School of Health Sciences (SHS) Researches

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Breakdown of simple female genital fi stula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial
(CrossMark, 2015) Mark A, Barone; Mariana, Widmer; Steven, Arrowsmith; Joseph, Ruminjo; Armando, Seuc; Evelyn, Landry; Thierno Hamidou, Barry; Dantani, Danladi; Lucien, Djangnikpo; Tagie, Gbawuru-Mansaray; Issoufa, Harou; Alyona, Lewis; Mulu, Muleta; Dolorès, Nembunzu; Robert, Olupot; Ileogben, Sunday-Adeoye; Weston Khisa, Wakasiaka; Sihem, Landoulsi; Alexandre, Delamou; Lilian, Were; Vera, Frajzyngier; Karen, Beattie; A Metin, Gülmezoglu
Summary Background Duration of bladder catheterisation after female genital fi stula repair varies widely. We aimed to establish whether 7 day bladder catheterisation was non-inferior to 14 days in terms of incidence of fi stula repair breakdown in women with simple fi stula. Methods In this randomised, controlled, open-label, non-inferiority trial, we enrolled patients at eight hospitals in the Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Niger, Nigeria, Sierra Leone, and Uganda. Consenting patients were eligible if they had a simple fi stula that was closed after surgery and remained closed 7 days after surgery, understood study procedures and requirements, and agreed to return for follow-up 3 months after surgery. We excluded women if their fi stula was not simple or was radiation-induced, associated with cancer, or due to lymphogranuloma venereum; if they were pregnant; or if they had multiple fi stula. A research assistant at each site randomly allocated participants 1:1 (randomly varying block sizes of 4–6; stratifi ed by country) to 7 day or 14 day bladder catheterisation (via a random allocation sequence computer generated centrally by WHO). Outcome assessors were not masked to treatment assignment. The primary outcome was fi stula repair breakdown, on the basis of dye test results, any time between 8 days after catheter removal and 3 months after surgery. The non-inferiority margin was 10%, assessed in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT01428830. Findings We randomly allocated 524 participants between March 7, 2012, and May 6, 2013; 261 in the 7 day group and 263 in the 14 day group. In the per-protocol analysis, ten (4%) of 250 patients had repair breakdown in the 7 day group (95% CI 2–8) compared with eight (3%) of 251 (2–6) in the 14 day group (risk diff erence 0·8% [95% CI –2·8 to 4·5]), meeting the criteria for non-inferiority. Interpretation 7 day bladder catheterisation after repair of simple fi stula is non-inferior to 14 day catheterisation and could be used for management of women after repair of simple fi stula with no evidence of a signifi cantly increased risk of repair breakdown, urinary retention, or residual incontinence up to 3 months after surgery.
Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey
(SICOT aisbl, 2018) Kristin, Alves; Norgrove, Penny; Olive, Kobusingye; Robert, Olupot; Jeffrey N., Katz; Coleen S., Sabatini
Abstract Purpose The purpose of this study is to estimate the burden of musculoskeletal disease among children treated in Kumi District, Uganda, to inform training, capacity-building efforts, and resource allocation. Methods We conducted a retrospective cohort study by reviewing the musculoskeletal (MSK) clinic and community outreach logs for children (age < 18 years) seen at Kumi Hospital in Kumi, Uganda, between January 2013 and December 2015. For each patient, we recorded the age, sex, diagnosis, and treatment recommendation. Results Of the 4852 children, the most common diagnoses were gluteal and quadriceps contractures (29.4% (95% CI 28.1– 30.7%), 96% of which were gluteal fibrosis), post-injection paralysis (12.7% (95% CI 11.8–13.6%)), infection (10.5% (95% CI 9.7–11.4%)), trauma (6.9% (95% CI 6.2–7.6%)), cerebral palsy (6.9% (95% CI 6.2–7.7%)), and clubfoot (4.3% (95% CI 3.8– 4.9%)). Gluteal fibrosis, musculoskeletal infections, and angular knee deformities create a large surgical burden with 88.1%, 59.1%, and 54.1% of patients seen with these diagnoses referred for surgery, respectively. Post-injection paralysis, clubfoot, and cerebral palsy were treated non-operatively in over 75% of cases. Conclusion While population-based estimates of disease burden and resource utilization are needed, this data offers insight into burden of musculoskeletal disease for this region of Sub-Saharan Africa.We estimate that 50%of the surgical conditions could be prevented with policy changes and education regarding injection practices and early care for traumatic injuries, clubfeet, and infection. This study highlights a need to increase capacity to care for specific musculoskeletal conditions, including gluteal fibrosis, post-injection paralysis, infection, and trauma in the paediatric population of Uganda.
Burden of gluteal fibrosis and postinjection paralysis in the children of Kumi District in Uganda
(BMC Musculoskeletal Disorders, 2018) Kristin, Alves; Norgrove, Penny; John, Ekure; Robert, Olupot; Olive, Kobusingye; Jeffrey N., Katz; Coleen S., Sabatini
Abstract Background: The purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital. Methods: We conducted a retrospective cohort study by reviewing the musculoskeletal clinic and community outreach logs for children (age < 18 yrs) diagnosed with either PIP or GF from Kumi Hospital in Kumi, Uganda between 2013 and 2015. We estimated the prevalence as a ratio of the number of children seen with each disorder over the total population of children seen for any musculoskeletal complaint in musculoskeletal clinic and total population of children seen for any medical complaint in the outreach clinic. Results: Of 1513 children seen in the musculoskeletal clinic, 331 (21.9% (95% CI 19.8–24.1%)) had PIP and another 258 (17.1% (95% CI 15.2–19.0%)) had GF as their diagnosis. Of 3339 children seen during outreach for any medical complaint, 283 (8.5% (95% CI 7.6–9.5%)) had PIP and another 1114 (33.4% (95% CI 31.8–35.0%)) had GF. Of patients with GF, 53.9% were male with a median age of 10 years (50% between 7 and 12 years old). Of patients with PIP, 56.7% were male with a median age of 5 years (50% between 2 and 8 years old). Conclusion: PIP and GF comprise over 30% of clinical visits for musculoskeletal conditions and 40% of outreach visits for any medical complaint in this area of Uganda. The high estimated prevalence in these populations suggest a critical need for research, treatment, and prevention. Keywords: Gluteal fibrosis, Post-injection paralysis
Magnitude of Birth Preparedness among Pregnant Women Seeking Skilled Birth Services at a Rural Hospital in Western Uganda:
(Scholars Academic and Scientific Publishers (SAS Publishers), 2018-09-30) Munguiko, Clement; Gorrette, Nalwadda; Masereka Enos, Mirembe; Nandutu, Alice; Conrad Ondieki, Miruka
Abstract: Although the practice of preparing for childbirth among pregnant women is associated with 24.0% and 53.0% reduction in neonatal and maternal mortality respectively in low income countries, it remains inadequately practiced in low income countries. This study sought to assess the level of birth preparedness among pregnant women at one of the rural hospitals in Uganda. This was a descriptive cross sectional study conducted among 332 pregnant women in first stage of normal labour between April and May 2017 at Kagadi hospital, a rural hospital in Uganda. A pregnant woman was considered prepared for childbirth if she fulfilled at least three of the following five birth preparedness elements; saving money, booking birth companion, identifying home caretaker, having at least six birth items and booking means of transport to the health facility. Data were collected using a researcher administered questionnaire. Nearly all respondents had identified birth companion (93.7%) and prepared at least one birth material (97.3%). However, only about half of respondents had procured at least six birth items (48.2%). A small proportion of respondents had reasonable money savings of at least 27.7 US dollars (20.7%). Slightly less than half of respondents had booked someone to take care of their homes (41.3%) and had booked means of transport (40.0%) Overall, only 28.3 percent of the participants had fulfilled at least three of the five elements and were considered as prepared for birth. We observed that most of the pregnant women were not prepared for childbirth. To scale up birth preparedness in rural settings, we recommend that providers of antenatal care services should intensify on assisting pregnant women to draw and continuously review birth plans. We further recommend that birth plan should focus on the five elements commended by the Ministry of Health.
Subacute toxicity study of aqueous root extract of Terminalia schimperiana in male Wistar rats
(Published by Elsevier B.V., 2019) O.S., Awotunde; S.O., Adewoye; Dhanabal, P.S; J., Hawumba
Abstract: The effect of administration of aqueous extract of Terminalia schimperiana root, “a medicinal plant”, on some ‘biomarker’ enzymes, hematology parameters, liver function and kidney function parameters of rat cellular system was investigated. The aqueous extract was administered orally to male wistar rats (Rattus norvegicus) at various doses (1000, 2000, 3000 mg/kg body weight) daily for 21 days and the rats were sacrificed under chloroform anesthesia after 1, 7 and 21 days of oral administration. The administration of the aqueous extract of Terminalia schimperiana root for 21 days resulted in significant (P < 0.05) increase in packed cell volume and red blood cells level when compared with the control but were all within the normal test range. The differentials remained normal and the white blood cells level remained constant throughout the test period but increased after day 21 of the administration. Aspartate transaminase, alkaline phosphatase and acid phosphatase serum activities significantly (P < 0.05) increased, while the serum activities of alanine transaminase and gamma glutamyl transferase significantly (P < 0.05) reduced after 21 days of administration when compared with the control but they all fell within the normal test range. The extract produced (out of normal test range) significant (P < 0.05) increase in the serum albumin and total bilirubin. The kidney function parameters level was normal for sodium and potassium while the levels of creatinine and urea increased when compared with the control but were within the normal test ranges. The extracts did not have deleterious effect on the male wistar rat organs at the dosages investigated, therefore, studies for extended period is suggested to determine if the prolonged continuous use of the extract might cause challenge on the functional capacity of the organs.
Factors Influencing the Timing of the First HIV Virological Test for HIV Exposed Infants;
(Global Journal of Medical Research: K, 2020) Enos Mirembe, Masereka; Edson Musungu, Bwambale; Edson, Katsomyo; Munguiko, Clement
Abstract- Introduction: Although Option-B plus has registered tremendous success in the Prevention of Mother to Child Transmission (PMTCT) of HIV, the failure to follow the HIV testing algorithm for HIV Exposed Infants (HEIs) after birth is likely to make achieving zero new HIV infections among children unrealistic. Due to this, we sought to determine the factors affecting uptake of first Polymerase Chain Reaction (PCR) test among HEIs to inform the selection of strategies to strengthen Early Infant Diagnosis (EID), an indicator that tracks progress towards achieving zero new HIV infections in children
Comparative Assessment of Red Blood Cell Morphology in Anaemic Children
(International Journal of Sciences, 2020) Samuel, Mwesige; Clement, Munguiko; Didas, Mushabe
Abstract Anaemia (haemoglobin level < 11 g/dl) is a health burden among preschool children and women of child bearing age and affects over 27% of the World population. Anaemia results from reduction in the functional haemoglobin or red blood cell numbers or mass leading to decreased oxygen carrying capacity characterized by clinical features such as; skin pallor, fatigue, shortness of breath, congestive heart failure, jaundice and tachycardia. Evaluating and interpreting red blood cell morphology provides key information in the differential diagnosis of Anaemia. However, the current standard Peripheral thin blood method of assessing red blood cell morphology is highly technical and time consuming. There was need to carry out assessment into the alternative Automated Complete Blood Count method to aid in the selection of the reliable assay. The objective of the study was to compare between Peripheral blood thin film and Automated Complete Blood Count morphologically classified Anaemia in children. The study was cross-sectional and employed simple random sampling technique. Blood samples were obtained from the participants, assessed for red blood cell morphology by Automated Complete Blood Count and Peripheral thin blood film. Data was analyzed using SPSS and a paired t-test used to test for the statistical significance. Results show no significant difference in the scores for Peripheral thin blood film (M=25.5, SD=11.82) and Automated Complete Blood Count (M=25.5, SD=12.66) t (3) =0.00, p =1.000. Automated Complete Blood Count is a method of choice in assessing red blood cell morphology and evaluating Anaemia. The study recommends assessment into various Automated Complete Blood Count models available in the market to aid in the selection of most reliable one.
The Silent Anaemia Epidemic in Children
(International Journal of Innovative Science and Research Technology, 2020-05) Samuel, Mwesige; Annete, Nankwanga; Didas, Mushabe
Abstract:- Anaemia (haemoglobin level < 11 g/dl) is a silent epidemic that affects about 293.1 million children aged <5 years worldwide with 28.5% of those located in sub-Sahara Africa. Child hood Anaemia is associated with poor cognition, reduced growth, problems with immune function and ultimately decreased survival. Uganda’s childhood Anaemia is insidious, multifactorial and undefined. The objectives of the study were to determine the prevalence, severity and leading cause of Anaemia amongst children ≤ 12 years attending Virika hospital. The cross-sectional study employed both qualitative and semi-quantitative methods. Participants were sampled by convenience and simple random techniques. Parents were given short interviews to obtain participants demographic and necessary information. Blood, stool and anthropometric measurements were obtained from the participants and tested for complete blood count, malaria, HIV, sickle cell disease, helminthes and malnutrition respectively. Data was analyzed using Excel computer program. Results show that Prevalence of Anaemia in children is high, presenting mostly in moderate form. Malnutrition plays a major role in the development of Anaemia. Nutritional support and awareness are key aspects in prevention of Anaemia development and progression. Other control interventions may include provision of improved diagnostic tests, optimizing compliance, appropriating referral practices, implementation of standard treatment guidelines and research.
Viability And Infectivity Of Coronavirus (2019-nCoV)
(International Journal of Innovative Research and Advanced Studies (IJIRAS), 2020-05) Samuel, Mwesige
Abstract: 2019-nCoV is one of the seven human coronaviruses responsible for causing COVID-19. The disease started in Wuhan China and was declared a global pandemic by the World Health Organization because of high number of confirmed COVID-19 cases and deaths across the world. COVID-19 is a rapidly spreading novel disease and yet has no defined treatment plan. It is imperative for us to understand viability and infectivity of 2019-nCoV with the hope of finding interventional and treatment solutions. Based on behavioral similarity and biological relatedness between 2019-nCoV and SARS-CoV, a number of viability and infectivity factors that influence the spread of COVID-19 have been elucidated. The viability factors are viral genes, protein factors and metrological features (fomites, low temperatures low humidity). Factors responsible for 2019-nCoV infectivity are virion N and S proteins and the human biology aspects of gender, sex hormones, sex-linked genes and immune cells. The biological factors can be used as biomarkers to develop therapies and diagnostics for COVID-19. Public health interventional strategies such as social distancing, isolation, contact tracing and use of facemasks should be encouraged to break COVID-19 transmission chain.
Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up
(Wolters Kluwer Health, Inc, 2021) Amanda L., Reilly; Francis R., Owori; Ruth, Obaikol; Elizabeth, Asige; Harriet, Aluka; Norgrove, Penny; Robert, Olupot; Coleen S., Sabatini
Background: Gluteal fibrosis (GF) is a fibrotic infiltration of the gluteal muscles resulting in functionally limiting contracture of the hips and is associated with injections of medications into the gluteal muscles. It has been reported in numerous countries throughout the world. This study assesses the 5-year postoperative range of motion (ROM) and functional outcomes for Ugandan children who underwent surgical release of GF. Methods: A retrospective cohort study of children who underwent release of GF in 2013 at Kumi Hospital in Eastern Uganda. Functional outcomes, hip ROM, and scar satisfaction data were collected for all patients residing within 40 km of the hospital. Results: One hundred eighteen children ages 4 to 16 at the time of surgery were treated with surgical release of GF in 2013 at Kumi Hospital. Of those 118, 89 were included in this study (79.5%). The remaining 29 were lost to follow-up or lived outside the study’s radius. Detailed preoperative ROM and functional data were available for 53 of the 89 patients. In comparison with preoperative assessment, all patients postoperatively reported ability to run normally (P<0.001), sit upright in a chair (P< 0.001), sit while eating (P<0.001), and attend the entire day of school (P< 0.001). Passive hip flexion (P<0.001) improved when compared with preoperative measurements. In all, 85.2% (n= 75) of patients reported satisfaction with scar appearance as “ok,” “good,” or “excellent” 29.2% (n= 26) of patients reported back or hip complaints. Conclusions: Overall, the 5-year postoperative outcomes suggest that surgical release of GF improves ROM and functional quality of life with sustained effect. Level of Evidence: Level IV—case series. Key Words: gluteal fibrosis, injection injury, pediatric hip contracture, fibrosis surgery, treatment outcome, Uganda
Infant and Young Child Feeding in the Developed and Developing Countries
(IntechOpen, 2022) Enos Mirembe, Masereka; Munguiko, Clement; Alex, Tumusiime; Linda Grace, Alanyo
Abstract Infant feeding challenges continue to manifest in developed and developing countries. Worldwide, more than 80% of babies are breastfed in the first few weeks of birth. However, about 37%, 25%, and less than 1% are exclusively breastfed at 6 months of age in Africa, the United States of America, and the United Kingdom, respectively. These statistics are far below the World Health Organization targets of 50% and 70% by 2025 and 2030, respectively. Complementary feeding practices are varied as well due to nonadherence to Infant and Young Child Feeding (IYCF) guidelines among parents. This accounts for the current trends in malnutrition in children under−5 years of age, adolescents, and the youth, and leads to intergenera tion malnutrition. In this chapter we have included sections on appropriate infant feeding; including how to initiate breastfeeding in the first hour of birth, how to exclusively breastfeed infants until 6 months of age, how to complement breastfeed ing after 6 months of infant’s age as well as continuing to breastfeed until 24 months of age and even beyond. Furthermore, we have included a description of how mothers who are unable to breastfeed can feed their infants on expressed breastmilk or replace breastmilk with appropriate homemade or commercial formula. This chapter as well covers infant feeding in prematurity
Prevalence of pulmonary tuberculosis and the associated clinical symptoms in Western Uganda
(International Journal of Life Science Research Archive, 2022) Florence, Tushabe; Samuel, Mwesige; Annet, Nankwanga; Ivan, Kasamba; Ruth, Kateeba
Abstract Pulmonary tuberculosis is a public health problem affecting over 5.8 million people worldwide per year. Burden of the disease varies across populations due to differences in biological and behavioral factors. In Western Uganda, the prevalence of pulmonary tuberculosis was not established and there was continued use of a biased clinical tuberculosis description guideline during treatment. Therefore, a cross-sectional study was conducted among people ≥12 years attending Buhinga hospital in Western Uganda from April to June 2019 to achieve the following specific objectives; (1)-Determine prevalence of pulmonary tuberculosis by age group and sex, 2-Assess the clinical symptoms associated with pulmonary tuberculosis amongst the participants. Participants were recruited by simple random sampling technique and standardized questionnaire were administered to obtain demographic and clinical data. 379 sputum specimens were collected and tested for M. tuberculosis using Gene X-pert and Classical Real Time PCR. Data was analyzed using SPSS software version 13. Prevalence of pulmonary tuberculosis by age group was highest in 20-29 years, high in 30-39 years and ≥50 years and least in 10-19 years old individuals. Females had a slightly higher prevalence of pulmonary tuberculosis than males. Youthful behavior of active participation in social activities and advanced age health associated factors contributed to the high prevalence of pulmonary tuberculosis amongst the participants. There was no significant relationship between pulmonary tuberculosis disease and demography; - age group and sex (P-value = 0.24). All pulmonary tuberculosis cases presented with persistent fevers, coughs for ≥ 2 weeks, night sweats and noticeable weight loss in the hierarchical order. The relationship between pulmonary tuberculosis disease and clinical symptoms; - persistent fevers, cough, noticeable weight loss and night sweats (P-values; <0.001, <0.001, 0.001 and <0.001 respectively) was significant. Age and clinical symptoms are important pulmonary tuberculosis control hotspots.
Diabetic Foot Ulcers: Surgical Characteristics, Treatment Modalities and Short-Term Treatment Outcomes at a Tertiary Hospital in South-Western Uganda
(Open Access Surgery, 2022) Mvuyo Maqhawe, Sikhondze; Deus, Twesigye; Charles Newton, Odongo; David, Mutiibwa; Edson, Tayebwa; Leevan, Tibaijuka; Samuel D, Ayana; Carlos Cabrera, Dreque
Abstract Background: Diabetic foot ulcers (DFUs) are a prevalent and serious consequence of poorly controlled diabetes. Hospitalizations are frequent among DFU patients, and these patients are at risk of lower extremity amputations (LEA). Uganda has few studies detailing DFUs and their management. We described the surgical characteristics, treatment modalities and short-term treatment outcomes of DFUs at Mbarara Regional Referral Hospital, in southwestern Uganda. Methods: A prospective cohort study involving 62 patients with DFUs was conducted from February 2021 to September 2021. We captured socio-demographic data, surgical characteristics, treatment and treatment outcomes of DFUs over a 5-week follow-up period, through an interviewer-administered structured questionnaire. Descriptive statistics were used at analysis. Results: The mean age of participants was 57.0 ± 12.27 years, comprising 35 (56.5%) females. Majority had diabetes mellitus (DM) for more than 10 years, predominantly type 2 (93.5%), and 33.9% with very poor glycaemic control (HBA1c>9.5%). Most ulcers involved the toes (27.4%), with 80.7% being large (>3 cm2 ). Severe DFUs (Wagner grade 3–5) were seen in 66.2% of patients. Clinically infected ulcers mainly had Pseudomonas spp cultured. Arterial occlusion was detected in 35.5% through lower extremity Doppler ultrasonography. Initial surgical interventions were surgical debridement and LEA performed in 50.0% and 46.8%, respec tively. Eight (42.1%) patients suffered surgical site infection, while 26.3% had persistent gangrene after initial surgery. Revision surgery was performed in 25.8% of the participants. Mortality rate was 1.6%, and mean length of hospital stay was 17.0 ± 11.1 days. Conclusion: More than half of the patients had advanced DFUs (Wagner grades 3–5). Poor glycemic control and late presentation were common. Lower extremity amputation was a common initial treatment modality for DFUs. Routine lower extremity Doppler ultrasonography is recommended to assess peripheral arterial disease for DFU patients. Wound swabbing for culture and sensitivity testing is encouraged for appropriate antibiotic coverage
The correctness and completeness of documentation of parameters on the partographs used by midwives in primary healthcare facilities in midwestern Uganda:
(Nursing Open published by John Wiley & Sons Ltd, 2022) Archbald, Bahizi; Munguiko, Clement; Enos Mirembe, Masereka
Abstract Aim: This study was conducted to determine the correctness and completeness of documentation of partographs. Design: This was a retrospective descriptive study. Methods: We included 365 partographs of deliveries conducted from January 1st to October 31st 2019. Data were collected using a checklist and analysed descriptively. The study based on 13 partograph parameters. Results: About 8–13 parameters were correctly documented in 71.5 % of the partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine contractions and cervical dilatation respectively. About 12.1% of the cervicographs crossed the action line and 61.4% of partographs where cervicographs crossed the action line had no documentation of action(s) taken.
The phenotypes and alleles frequencies of ABO blood groups in Western Uganda
(Open Access Research Journal, 2022) Samuel, Mwesige; Annet, Nankwanga; Florence, Tushabe; Ivan, Kasamba; Ruth, Kateeba
Abstract ABO blood group system is one of the clinically significant blood classification systems that vary across populations. Knowledge of distribution of the ABO blood system can help us to predict herd immunity and transmissibility of a disease in a population. In Uganda, little was known about this system and no research had been carried out to elaborate on the distribution of the A, B, AB and O blood types. Therefore, a cross-sectional study was conducted among people ≥12 years attending Buhinga hospital in Western Uganda from April to June 2019 to determine the phenotypes and alleles frequencies of the A, B, AB and O blood groups. Participants were recruited by simple random sampling technique and demographic data was obtained. 379 venous blood samples were collected and tested for ABO sero-types. Phenotypic data was analyzed using descriptive statistics, chi-square test of association and Hardy-Weinberg law of computation. Frequencies of ABO phenotypes were in the following order; O (39.8%)>, A (39.6%) >, B (12.4%)> AB (8.2%). There was no significant difference in the A, B, AB and O phenotype frequencies between males and females (p-value= 0.91). Based on Hardy-Weinberg Law, frequencies of the A, B, O alleles were; 0.63 for the O allele, 0.27 allele for the A allele and 0.14 for the B allele. Predominance of blood group O is more likely to influence population immunity.
Urinary bladder cavernous hemangioma in a 3-year-old:
(John Wiley & Sons Ltd., 2022-04-26) Charles Newton, Odongo; Raymond, Atwine; Fred, Kirya; Patrick Ambrose, Okello; Eugene, Ogwang; Moses, Acan; Felix, Bongomin; Martin, Situma
Cavernous hemangioma (CH) of urinary bladder occurs relatively infrequently, accounting for 0.6% of all bladder tumors. This tumor may occur sporadically or coexist with other benign and malignant vascular lesions. In this report, we present a rare case of CH in a 3-year-old Ugandan girl. A 3-year-old girl was re ferred to Mbarara Regional Referral Hospital (MRRH) for urological evaluation following a 3-year history of intravaginal swelling, dysuria, and heavy hematuria resulting in anemia. Imaging was consistent with polypoid bladder mass arising from the bladdertrigone. Embryonalrhabdomyosarcoma wassuspected based on clinical eyeballing. She was worked up for chemotherapy and received 26 cycles of vincristine sulfate, actinomycin-d, and cyclophosphamide (VAC). Biopsy and fulguration were performed after optimizing the patient. Histopathology con firmed CH. The surgery was uneventful and resulted in complete cure. CH should be considered in the differential diagnosis of childhood genitourinary masses. It is a rare entity in the real-life clinical practice and therefore can be overlooked. Excision biopsy and histology should be performed before initiating the patients to chemotherapy. CH is very insensitive to chemotherapy and therefore surgery maybe adequate in resource-limited settings.
Malignant mixed mullerian tumor:
(Elsevier Ltd on behalf of Surgical Associates Ltd., 2022-05-20) Emmanuel D, Morgan; Tonny, Okecha; James J., Yahaya; Emmanuel, Othieno
Abstract: Introduction: Malignant mixed Mullerian tumor (MMMT) is an exceedingly rare and aggressive tumor which occurs predominantly in postmenopausal women though it has been reported rarely in premenopausal women. Case presentation: A 54-year old nulliparous postmenopausal female presented with a 3-month history of vaginal bleeding, mild lower abdominal pain and weight loss. Ultrasound revealed markedly enlarged uterus with a hyper-echoic solid and cystic mass and a right adnexal complex mass. Total abdominal hysterectomy and bilateral salpingioopherectomy were done. Histopathological features were consistent with MMMT. The patient is currently stable after 6 cycles of adjuvant chemotherapy which consisted of paclitaxel and carboplatin. Clinical discussion: MMMT of the uterus is rare, high-grade neoplasms comprising only 1–2% of uterine cancers and 3–5% of all uterine malignancies. This tumor may arise in the ovaries, fallopian tubes and vagina. Histologically, MMMT is a biphasic tumor composed of both epithelial (carcinoma) elements and mesenchymal (sarcoma) elements; though, which component is responsible for the tumor’s aggressive biological behavior remains undetermined. Conclusion: MMMT is a rare and aggressive tumor which is commonly seen in postmenopausal women with high rate of recurrence therefore, Radical surgery and close follow-up is mandatory since the role of chemoradiotherapy remains unclear in the management of patients with this tumor. Both stage of the tumor and myometrial invasion are considered as potential prognostic factors.
Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda
(Clinical and Experimental Gastroenterology journal, 2022-11-13) Charles Newton, Odongo; Carlos Cabrera, Dreque; David, Mutiibwa; Felix, Bongomin; Felix, Oyania; Mvuyo Maqhawe, Sikhondze; Moses, Acan; Raymond, Atwine; Fred, Kirya; Martin, Situma
Background: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda. Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files. Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pan creatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%). Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.
Severe malaria burden, clinical spectrum and outcomes at Apac district hospital, Uganda
(Malaria Journal, 2023) Emmanuel, Ocen; Ronald, Opito; Crispus, Tegu; Alex, Oula; Peter, Olupot‑Olupot
Abstract Background Most data describing severe malaria (SM) in sub‑Saharan Africa (SSA) are from research settings out side disease endemic areas. Using routinely collected data from Apac District Hospital, this study aimed at determin ing the burden and clinical spectrum of severe malaria. Methods This was a retrospective study that reviewed all paediatric admission records for malaria in the 24 months period from Jan 2019 to Dec 2020 at Apac District Hospital. Data on children aged 60 days to 12 years who at admis sion tested positive for malaria and fulfilled the World Health Organization clinical criteria for surveillance of severe malaria were abstracted using a customized proforma designed to capture variables on social demographic, clinical presentation, treatment, and outcomes. In addition, the tool included laboratory variables for complete blood counts, haemoglobin, and glucose levels. Data were analysed using STATA V15.0. The study had ethical approval from Mbale Regional Referral Hospital REC, Approval No. MRRH‑REC 053/2019. Results A total of 5631 admission records were retrieved for this study period. Of these, 3649 (64.8%) were malaria admissions and 3422/3649 were children below 12years, with only 1864 (54.5%) of children having complete data. Of the 1864 children, 745 (40.0%) fulfilled the severe malaria inclusion criteria. Of the 745 children, 51.4% (n = 381) were males. The median age at admission was 31 months (IQR = 17–60). The most common clinical presentations among children with severe malaria were fever 722 (97.3%), cough 478 (64.2%), and difficulty in breathing 122 (17.9%). The median length of hospital stay was 2 (IQR; 2–4) days and 133 (17.9%) had prolonged hospital stay (> 4 days). Factors independently associated with prolonged hospital stay were, presenting with difficulty in breathing, aOR 1.83 (95% CI 1.02–3.27, P = 0.042) and prostration aOR 8.47 (95% CI 1.94–36.99, P = 0.004). A majority of admitted children, 735 (98.7%) survived, while 10 (1.3%) died of SM. Conclusion A high proportion (40.0%) of malaria admissions were due to SM. Prolonged Hospital stay was associ ated with prostration and difficulty in breathing. Overall mortality was low, 1.3% compared to mortality in the previ ously reported series. This study was able to use routinely collected data to describe the burden and clinical spectrum of SM. Improvement in the quality of data from such settings would improve disease descriptions for policy, monitor ing of epidemics, response to interventions and to inform research
Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute
(John Wiley & Sons Ltd., 2023) Jennifer, Achan; Francis Xavier, Kasujja; Ronald, Opito; Henry, Wabinga; Christopher Garimoi, Orach; Amos Deogratius, Mwaka
Abstract Background: Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). Methods: This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals. Results: The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis diagnostic interval (DI) was 5.6 months (IQR: 1.5–17.0), while the median interval from histological diagnosis to start of chemotherapy pre-treatment interval (PTI) was 1.7 months (IQR: 0.7–4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100–199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15–13.0] and [aPR = 2.19; 95% CI: 1.06–4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. Conclusion: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.

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