Short term outcomes of unstable pelvic fractures in adults treated at Mulago National Referral Hospital

A dissertation submitted to the Directorate of Graduate Studies in partial fulfillment of the requirements for the award of the degree of Master of Medicine in Orthopedic Surgery of Makerere University.Introduction Pelvic fractures are perhaps the most severe & life-threatening musculoskeletal injuries, constituting about 1.5%–3% of all skeletal injuries. Despite their severity, unstable pelvic fractures can yield favorable outcomes, particularly when timely and appropriate management strategies are implemented. However, some patients who survive may incur temporal or permanent disabilities affecting function. Thus, the study aimed to describe the functional and radiological outcomes of unstable pelvic fractures of adults treated at MNRH. Methods We recruited 51 patients consecutively from November 2024 to February 2025. Functional outcomes were assessed using the Majeed Pelvic score, while Radiological outcomes were evaluated for bony union, non-union, and malunion. Data was collected using a structured questionnaire and analyzed using STATA version 15. Continuous variables were summarized using the median and interquartile ranges, while the categorical variables were summarized using frequencies and proportions. Figures and tables were used to present the data. Results The median age was 31 (IQR 25,38), and the male sex dominated 56.9% (n=29). Road traffic accidents were the commonest mechanism of injury, 88% (n=45), with Tile B fractures being the most predominant. Operative fracture management dominated by 54.9% (n=28), 21% (n=11) had associated nerve damage, and only 11.8% (n=6) did not adhere to the rehabilitation protocol. A satisfactory functional outcome was observed among 57% (n=29) of the patients, and of these, Tile B fracture dominated with 68.9% (n=20). Radiological union occurred among 78% (n=40) of the patients. The factors associated with the unsatisfactory short-term functional outcome were non-adherence to the rehabilitation protocol [PR 1.22, 95% CI (1.05 – 1.42)], and being managed non-operatively [PR 1.34, 95% CI (1.16 – 1.55)]. Falling from heights as a mechanism of pelvic injury [PR 0.80, 95% CI (0.67 – 0.94)] and having an occupation following injury [PR 0.77, 95% CI (0.66 – 0.91)] were associated with reduced prevalence of unsatisfactory functional outcomes. Conclusion In this study, 57% of the patients with unstable pelvic fractures had satisfactory functional outcomes following treatment. Radiological union rates showed better results with 78% attaining union. Being managed operatively and adherence to rehabilitation protocol were associated with satisfactory functional outcomes

Prevalence and factors associated with pre-operative delays among neurotraumatic patients at Mulago National Referral Hospital: a cross-sectional study

A dissertation submitted to the directorate of research and graduate training in partial fulfilment of the requirements for the award of the degree of Master of Medicine in Surgery of Makerere University.Introduction Neurotraumatic emergencies affect more than 10 million people globally with majority of them from sub-Saharan. Neurotraumatic emergencies present a challenge in emergency surgical care, demanding quick and precise intervention to mitigate potentially life-threatening outcomes. Despite this there are still preoperative delays for these patients. Study Objective; To determine the prevalence and factors associated with pre-operative delays among neurotraumatic patients requiring surgery at Mulago National Referral Hospital. Methods: This was a descriptive cross-sectional study, and the participants were recruited through consecutive sampling. An interviewer administered questionnaire was used to collect data on prevalence and factors associated with preoperative delays. Preoperative delay was defined as the time exceeding six hours (> 6 hours) from the decision to operate to the initiation of surgery and measured as a binary outcome (categorized as either delayed or not delayed). Modified Poisson regression was used to determine independent factors associated with preoperative delays. Results: A total of 184 participants were recruited into the study. The median age of the participants was 33.5 years (IQR, 24-50), 162 (88%) were male. Majority 111(60.3%) of the participants had mild head injury whereas RTA contributed to majority of the injuries at 100 (54.3%). Majority 158 (85.9%) of the participants reported lack of anaesthetic drugs/equipment. The prevalence of pre-operative delays was 90.2% (95%CI,84.9-93.8). The patient related factors associated with pre-operative delays were the GCS score (aRR, 1.02; 95%CI,1.01-1.04; P=0.014) and being unknown patient (aRR, 1.15; 95%CI CI,1.04-1.28; P=0.006). The health system related factors were lack of anaesthetic drugs (aRR, 1.39; 95%CI,1.08-1.81; P=0.011) and lack of theatre space (aRR, 1.09; 95%CI,1.02-1.18; P=0.02). Conclusion: The prevalence of pre-operative delays among neurotraumatic patients at MNRH is high at 90.2%. The patient related factors associated with pre-operative delays were a high GCS score and being an unknown patient whereas the health system related factors associated with pre-operative delays were lack of anaesthetic drugs and lack of theatre spac

Adult patients with cancer in Uganda : validation of the tool, health-related quality of life, and patient experiences

A thesis submitted to the Directorate of Research and Graduate Training in fulfillment of the requirements for the award of the Doctor of Philosophy Degree of Makerere University.Background: This study aimed to assess the validity and reliability of the Luganda version of the tool used to measure health-related quality of life (HRQoL), specifically the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The study sought to investigate the prevalence of poor HRQoL concerning clinical and sociodemographic characteristics and to describe the experiences of adult cancer patients undergoing treatment at a specialized cancer facility in Uganda. Methods: A sequential explanatory multi-method study was conducted at the Uganda Cancer Institute among adult patients with various types and stages of cancer. Clinical and sociodemographic information was collected using study-specific items and patients' medical records. Sub-study 1: Tool validation evaluated the reliability and validity (including construct, known group, and criterion validity) of the Luganda and English versions of the EORTC QLQ-C30 instrument. Sub-study 2: This sub-study investigated the prevalence of and factors associated with poor health-related quality of life (HRQoL). It used predetermined validated clinical thresholds to identify patients with poor HRQoL and conducted a multivariable logistic regression analysis to determine the associated factors. Sub-study 3: This sub-study described the experiences of adult men and women receiving treatment at a specialized cancer facility, utilizing reflexive thematic analysis. Main results: Sub-study 1. Construct validity, CFA yielded good fit indices (RMSEA = 0.08, SRMR = 0.05, and CFI = 0.93). Known-groups validity was supported by statistically significant better HRQoL among patients with early-stage compared to those in late-stage. Criterion validity: positive correlations between the Karnofsky Performance Scale and the Physical Function (0.75 - 0.76) and Global quality of life (0.59 - 0.72) for Luganda and English versions, respectively. Cognitive function did not reach acceptable Cronbach’s alpha values (Luganda α = 0.66, English α = 0.50). Sub-study 2: (68%−87%) reported functional impairment and symptoms of pain (80%) and fatigue (63%). Increasing age, no formal education, unemployment, being an inpatient, diagnosed with cervical cancer or leukemia were factors associated with poor HRQoL. Sub-study 3: Organization of care, personal challenges, mental suffering, and satisfaction with care were the themes generated. Conclusion: The validated Luganda and English versions of the EORTC QLQ- C30 appear to be a valid and reliable instrument recommended for assessing HRQOL in adult Ugandans with cancer. Most patients reported poor functioning and a significant burden of symptoms, including pain and fatigue, that warrant concern. The prevalence of poor health-related quality of life (HRQoL) is especially noticeable among older adults, those without formal education, and those who are unemployed. Furthermore, being an inpatient and having a cancer diagnosis are both linked to a lower quality of life related to health. Patients also described their penurious experiences of care, including inadequate infrastructure and resources (food, staff, and drugs), delays in accessing care, the poor health system, and high treatment costs as well as stigma, abandonment, isolation, and emotional distress. This situation calls for policymakers'’ interventions including a need to adapt and adopt the cancer pain management clinical guidelines in the Ugandan context, development of a psychosocial oncology center, and training of health professionals Policymakers are urged to update the budget for cancer care to improve the infrastructural challenges and ensure adequate resources, decentralize cancer care for easier access, and to create awareness about cancer and its treatment to reduce stigma.Uganda Cancer Institute/African Development Bank (AfDB

Financial literacy skills acquisition and application among women with physical disability in Kampala

A thesis submitted to the Graduate School for the award of Master of Adult and Community Education Degree of Makerere UniversitySeveral studies have been carried out to investigate how persons with disabilities use financial knowledge and skills in their day-to-day lives and the therefore business operations. However, there is less in-depth insight into how women with physical disabilities (WPDs) acquire and apply financial literacy. This study, therefore, sought to analyse acquisition and application of financial literacy among women with physical disabilities in Kampala, Uganda a case of NUWODU beneficiaries. This case study followed a qualitative approach informed by the fundamental assumptions and beliefs of the interpretative paradigm. The study adopted the theoretical orientation of transformative learning, which has a fascinating connection with how WPDs can recognise and encounter financial challenges and biases to improve their competence and confidence. Data was collected through in-depth interviews, observations, and key informant interviews. Findings revealed that WPDs utilised a variety of learning options. They engaged in workshops and conferences, referred to printed materials, attended mentoring and coaching classes, and were involved in financial community outreach programmes. However, significant gaps remain between financial knowledge and practical application. Limited access to finances, inaccessible learning spaces, limited understanding of facilitators, and societal stigma hindered business success. The study recommended tailored financial literacy programmes designed in simplified formats, and advocacy for accessible financial services without prejudice and judgement. Additionally, learning should be conducted in accessible learning spaces as it is difficult for physically disabled persons to access existing classroom facilities efficiently. By addressing these gaps, a radical improvement in financial inclusion, economic empowerment and improved livelihood for WPDs can be realised

The Y-Chromosomal haplotype diversity of the Sabiny, Jopadhola and Samia of Eastern Uganda

A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of the Degree of Master of Science in Biochemistry of Makerere University.The Y-Chromosome genetic relatedness among and between the Sabiny, Jopadhola, and Samia populations from Eastern Uganda was investigated in this study. Y-Chromosome haplogroups of 117 individuals (35 Sabiny, 40 Jopadhola, and 42 Samia) were genotyped. Prior to this research, genetic studies on these populations were limited, particularly for those in remote areas. Six bi-allelic haplogroups were identified: A3-M32, B-M181, F-M89, E3a-M2, E3b2-M81, and E3b3-M123. Haplogroups E3a-M2 and E3b3-M123 were most prevalent, while E3b2-M81 and A-M32 showed moderate frequencies. B-181 and F-M89 were observed at very low frequencies. A low mean pairwise FST value (0.13588) between the three populations suggested a relatively recent common ancestor. Phylogeographic analysis, including data from other African populations, revealed that the study groups were more closely related to East African Nilo-Saharan, Afro-Asiatic, and Khoisan populations than to Central African Niger-Congo groups. This finding may reflect geographical barriers to gene flow between East African non-Bantu and Central African Bantu speakers. The study demonstrated that Eastern Uganda is an important source of Y-Chromosome diversity, with potential implications for understanding population history and migration patterns in the African Great Lakes region. These Y-Chromosome data from Sabiny, Jopadhola, and Samia individuals have potential applications in forensics, population genetics, and serve as valuable references for assessing Y-Chromosome diversity in other Ugandan and East African populations

Severity of post - operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago National Referral Hospital

A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirement for the award of a Master's Degree in Orthopaedic Surgery of Makerere University.Background: Knee stiffness following surgical fixation of knee osseous injuries is a common and potential complication of surgery and rehabilitation with a global incidence of 4% to 38%. Even with the currently recommended surgical fixation techniques of these injuries, it was noted that patients develop varying degrees of stiffness. Main objective: To establish the severity of post – operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago national referral hospital. Methods: A period cross sectional study was done between September 2024 and January 2025, among adults with knee osseous injuries managed by surgical fixation. A total of 115 participants were enrolled into the study and consecutive sampling was used to recruit the participants. Descriptive statistics was done and then Bivariate and multivariate ordinal logistic regression model analyses were conducted, with STATA version 15 to identify the factors associated with severity of POKS. Results: 90 (78.3%) out 115 patients had varying severity of POKS. 25.2% had extreme POKS, 28.7% had severe POKS, 19.1% had moderate POKS and 5.2% had mild POKS. 15 patients had extension limitation, 39 patients had flexion limitation and 36 patients had combined extension and flexion limitation. After controlling for other factors, non-adherence to physiotherapy (cOR = 0.28, 95% CI 0.16 – 0.49), cigarette use (cOR = 3.49, 95% CI 1.29 – 10.92) and surgical fixation done greater than 2 weeks post-injury (cOR = 1.35, 95% CI 1.02 – 7.76) were significantly associated with the severity of POKS, with P – values less than 0.05. Conclusion: In this study, most participants presented with the extreme and severe forms of severity of POKS. The independent predictors of POKS severity included non-adherence to physiotherapy, surgical fixation performed more than 2 weeks post-injury, and cigarette use

Prevalence, etiology and computed tomography finding in patients with traumatic brain injury at Mulago National Referral Hospital: A cross sectional study

Background: Traumatic brain injury (TBI) refers to brain damage following trauma to the head. It is one of the leading causes of morbidity and mortality in the world. The incidence of TBI is a growing burden due to increasing number of high-speed motor vehicle, more movement of the public and increasing industrial activities. Globally TBI incidence is approximated at 27 million per year, with high prevalence in developing counties. In developing countries, the incidence is approximated to be 3.2 million per year, with a 3.5-fold increase in Sub Saharan Africa, estimated to be 14 million per year by 2050. Uganda as part of sub-Sahara Africa is not excluded in the TBI burden growth. Objective: This study aimed to determine the prevalence, etiologies and computed tomography findings in patients with traumatic brain injury at MNRH. Methodology: We conducted a hospital based cross-sectional study on traumatic brain injury patients for one month to determine the prevalence, etiology and Computed tomography findings. Patient’s data collected included demographic data, etiology and CT-findings. Data collected were exported to STATA 18 for analysis. Results: There were 419 TBI patients out of 822 trauma patients giving a prevalence of 50.97%. Males accounted for 75.3% of the 370 head trauma cases with an approximate male to female ratio of 5.2:1. The mean age of the patients 33.21 years with a standard deviation of 11.88 years. RTA was the most common etiologic factor accounting for 245, (66.67%) of cases. There was 1 case due to industrial injury in the study population. Abnormal CT findings were present in (90.68%) of cases. Skull fracture was demonstrated in (29.19%) patients and was the most common finding. Extraaxial bleeds were present in (30.46%) and the incidence of contusion was also high (24.64%). Conclusion: MNRH has a high prevalence traumatic brain injury with young males disproportionately affected. Road traffic accident was the most common cause and skull fracture was the commonest findings on CT followed by contusion

Molecular analysis of the MNS, KELL and LEWIS blood group systems in Sickle cell disease patients and blood donors from Kampala, Uganda

A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of Master of Science in Biochemistry of Makerere University.Introduction: The Sickle cell disease (SCD) is a major red blood cell genetic disorder which is majorly managed by red blood cell transfusion that sometimes culminates into alloimmunisation. In 2016, the rate of alloimmunisation in Ugandan transfused patients was reported to be 6.1%. Objective: This study aimed to determine the genetic diversity of the MNS, KELL and LEWIS blood group systems in sickle cell disease patients and blood donors from Kampala, Uganda. Methods: A total of 250 samples from Mulago Sickle cell clinic and 250 samples from Nakasero blood bank were collected. Genomic DNA from all samples was extracted and this was used to determine the genetic diversity of the MNS, KELL, and LEWIS blood group systems by Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) methods. Results: The study revealed that MNS+s+ blood group of the MNS is the most prevalent with frequencies of 47.2% and 48.4% among sickle cell disease patients and donors respectively. S-s-U- was not detected in sickle cell patients whereas among donors, it was at a frequency of 1.2%. S-s-U+var was at a frequency of 0.4% among sickle cell patients and 0.8% among donors. All individuals in both groups were homozygous for KEL*2 and KEL*4. KEL*6 was only in a heterozygous state with KEL*7 in both groups with a frequency of 25.5% among sickle cell patients and 18.4% among donors. KEL*7 in a homozygous state was the most prevalent with frequencies 74.5% and 81.6% among sickle cell patients and blood donors respectively. The 59T>G SNP in the FUT3 gene of the LEWIS blood groups systems was detected at frequencies of 6.8% and 10.8% among sickle cell disease patients and blood donors respectively whereas 508G>A was at a frequency of 42.1% among sickle cell disease patients and 50.4% among donors. There was no individual in both groups that was detected with 1067T>A SNP. Conclusion: This study revealed that MNS, KELL and Lewis blood groups varied between sickle cell disease patients and blood donor groups and therefore Extended DNA typing of the MNS, KELL and LEWIS blood group systems by PCR and RFLP methods can contribute to management of alloimunisation in multi transfused sickle cell disease patients

The 14-day incidence and risk factors of gastrointestinal anastomotic leak among adult patients in Mulago Hospital, a prospective cohort study

A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of a Master's Degree in Surgery of Makerere University.Background: Anastomotic leak is one of the most feared complications following gastrointestinal (GI) anastomotic surgery. It increases morbidity and mortality of patients undergoing GI surgery. Globally, the frequency of anastomotic leak varies depending upon the tissue that is being anastomosed. Higher incidences of anastomotic leak up to 36.5% have been reported in Low- and Middle-income countries compared to the lower rates of less than 10% in Higher income countries for small and large bowel anastomoses. Despite the burden, the incidence and risk factors of anastomotic leak following gastrointestinal surgery are not well defined in Uganda. Objective: We aimed to determine the incidence and risk factors of anastomotic leak following gastrointestinal surgery at Mulago National Referral Hospital (MNRH). Methods: In this prospective cohort study, we recruited 85 adult patients admitted to the general surgery wards of MNRH 24 hours following gastrointestinal surgery. Independent variables including preoperative anemia, preoperative albumin level, and ASA status were recorded on entry, while the dependent variable (anastomotic leak) was obtained upon 14 day’s follow- up. Data was analysed using SPSS version 26. Multivariate logistic regression was used to determine the independent risk factors for anastomotic leak, p< 0.05 was considered statistically significant. Results: Out of the 85 participants recruited, 7 (8.2%) developed anastomotic leak during the 14 day follow up. Hemoglobin level less than 10 g/dl (RR, 8.15; 95% C.I, 1.16 - 57.48; p=0.035) was identified as independent risk factor for anastomotic leak after multivariate logistic regression adjusted for confounders. Conclusion: The incidence of anastomotic leak in Mulago National Referral Hospital was low, (8.2%). Low Hb (Hb<10g/dl) was the only statistically significant predictor variable of gastrointestinal anastomotic leak in this study

Prevalence of multi-drug resistant UTIs and antibiotic sensitivity profiles amongst male patients with bladder outlet obstruction: A cross-sectional study

Background: Antimicrobial resistance (AMR) is a rapidly emerging global problem with multidrug resistant (MDR) urinary tract infections (UTIs) complicating treatment, particularly in low and middle-income countries (LMICs). Patients with bladder outlet obstruction (BOO) are at heightened risk of recurrent UTIs, contributing to irrational antibiotic use and resistance. The limited treatment options for MDR UTIs create significant challenges in patient management. Objective: To determine the prevalence of MDR UTIs and assess the antibiotic sensitivity profiles amongst patients with BOO at Mulago National Specialized Hospital from July to September 2024. Methodology: A cross-sectional study recruited 156 male BOO patients consecutively. Socio-demographic data was collected using quantitative tools, while urine samples underwent microbiological and antibiotic sensitivity testing. Data were analyzed using STATA (version 18). Ethical approval and informed consent were secured. Utility: Findings may inform local treatment protocols to enhance patient management and combat antibiotic resistance. Results: Microbiologically confirmed UTIs were found in 65 (41.03%) participants, with gram-negative rods / Enterobacteriaceae (88.06%) as the predominant cause. E. coli (35.82%) and Klebsiella (10.45%) were the most common isolates. MDR UTI prevalence was 39.10% (95% CI: 30.48–45.76), with ESBL-producing E. coli being the most resistant strain. Common uro-pathogens exhibited high resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, cefuroxime, levofloxacin, and ceftriaxone but remained sensitive to amikacin, piperacillin-tazobactam, and meropenem. Having an indwelling catheter increases the odds of developing MDR UTIs by 4.63 compared to not having an indwelling catheter. Conclusion: We observed a high proportion of MDR UTIs in symptomatic patients with BOO with high microbial resistance observed towards commonly used antibiotic options in our setting