School of Health Sciences (SHS) Researches

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Aneurysmal bone cyst of the mandible: a rare case report and literature review
(Annals of Medicine & Surgery, 2023) Yahaya, J. J; Morgan, E. D; Abraham, Z. S; Othieno, E
Introduction and importance: Aneurysmal bone cysts (ABCs) are benign, non-neoplastic cystic lesions composed of multiple blood-filled cavities, which are separated by connective tissue septa and they constitute ~6 and 1.5% of all cases of the skull and jaws lesions, respectively. Case presentation: Herein, the case of an 80-year-old male with a histologically confirmed diagnosis of ABC involving the body of the left mandible was presented. The patient underwent partial mandiblectomy after confirmation of the diagnosis using orthopantomography, a computed tomography scan, and a tissue biopsy. The patient was free from pain after 1-year of follow-up, and the control orthopantomography showed no evidence of recurrence. This was followed by reconstruction of the healed part of the bone with titanium plates and a piece of bone from the lateral two-thirds of the left femur and thereafter he was cosmetically well. Clinical discussion: Patients with ABCs present with expansile and radiolucent bone lesions, which may be associated with displacement and loss of teeth due to alveolar bone erosion. Complete excision of the lesions is mandatory for the prevention of recurrence and increased morbidity. Conclusion: ABCs that involve the jaws are extremely rare and are more likely to pose a diagnostic challenge as they are more likely to be confused clinically with other expansile radiolucent bone lesions such as ameloblastoma, osteoblastoma, and giant cell tumor among many others. Also, those with extensive bone matrix formation may sometimes be confused histologically with other bone forming tumors including osteosarcoma. Recurrence is common but it can be avoided or minimized by complete resection of the lesion.
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.
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
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 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.
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
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, Mwaka
Abstract 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.
Disseminated peritoneal leiomyomatosis as an incidental finding: A case report
(John Wiley & Sons Ltd., 2023-02-16) Morgan, E. D; Kahiye, M; Kule, I; Yahaya, J. J; Othieno, E
We 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.
Duodenal Strongyloides stercoralis infection in a 56-year old male: A case report
(International Journal of Surgery Open, 2023) Yahaya, J. J; Morgan, E. D; Othieno, E
Introduction and importance: The infection caused by Strongyloides stercoralis (S stercoralis) is usually an asymptomatic condition particularly in immunocompetent individuals and the condition may remain unnoticed even for decades, however, strongyloidiasis is more severe in patients who are immunocompromised. Case presentation: The patient is a 56-year old male who presented with nine months history of episodes of abdominal pain, nausea loss of appetite, and chronic diarrhea. His diarrhea had mucus and trace blood. His oesophagogastroduodenoscopy (OGD) revealed erythematous, hypertrophied, and ulcerating lining mucosa of the duodenum. The specimen sampled showed sections of the duodenum with numerous Strongyloides stercoralis larvae, some inside the crypts with associated active duodenitis. Clinical discussion: Despite the asymptomatic nature of Strongyloides stercoralis infectious condition especially for immunocompetent patients, the infection may sometimes result into serious complications including exudative enteropathy and paralytic ileus. The clinical outcome of patients with strongyloidiasis is usually better despite severe infection may develop and it is associated with slightly increased morbidity and even mortality. Conclusion: Diagnosis of Strongyloides stercoralis infection in individuals residing in tropical or subtropical countries who present with chronic diarrhea, abdominal pain should always be considered so as to avoid delay of diagnosis. This may help in preventing unnecessary complication such as severe anaemia, intestinal perforation or even death.
Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review
(Annals of Medicine and Surgery, 2023) Yahaya, J. J; Morgan, E. D; Abraham, Z. S
Introduction and importance: Extrapelvic endometriosis is quite rare, with a reported prevalence ranging between 0.5 and 1%, and the condition is more likely to pose diagnostic challenges. This condition is more likely to pose clinical diagnostic challenges as it may mimic metastasis such as Sister Mary Joseph’s nodule. Case presentation: Herein is reported the case of a 36-year-old woman who presented with a hard nodular dark-bluish umbilicus mass that had a tendency to increase in size and was accompanied by severe pain during menstruation for ∼2 years is reported. Laparotomy revealed a normal uterus without involvement of any other pelvic organ by the endometrial tissue except the umbilicus part. Histological evaluation revealed endometriosis of the umbilicus. Clinical discussion: By far, primary endometriosis of the umbilicus is extremely rare, and most of the time, extrapelvic endometriosis involving the umbilicus would be secondary to surgical procedures involving the abdominal cavity as it was for the presented patient. Although endometriosis is rare, it should always be considered among women of reproductive age presenting with cyclic pains. Conclusions: Meticulous investigation of patients suspected to have umbilical endometriosis helps to confirm the diagnosis and hence expedites proper management of the patients; this also prevents chances of malignant transformation of the condition despite such possibilities being extremely rare.
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.
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.
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., Matovu
Abstract 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.
Factors associated with uptake and acceptability of cervical cancer screening among female sex workers in Northeastern Uganda: A cross-sectional study
(PLOS One, 2025-01-24) Ronald Opito; Emmanuel Tiyo Ayikobua; Hellen Akurut; Susan Alwedo; Saadick Mugerwa Ssentongo; Walter Drake Erabu; Lazarus Oucul; Musa Kirya; Lameck Lumu Bukenya; Elly Ekwamu; Abraham Ignatius Oluka; Samuel Kabwigu; Emmanuel Othieno; Amos Deogratius Mwaka
Background Cervical cancer screening program in Uganda is opportunistic and focuses mainly on women aged 25–49 years. Female sex workers (FSWs) are at increased risk of developing invasive cervical cancer. There is limited data regarding the uptake and acceptability of cervical cancer screening among FSWs in Uganda. This study aimed at identifying factors associated with uptake and acceptability of cervical cancer screening among FSWs in Eastern Uganda. Methods This was a cross-sectional study conducted among 423 FSWs aged 18–49 years attending care at six health facilities serving Key Populations (FSWs, Men who have sex with men, transgender people, people who inject drugs and people in prisons) in the Teso sub-region. Data was collected using structured investigator administered questionnaire and analyzed using Stata statistical software version 15.0 (Stata Corp, Texas, USA). The primary outcome was uptake of cervical cancer screening measured as the proportion of female sex workers who have ever been screened for cervical cancer. Chi-square test was used to compare the differences in uptake of cervical cancer screening by HIV status. Modified Poisson regres sion model with a robust variance estimator was used to determine association between the outcome variables and selected independent variables including demographic charac teristics. Prevalence ratios (PR) with accompanying 95% confidence intervals have been reported. Statistical significance was considered at two-sided p-values ≤ 0.05. Results The mean age of the participants was 28.1 (±SD = 6.6) years. The self-reported HIV prevalence was 21.5% (n = 91). There were 138 (32.6%) participants who had ever been screened for cervical cancer (uptake), while 397 (93.9%) were willing to be screened (acceptability). There was a significant difference in cervical cancer screening uptake between women living with HIV (WLHIV) and those who were HIV negative, 59.3% vs 26.9% respectively (P < 0.001). The significant factors associated with uptake of cervical cancer screening included living with HIV, adjusted prevalence ratio (aPR) = 1.53 (95%CI: 1.15–2.07), increasing number of biological children, aPR = 1.14 (1.06–1.24) living near a private not for profit (PNFP) facility, aPR = 2.84 (95% CI; 1.68–4.80) and availability of screening services at the nearest health facility, aPR = 1.83 (95% CI, 1.30–2.57). Factors significantly associated with acceptability of cervical cancer screening included being 40 years or older, aPR = 1.22 (95%CI: 1.01–1.47), having a family history of cervical cancer, aPR = 1.05 (1.01–1.10), and living near a PNFP facility, aPR = 1.17 (95% CI, 1.09–1.27) and having ever screened before, aPR = 0.92 (0.86–0.98). Conclusion Female sex workers living with HIV are more likely to screen for cervical cancer than the HIV negative clients. Cervical cancer screening uptake is relatively low among the female sex workers. However, majority of the FSWs are willing to be screened for cervical cancer if the services are provided in the nearby healthcare facilities. There is need to make cer vical cancer screening services available to all eligible women especially the female sex workers and integrate the services with sexual reproductive health services in general and not just HIV/ART clinics services
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
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) Vuhahula, E. A; Yahaya, J; Morgan, E. D; Othieno, E; Mollel, E; Mremi, A
Objectives 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.
Frequency and distribution of ABO and Rh blood group systems among blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania: a retrospective cross-sectional study
(BMJ open, 2023) Vuhahula, E. A; Yahaya, J; Morgan, E. D; Othieno, E; Mollel, E; Mremi, A.
Objectives: 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.
Immunohistochemical expression of Ki-67 and p53 and their prognostic role in ameloblastoma: A longitudinal study.
(Oman Medical Journal, 2024) Yahaya, J. J; Bwambale, P; Morgan, E. D; Abraham, Z. S; Owor, G; Wabinga, H
Objectives: Ameloblastoma, comprising approximately 11% of all odontogenic tumors, is a locally aggressive tumor with a high recurrence rate. This study aimed to assess the immunohistochemical expression of Ki-67 and p53 and their association with clinical and pathological factors among patients with ameloblastoma. Methods: Retrospective follow-up data of patients histologically confirmed with ameloblastoma at Makerere College of Health Sciences in Kampala, Uganda from January 2012 to December 2018 were retrieved. Factors associated with Ki-67 and p53 immunohistochemical expression were determined using one-way one-way analysis of variance. Chi-square and Fisher’s exact statistical tests were used to assess factors associated with recurrence. A two-tailed p < 0.05 was considered statistically significant. Results: A total of 40 patients confirmed histologically with ameloblastoma were included in the analysis. The majority (62.5%) of cases were of the conventional type of ameloblastoma. The expressions of Ki-67 and p53 were 52.5% and 85.0%, respectively. Recurrence was found in 47.5% of patients and it was associated with conventional histological type (p = 0.042), segmental resection (p < 0.001), tumor size (p < 0.001), and high p53 expression (p = 0.041). Conclusions: Almost half the cases in this study had recurrence. The immunohistochemical expression of p53 was significantly higher than that of Ki-67.
Immunohistochemical expression of P53 protein in nephroblastoma: a predictor of unfavorable prognosis
(Journal of the Egyptian National Cancer Institute, 2023) Morgan, E. D; Yahaya, J. J; Ngaiza, A. I; Othieno, E; Livex, O. A
Objective Immunohistochemical expression of P53 protein is so closely related to status of mutation of P53 gene which is tightly linked with pathogenesis of nephroblastoma or Wilms tumor. This study aims to determine the immunohistochemical expression of P53 protein and its predictors in formalin-fixed paraffin-embedded tissue blocks of patients with nephroblastoma. Materials and methods A series of 83 histologically diagnosed cases of nephroblastoma from formalin-fixed paraffin-embedded tissue blocks archived at the Department of Pathology, Makerere University, in Kampala, Uganda, were analyzed. Monoclonal anti-p53 antibody (DO-7, DAKO) was used to assess the expression of P53 protein expression. Multivariable logistic regression analysis was performed to determine the predictors of P53 protein immunohistochemical expression, and statistical significance was considered when p-value was less than 0.05. Results: Most (42.2%, n = 35) of the cases were in advanced tumor stages (III–V), and almost one-quarter (21.7%, n = 18) of the cases were in high-risk group. The immunohistochemical expression of P53 protein was (8.4%, n = 7), and there were more (83.3%, n = 5) positive anaplastic cases for P53 protein compared with (2.6%, n = 2) of P53 expression for non-anaplastic cases. High risk (AOR = 3.42, 95% CI = 7.91–12.55, p = 0.037) and anaplasia (AOR = 1.41, 95% CI = 13.85–4.46, p = 0.001) were potential predictors of immunohistochemical expression of P53 protein. Conclusion: Most of patients with nephroblastoma in resources-limited settings are diagnosed with advanced clinical stages. Association of P53 protein with anaplasia found in this study indicates the possibility of having novel target therapy for treatment of patients with anaplastic form of nephroblastoma with a focus of identifying molecules that lead to its suppression in such subpopulations of patients with nephroblastoma.
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

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