School of Health Sciences (SHS) Researches
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Item 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, GülmezogluSummary 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.Item 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., SabatiniAbstract 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 paralysisItem Comparative Assessment of Red Blood Cell Morphology in Anaemic Children(International Journal of Sciences, 2020) Samuel, Mwesige; Clement, Munguiko; Didas, MushabeAbstract 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.Item 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, MaserekaAbstract 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.Item 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, DrequeAbstract 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 coverageItem Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study(BMC Women's Health, 2023-11-27) Jackie, Lalam Lacika; Henry, Wabinga; Joseph, Kagaayi; Ronald, Opito; Christopher, Garimoi Orach; Amos Deogratius, MwakaAbstract Background Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. Methods This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. Results The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemoradiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). Conclusion Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.Item Disseminated peritoneal leiomyomatosis as an incidental finding: A case report(John Wiley & Sons Ltd., 2023-02-16) Emmanuel D, Morgan; Mohamed, Kahiye; Isaiah, Kule; James J, Yahaya; Emmanuel, OthienoWe present the case of a 23-year-old female with multiple diffuse and nodular masses of different sizes involving predominantly the posterior wall of the uterus, omentum, and peritoneum which were histopathologically confirmed to be dis seminated peritoneal leiomyomatosis. Meticulous investigation and accurate di agnosis are of utmost importance for the establishment of the correct diagnosis. Additionally, proper management of the patient while considering choice of the patients including close follow-up of the patients is mandatory for the reason of ensuring early detection of recurrence.Item 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, SitumaBackground: 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.Item 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, MwakaAbstract 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.Item Factors associated with retention of motherbaby pairs in the elimination of mother-tochild transmission of HIV program in Kaberamaido district: A longitudinal analysis(PLOS One Publishers, 2023-07-21) James Daniel, Odongo; Ronald, Opito; Benon, Wanume; Denis, Bwayo; David, Mukunya; Samuel, Okware; Joseph K. B., MatovuAbstract Background Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Uganda remains poor as only 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCT cascade (12 and 18 months) and associated factors. Methods This was a longitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCT program in Kaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Microsoft Excel and then exported to Stata statistical software package version 14.0 for management and analysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent variable, while Cox proportional hazard regression model was built at multivariate level to determine the factors independently associated with retention of mother-baby pairs in the eMTCT program. Results Of the 368 mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI = 92.0–96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3–8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0–90.8) were active in eMTCT program while 45(12.2%, 95 CI = 9.2–16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers’ ART treatment supporter, and mothers’ ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers’ time of ART initiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those who initiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62– 11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFU as compared to those enrolled before the implementation of test and treat policy in Uganda (year 2013–2016), aHR = 2.22(95% CI, 1.15–4.30, P = 0.017). All the other factors had no significant association with lost to follow up and cascade completion at multivariate level. Conclusion There was high level of retention of mother-baby pairs in the eMTCT program in Kaberamaido at 12 months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of motherbaby pairs along the eMTCT cascade.Item 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, ClementAbstract- 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 childrenItem Frequency and distribution of ABO and Rh blood group systems among blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania(BMC Open, 2023-02-02) Edda A M, Vuhahula; James, Yahaya; Emmanuel D, Morgan; Emmanuel, Othieno; Edson, Mollel; Alex, MremiObjectives ABO and Rh blood group systems are the major factors affecting the blood transfusion safety. The frequency and distribution of these blood group systems vary worldwide. We aimed to determine the frequency and distribution of ABO and Rh blood group systems among first-time blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania. Design Cross-sectional descriptive population-based study. Setting Data on ABO and Rh blood group systems were obtained and analysed from the Northern Zone Blood Transfusion Center among first-time blood donors. Participants There were 65 535 first-time blood donors aged 15–55 years who donated at the Northern Zone Blood Transfusion Center from January 2017 to December 2019. Outcome measures The percentage of ABO and Rh blood group systems among different categories of blood donors was calculated. Results Retrospective data from Blood Establishment Computer System of 65 535 first-time blood donors were analysed in the present study. The mean age of the blood donors was 30.6±11.2 years (range: 15–55 years). The vast majority of the blood donors 84.2% (n=55 210) were men. Also, the majority 69.6% (n=45 595) were aged ≥35 years. Blood group O was the most common blood group which was found in over half 52.4% (n=34 333) of the blood donors and majority 95.3% (n=62 461) of the donors were Rh positive. Moreover, the majority 78.3% (n=51 336) were voluntary donors and the remaining 21.7% (n=14 199) were replacement donors. Conclusion Majority of the donors had blood group O and also the vast majority of the donors were Rh positive. Considering the large size of our study population, this has provided a more comprehensive information regarding the frequency and patterns of ABO and Rh blood group systems in Tanzania. The observed association of blood group A with one of the regions from which donors were coming from, is intriguing and further studies may confirm possible related genetic evolution.Item Infant and Young Child Feeding in the Developed and Developing Countries(IntechOpen, 2022) Enos Mirembe, Masereka; Munguiko, Clement; Alex, Tumusiime; Linda Grace, AlanyoAbstract 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 prematurityItem Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda(PLOS One Publishers, 2024-01-02) Levicatus, Mugenyi; Proscovia, Mukonzo Namuwenge; Simple, Ouma; Baker, Bakashaba; Mastula, Nanfuka; Jennifer, Zech; Collins, Agaba; Andrew, Mijumbi Ojok; Fedress, Kaliba; John, Bossa Kato; Ronald, Opito; Yunus, Miya; Cordelia, Katureebe; Yael, Hirsch-MovermanBackground Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective way of delivering ART. DSD models include Community Drug Distribution Point (CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management (FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is known about the impact of delivering IPT through DSD. Methods We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH). We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized a modified Poisson regression to compare IPT completion across DSD models and determine factors associated with IPT completion in each DSD model. Results Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females: 60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen: 61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD (aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67–0.97). Conclusion IPT completion was high overall but highest in community-based models. Our findings provide evidence that supports integration of IPT within DSD models for ART delivery in Uganda and similar settings.Item Levels of total aflatoxins in maize and groundnuts across food value chains, gender and Agro-ecological zones of Uganda(International Journal of Life Science Research Archive, 2023-08-08) Samuel, Mwesige; Florence, Tushabe; Thomas, Okoth; Ivan, Kasamba; David, AreuAbstract Maize and groundnuts are traditional nutrient-rich and high economic value foods grown in Uganda. However, these crops are susceptible to aflatoxin contamination which may result into aflatoxicosis related illnesses. Occurrence of flatoxins in the foods varies across food value chains, gender and agro-ecological zones of Uganda. Therefore, we conducted a cross-sectional study in 80 maize and groundnut foodstuff from Masindi and Soroti agro-ecological districts respectively. We determined levels of total aflatoxins in maize and groundnut samples across food value chains, gender and agro-ecological zones. This was aimed at assessing safety and quality status of the foods in Uganda. Questionnaires were administered to obtain information on food handling practices. 500g of each food sample were obtained and analyzed for total aflatoxin levels using ELISA assay. Data was analyzed using descriptive and analytical statistics. In overall, 45% of maize and 30% of groundnut foods were contaminated with aflatoxins. Mean aflatoxin levels in foods from Eastern and Western agro-ecological zones were 0.052±0.036ppb and 0.045±0.033ppb respectively (p=0.124). Mean aflatoxin levels in groundnuts from both male and female respondents were coincidentally 0.052ppb. Whereas, the mean aflatoxin levels in maize from male and female respondents were 0.056±0.037ppb and 0.039±0.029ppb respectively. Across the food value chain, wholesaler groundnut foods contained the highest mean aflatoxin levels of 0.088ppb (p= 0.27). Growing high polyamine containing crops, routine testing of aflatoxin prone foods and sensitizing food value chain players are important aflatoxin control strategies.Item 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, MirukaAbstract: 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.Item Malignant mixed mullerian tumor:(Elsevier Ltd on behalf of Surgical Associates Ltd., 2022-05-20) Emmanuel D, Morgan; Tonny, Okecha; James J., Yahaya; Emmanuel, OthienoAbstract: 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.Item One year overall survival of wilms tumor cases and its predictors, among children diagnosed at a teaching hospital in South Western Uganda:(MBC - Springer Nature, 2023-03-02) Eddymond, Ekuk; Charles Newton, Odongo; Leevan, Tibaijuka; Felix, Oyania; Walufu Ivan, Egesa; Felix, Bongomin; Raymond, Atwiine; Moses, Acan; Martin, SitumaAbstract Background Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival. Objective The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda. Methodology Children’s treatment charts and fles diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confrmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities. Results One-year overall survival was found to be 59.3% (95% CI: 40.7–73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. Conclusion Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavora ble histology and tumor size greater than 115 cm.Item 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., SabatiniAbstract 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.Item 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, KateebaAbstract 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.