Predictors of In-Hospital Mortality Among Under-Five Children with Severe Acute Malnutrition in South-Western Uganda

Background Severe acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM. Methods This was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0. Results We enrolled 122 children, median age of 15 months [IQR:11–24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14–24.08, p = 0.001). Conclusion The in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines

Effect of Male Involvement on the Nutritional Status of Children Less Than 5 Years: A Cross Sectional Study in a Rural Southwestern District of Uganda

Background. Undernutrition among children less than 5 years is still a public health concern in most developing countries. Fathers play a critical role in providing support in improving maternal and child health. There is little studied on male involvement and its measurement in child nutrition; therefore, this paper explores the level of male involvement in child feeding and its association with the nutritional status of the children less than 5 years of age. Methods. A cross sectional study among 346 households, 3 focus group discussions, and 4 key informant interviews were conducted in one rural district in Uganda. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) of associated factors were estimated and focus group discussions and in-depth interviews were conducted and summarized into themes. Results. The study revealed the highest percentage of the males provided money to buy food for the children (93.6%), and only 9.8% have ever accompanied mothers to young child clinics. Conclusion. In this study, most males were involved in buying food for their children, and providing money for transport to young child clinics was associated with normal nutritional status of children less than 5 years in the study area

Increasing access to business incubation services for cottage start-ups to promote inclusive entrepreneurship in Southwest Uganda

In the last 30 years, Uganda has grappled with rising unemployment, notably impacting small businesses, with 85% failing within the first five years. This trend is pronounced in the cottage industry, where 46% of businesses couldn't sustain operations in 2017. In Mbarara district, 65% of cottages established in 2015 had closed or relocated by 2019. This study explores the impact of business incubation support services on reducing cottage start-up failures and promoting inclusive entrepreneurship in Mbarara City. Examining 800 start-ups in handicrafts, soap making, pottery, tailoring, and shoe making, the study employed a correlational research design. The data, collected through a Likert scale questionnaire, revealed that access to finance, capacity building, and information technology (ICT) adoption accounted for 13.2% of the variation in cottage enterprise growth potential. Notably, increased finance positively correlated with growth, while capacity building showed no significant association. ICT adoption, however, had a negative correlation. The study emphasizes the need for cottage entrepreneurs to receive more training on product improvement, additional capital, equipment, and partnerships. In conclusion, access to capacity building, funding, and ICT adoption is pivotal for cottage enterprise expansion, advocating for incubation support services to enhance collaboration, funding, equipment, and product improvement training for cottage entrepreneurs

Building needs-based healthcare technology competencies across Africa

Needs-based technology innovation for better health on the African continent requires that African countries develop a strong health technology research and development base, grounded in an understanding of the local context. The discipline of biomedical engineering plays an important developmental role in this regard, through research and training to advance health technology capacity. In recognition of this strategic imperative, the African Biomedical Engineering Consortium (ABEC) was founded in 2012, with the vision of building and nurturing the competencies required to support a robust and dynamic health technology sector

Prevalence and Factors Associated With Genital Chlamydial Infections among Women Attending the Gynaecology Clinic At Mbarara Regional Referral Hospital

Background: Chlamydia trachomatis is responsible for the most common bacterial sexually transmitted bacterial infection. The largest burden is in low income countries. These organisms are not screened for in Mbarara, and information about the burden of disease is no available. This study aimed at establishing the prevalence and factors associated with genital Chlamydia infection among women of reproductive age attending the gynecology clinic at Mbarara Regional Referral Hospital. Methods: In a cross-sectional study done at Mbarara Regional Referral Hospital, 324 women aged 15-49years were consented and interviewed. Data on socio-demographics, maternal medical conditions, obstetric and gynaecological factors and endocervical swabs were collected consecutively from November 2015 to January 2016 from women attending gynaecology clinic at Mbarara Regional Referral Hospital. Samples were analysed using a using CTK biotech Chlamydia kit, which is a rapid immunoassay test for the detection of genital chlamydial antigen in urogenital samples. Results were analysed using STATA 13, Logistic regression models were used to estimate level of significance, the odds ratios (OR) and 95 % CI of the association between the factors and genital infections. Significance was set at a p value of <0.05. Results: Of the 324 samples collected,86 were positive for C. trachomatis antigen giving a prevalence rate of 26.5%. Of all the associated factors examined, only type of residence was significantly associated with C. trachomatis infection (p= 0.0413) with those living in peri-urban areas at greater risk of infection ( aOR 2.4  95%CI (1.22-4.82). Other social demographic ,medical obstetric and gynecological factors were not associated with C. trachomatis infection. No symptom or clinical sign was significant for the infection. Conclusion and recommendation: The prevalence of genital C. trachomatis infection among women attending gynecology clinic is high. Genital Chlamydia infection has no predictive signs and symptoms in our setting. Screening of women in reproductive age should be encouraged. Keywords; Genital Chlamydia trachomatis, endocervical swabs, gynaecology clinic.

Evaluation of the SD Bioline TB Ag MPT64 test for identification of <i>Mycobacterium tuberculosis</i> complex from liquid cultures in Southwestern Uganda

Background: To confirm presence of Mycobacterium tuberculosis complex, some tuberculosis culture laboratories still rely on para-nitrobenzoic acid (PNB), a traditional technique that requires sub-culturing of clinical isolates and two to three weeks to give results. Rapid identification tests have improved turnaround times for mycobacterial culture results. Considering the challenges of the PNB method, we assessed the performance of the SD Bioline TB Ag MPT64 assay by using PNB as gold standard to detect M. tuberculosis complex from acid-fast bacilli (AFB) positive cultures. Objectives: The aim of this study was to determine the sensitivity, specificity and turnaround time of the SD MPT64 assay for identification of M. tuberculosis complex, in a setting with high prevalence of tuberculosis and HIV. Methods: A convenience sample of 690 patients, with tuberculosis symptoms, was enrolled at Epicentre Mbarara Research Centre between April 2010 and June 2011. The samples were decontaminated using NALC-NaOH and re-suspended sediments inoculated in Mycobacterium Growth Indicator Tubes (MGIT) media, then incubated at 37 °C for a maximum of eight weeks. A random sample of 50 known negative cultures and 50 non-tuberculous mycobacteria isolates were tested for specificity, while sensitivity was based on AFB positivity. The time required from positive culture to reporting of results was also assessed with PNB used as the gold standard. Results: Of the 138 cultures that were AFB-positive, the sensitivity of the SD MPT64 assay was 100.0% [95% CI: 97.3 – 100] and specificity was 100.0% (95% CI, 96.4 – 100). The median time from a specimen receipt to confirmation of strain was 10 days [IQR: 8–12] with SD MPT64 and 24 days [IQR: 22–26] with PNB. Conclusion: The SD MPT64 assay is comparable to PNB for identification of M. tuberculosis complex and reduces the time to detection

Nurturing next-generation biomedical engineers in Africa: The impact of Innovators’ Summer Schools

The mission of healthcare systems in Africa to deliver compassionate and effective care has been constrained by growing populations, increasing burden of disease, political conflict and limited resources. The impacts of these constraints can be substantially alleviated, and the healthcare services strengthened, through the creation and adoption of affordable, accessible and appropriate biomedical engineering systems and technologies. There is an urgent need for building capacities in biomedical engineering, innovation and entrepreneurship in African countries. The African Biomedical Engineering Consortium has been organising a series of Innovators’ Summer Schools to meet this need by empowering students and researchers with entrepreneurial and innovative skills, and facilitating the design and development of robust, appropriate, and commercially viable medical systems and devices. In this paper, we analyse and discuss the impact of six of these schools held between 2012 and 2017. We used a questionnaire-based survey to collect responses from students who had attended the summer schools. The results of this study demonstrate that the teaching-learning model adopted in the ABEC summer schools was largely effective in promoting biomedical engineering skills, career choices, professional networks and partnerships amongst young African engineers and life scientists who attended the summer schools

Open Biomedical Engineering education in Africa

Despite the virtual revolution, the mainstream academic community in most countries remains largely ignorant of the potential of web-based teaching resources and of the expansion of open source software, hardware and rapid prototyping. In the context of Biomedical Engineering (BME), where human safety and wellbeing is paramount, a high level of supervision and quality control is required before open source concepts can be embraced by universities and integrated into the curriculum. In the meantime, students, more than their teachers, have become attuned to continuous streams of digital information, and teaching methods need to adapt rapidly by giving them the skills to filter meaningful information and by supporting collaboration and co-construction of knowledge using open, cloud and crowd based technology. In this paper we present our experience in bringing these concepts to university education in Africa, as a way of enabling rapid development and self-sufficiency in health care. We describe the three summer schools held in sub-Saharan Africa where both students and teachers embraced the philosophy of open BME education with enthusiasm, and discuss the advantages and disadvantages of opening education in this way in the developing and developed world

Predictors of delayed culture conversion among Ugandan patients.

BACKGROUND: Estimates of month-2 culture conversion, a proxy indicator of tuberculosis (TB) treatment efficacy in phase-2 trials can vary by culture-type and geographically with lower rates reported among African sites. The sub-study aimed at comparing TB detection rates of different culture media, within and across rifampicin-based regimens (R10, 15 and 20 mg/Kg) over a 6-month treatment follow-up period, and to establish predictors of month-2 culture non-conversion among HIV-negative TB patients enrolled at RIFATOX trial site in Uganda. METHODS: Unlike in other Rifatox Trial sites, it is only in Uganda were Lowenstein-Jensen (LJ) and Mycobacteria growth indicator tube (MGIT) were used throughout 6-months for treatment monitoring. Conversion rates were compared at month-2, 4 and 6 across cultures and treatment-type. Binomial regression analysis performed for predictors of month-2 non-conversion. RESULTS: Of the 100 enrolled patients, 45% had converted based on combined LJ and MGIT by month-2, with no significant differences across treatment arms, p = 0.721. LJ exhibited higher conversion rates than MGIT at month-2 (58.4% vs 56.0%, p = 0.0707) and month-4 (98.9% vs 88.4%, p = 0.0391) respectively, more so within the high-dose rifampicin arms. All patients had converted by month-6. Time-to-TB detection (TTD) on MGIT and social service jobs independently predict month-2 non-conversion. CONCLUSION: The month-2 culture conversion used in phase 2 clinical trials as surrogate marker of treatment efficacy is influenced by the culture method used for monitoring mycobacterial response to TB treatment. Therefore, multi-centric TB therapeutic trials using early efficacy endpoint should use the same culture method across sites. The Time-to-detection of MTB on MGIT prior to treatment and working in Social service jobs bear an increased risk of culture non-conversion at month-2. TRIAL REGISTRATION: ISRCTN ISRCTN55670677 . Registered 09th November 2010. Retrospectively registered