediatric patients with brain tumors seen at Mulago National Referral Hospital in Uganda from May 2019 to March 2023. METHODS A retrospective study was conducted in Mulago National Referral Hospital, pediatric oncology unit, in patients below 18 years of age, admitted with a radiological finding of a brain tumor from May 2019 to March 2023. RESULTS The total number of children treated for a brain tumor in this period was 121.Majority (69 /121 (57 %)) of patients were males. The commonest symptom at presentation was headache (42%). Brain Ct-Scans were done in all, and majority (52%) had infratentorial tumors. The commonest diagnosis was glioma (38%), craniopharyngioma (26%), medulloblastoma (11%). Fifty-two patients had surgical resection and a histological diagnosis. Ten percent of patients had no diagnosis. Only 24(20%) patients received radiotherapy. Twenty patients received chemotherapy. Sixty-six are still alive and attending clinical reviews. The overall one-year survival was 63% (95%CI (50.3.0-73.4). CONCLUSION Gliomas were the commonest diagnosed pediatric brain tumor at the Mulago National Referral Hospital, pediatric oncology unit.

“We felt so proud by the president calling us my heroes.” An exploration of the nurse’s experiences in the management of COVID-19 patients in Uganda

IntroductionAdequate and intensive nursing care was a key characteristic of recovery of the COVID-19 patients globally and in Uganda. However, there is limited literature on the experiences of nurses who participated in the care of COVID-19 patients in Uganda, East Africa, and Africa at large, yet imperative in designing approaches to increase the efficiency of the health systems’ response to future pandemics. To address this gap, this study aimed to explore the experiences of the nurses who managed COVID-19 patients at Mulago National Referral Hospital in Uganda.MethodsThis was an exploratory qualitative study that used purposive sampling to identify 21 nurses who treated COVID-19 patients at Mulago National Referral Hospital in Uganda. Focus Group Discussions were used to collect data. Thematic Analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes.ResultsSix themes were identified: 1) Motivation to work on COVID-19 patients, 2 ) Roles performed by nurses, 3) High workload and professional role strain, 4) Challenges with maintaining personal health and relationships, 5) Institutional and government support, 6) Acquired professional knowledge and skills to manage critical patients and epidemics. Most of the nurses faced work burnout, social isolation, stress, and psychological trauma. However, interprofessional collaboration, financial incentives, government recognition, and provision of personal protective equipment, were key motivators for the nurses. The majority reported to have gained new knowledge and skills in the management of pandemics and highly infectious diseases.ConclusionThe nurses experienced negative scenarios like work burnout due to high workload, social isolation, and psychological stress. Therefore, there is a need for health systems to develop approaches and policies that support nurses’ well-being. Nevertheless, key attributes like resilience, adaptability, and diligence to serve enabled them to persevere despite the hardships faced.

36 Quality Improvement Integrated Kangaroo Mother Care (QIiKMC)-Development with Evidence-based Practice for Improving Quality (EPIQ) to Improve Learning and Implementation

Abstract Introduction/Background Kangaroo Mother Care (KMC) improves outcome for small newborns, but implementation has been slow. This lag may be associated with lack of short, effective learning programs for healthcare workers, and limited ability to overcome barriers to KMC program development. Objectives To develop a practical learning program for KMC with focus on facilitating healthcare workers assisting the learning of mothers and other family members in KMC care of small babies. To integrate KMC with quality improvement to assist healthcare workers overcome barriers to implementation and improve practice. Design/Methods Six neonatologists, with other global experts, developed as simulation-based, interactive, 12-contact-hour learning program with virtual pilot testing in Uganda, Tanzania, and Nepal, prior to implementation in Mbarara Regional Referral Hospital in Uganda. Revisions in QIiKMC course content and integration with quality improvement were accompanied by development of A KMC Readiness, Survey, Knowledge and Confidence Check, Parent Information, and Course Evaluation, with all components available at www.cnf-fnc.ca. Results Thirty-three nurses and physicians increased knowledge scores from 79% to 88% post-learning. 77% indicated the course was useful or very useful, appreciating “The link between EPIQ and KMC in identification and solving problems” and the “Usefulness of family involvement in caring for the newborn in the hospital and home”. Participants indicated preferences for face-to-face learning and more time for hands-on practice. KMC for small babies increased from 0% to 65% (by August-October 2022). Length of hospital stay decreased by 5 days. Government increased KMC beds from 4 to 8. Staff reported increased job satisfaction along with increased quality improvement activities. Family members in addition to mothers were involved (especially with multiple births or if the mother was ill). Families helped other families with learning. One father reported that “When my baby grows up, I will let him know that it was my warmth which kept him alive”. Conclusion Development of a short, practical KMC learning program was feasible. Integration with quality improvement was empowering and impactful. Acknowledgements Funding from the Royal College of Physicians and Surgeons of Canada and a Rotary Global Grant is appreciated. Potential competing interests Funding for learning program development was received from the Royal College of Physicians and Surgeons of Canada. Funding for KMC implementation in Uganda was supported by a Rotary Global Grant.

Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda.

In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies. The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities. The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital's ambulance log book for each case. The sample size was 215. The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50min, from ambulance activation until the mother was received at KNRH. Differences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Ambulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken. Recommendations are to develop an integrated ambulance system for both government and non-government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.