HIV/AIDS Stigmatization, the Reason for Poor Access to HIV Counseling and Testing (HCT) Among the Youths in Gulu (Uganda)

HIV/AIDS-related stigma still exists in many communities in Uganda. Stigma perpetuates discrimination and this may be a key contributor to the spread of HIV/AIDS in this country. Right from the beginning, HIV/AIDS epidemic has been accompanied with fear, ignorance and denial, leading to stigmatization and discrimination against people living with HIV/AIDS and their families. A study conducted by Uganda AIDS Commission (UAC) in Uganda indicated that 64% of the people who tested for HIV/AIDS did not disclose status to their partners due to fear of stigmatization. A cross-sectional study was conducted in Gulu District, Pece sub County among the youths 15 to 35 years old. A structured questionnaire was administered to 86 consented youths who were consecutively selected. Ethical approval was obtained from Gulu Hospital. Most youths (90%) practiced stigmatization,(93.1%) respondents had adequate knowledge on HIV counseling and testing (HCT). However, only (36.1%) had undertaken HCT and the majority did not do because of fear of stigmatization. There is sufficient knowledge, a positive attitude but a poor practice to HCT. There is high level of HIV/AIDS stigmatization among the youths.Keywords: HIV counseling and testing, stigmatization, youths, Gulu (Uganda

POSSUM scoring system in patients undergoing laparotomy in Mulago Hospital

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction in surgery. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) was used to score and predict the outcomes of Laparotomy in Mulago Hospital. The main objective of this study was to determine the morbidity and mortality POSSUM scores for patients who underwent Laparotomy in Mulago Hospital, between September 2003 and February 2004.Methodology: Consecutive patients, who underwent a Laparotomy in the three surgical wards in Mulago Hospital, were scored using POSSUM system. For each patient the predicted risk of mortality and morbidity was calculated from POSSUM equation. Multivariate logistic regression analysis was used to determine the relationships between the predicted and observed morbidity and mortality rates. Postoperative complications and mortality within 30days were described.Results: Seventy-six patients were studied. The observed and expected mortality and morbidity rates were 14.5%, 2.6% and 35.4%, 0% respectively. Physiological scores, operative scores, co morbid condition such as Diabetes Mellitus significantly determined the outcomes.Conclusion: POSSUM scoring system can be used to predict the risk of mortality but not morbidity for patients admitted to a surgical ward in Mulago Hospital.Recommendations: The POSSUM scoring system can be used in decision-making process before a Laparotomy is carried out

Pyomyositis in Nodding Syndrome (NS) patient - A case report

We report a case of Pyomyositis in a 13-year-old boy diagnosed using WHO surveillance definition of Probable Nodding syndrome. Complete blood count showed Leukocytosis with immature granulocytes and atypical lymphocytes. Except for the liver enzymes which were high the renal functions and serum electrolytes were within normal range values. Culture of a pus-swab grew Staphylococcus aureus. Abdominal ultrasound scan showed a focal mass on the internal and external oblique muscles of the right abdominal wall. Incision and drainage was performed. Histology of the muscle showed non-specific inflammation of the external and internal oblique muscles. This finding may highlight some of the other tropical diseases that occur in children with Nodding syndrome

Roll-out of Medical Male circumcision (MMC) for HIV prevention in non-circumcising communities of Northern Uganda

Introduction: Recent studies have shown that circumcision reduces HIV/AIDS infection rates by 60% among heterosexual African men. Public health officials are arguing that circumcision of men should be a key weapon in the fight of HIV/AIDS in Africa. Experts estimate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure becomes widely used. Some communities in Uganda have misconceptions to MMC and resist the practice. Methods: To roll out MMC to a non-circumcising population of Northern Uganda from June 2011 as a strategy to increase access and prevent the spread of HIV/AIDS. Results: Circumcision in a non-circumcising communities of Lango and Acholi sub-regions with a population of about 0.5 million mature males 15-49 years. Enrolment was voluntary, clinical officers, nurses carried out MMC after training in the surgical procedure. Mass sensitization and mobilization was conducted through radios, community leaderships and spouses. Cervical cancer screening was incorporated at circumcision sites and used as incentive for the women. Circumcisions were conducted at static sites, camps and outreach services where VCT and adverse events (AEs) were recorded and managed. All clients assented/or consented. Conclusion: A total of 26, 150 males were circumcised in eight months. The AEs rate was 1.2 % and was mild. 2,650 women were screened for cervical cancer and positive test rate was 1.7%. Mobilization and sensitization were by radios and spouses' involvement in cervical cancer screening exercise.Key words: Medical Male circumcision, Northern Uganda, scale-up of services, non-circumcising communitie

The Postoperative Complications Prediction in Mulago Hospital using POSSUM Scoring System

Introduction: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction. The postoperative complications of patients who underwent Laparotomy in Mulago Hospital were studied using POSSUM scoring system. The main objective of this study was to determine the postoperative complications of Laparotomy in Mulago Hospital, between September 2003 and February 2004.Methods: Consecutive patients, who underwent Laparotomy in Mulago, were studied using POSSUM system for development of complications. For each patient operated, they were followed up in wards until discharge. When the postoperative complications were reported, they were reexamined by the surgeons, treated and followed up for 30 days postoperatively. Phone contacts were used for the follow up. Surgical reviews were conducted once a week in Mulago Hospital and the data obtained recorded in the data sheet for the patients.Results: Seventy-six patients were studied. The observed post operative complications were as follows: Respiratory tract infection (28.2%), wound haemmorrhage (18.2%), anaemia (15.5%), hypotension (14.1%), UTI (2.2%), Anastomotic leak (1.4%), Wound sepsis (9.9%), wound dehiscence (4.2%), Thromboembolism (1.4%). The postoperative nursing care significantly determined the outcomes.Conclusion: Postoperative complications can be predicted in the modern management of surgery especially while using a scoring system

TB co-infection with HIV/AIDS: a unique radiological presentation at Lacor hospital -a postconflict northern Uganda.

Background: Tuberculosis infection is thought as having the capacity to develop at any stage of HIV/AIDS infection. Pulmonary tuberculosis and extra-pulmonary tuberculosis are major complications in HIV/AIDS. Tuberculosis is still a diagnostic dilemma in low resource countries, with approximately 68.4% of all active pulmonary TB cases being negative for AAFBs on sputum. Additionally, it is reported that 46.7% of the active cases have disseminated TB with extra-pulmonary TB; further complicating the diagnosis in low resource communities. We therefore sought to clinically, histologically and radiologically characterize the various TB diagnosed in HIV/AIDS patients in Northern Uganda.Materials and Methods: A prospective cohort study was conducted on 320 sero-positive patients at Lacor Hospital. Clinical, histological, radiographic and ultra-sonographic features of confirmed HIV sero-positive patients with suspected TB co-infection were assessed. Patients were recruited consecutively and Chest, thoraco-lumbar and lumbar spine radiographs were taken and analyzed. Trans-thoracic ultrasonography for justified cases with pleural and pericardial effusion was conducted. FNAB and Tru-cut biopsies were performed for histological confirmation. Cases were followed-up for clinical outcomes within 2 months. Ethical review committee of Gulu University approved the study.Results: Atypical PTB chest x-ray findings: reticulo-nodular infiltrates 223(69.7%); hilar and mediastinal adenopathy 128(40%); pleural effusion 88(27.5%) and miliary 66(20.6%). Typical PTB chest x-ray findings: Apical reticulo-nodularities and fibro-cavitations 88(27.5%) and normal Chest x-ray 7(2.2%). Abdominal Ultrasound findings: porta-hepatis, para-aortic and splenic hilum lymphadenopathy 51(15.9%); Ascitis 26(8.1%); TB splenitis 17(5.3%) and TB nephritis with peri-renal abscess 1(0.3%). PTB was observed in 171(53.4%); disseminated TB in 135(42.2%) and EPTB in 14(4.4%). The majority 262(81.9%) of the patients improved and was discharged on DOTS while 58(18.1%) died.Conclusion: Imaging assessment is an important modality in TB/HIV/AIDS co-epidemic diagnosis. It is useful in making early diagnosis and prompt management of TB/HIV/AIDS co-infection.Key words: Tuberculosis, HIV/AIDS, co-infection, clinico-radiological methods, Lacor, Gulu (Uganda)

Assertiveness and attitudes of HIV/AIDS orphaned girls towards education in Kampala (Uganda)

Whereas HIV/AIDS prevalence has been declining in Uganda from 30% to less than 10% in the last 2 decades, the number of HIV/AIDS orphaned girls in secondary schools is still high and girl children have tended to carry the heaviest burdens of family responsibilities thereby adversely affecting their assertiveness and attitudes towards education. Assertiveness is a critical life skill that enables a person to state an opinion, claim a right, or establish authority and it is important to improve attitude towards education. This study examined the relationship between assertiveness and attitude towards education of HIV/AIDS orphaned and non-orphaned adolescent school girls in Kampala. The California Psychological Inventory (CPI) Dominance (Do) Assertiveness Scale and the Attitude Scale were administered to 225 students consecutively selected from 6 secondary schools in Kampala. HIV/AIDS Orphaned girls had lower levels of  assertiveness and most had a negative attitude towards education compared to non-orphaned girls. Girls orphaned to HIV/AIDS were less assertive compared to those orphaned by other causes. There was a positive relationship between assertiveness and attitude towards education among orphaned adolescent secondary school girls in Kampala. Girls orphaned to HIV/AIDS were less assertive compared to other school girls and have a poor attitude towards education.Key words: HIV/AIDS, Orphans, adolescent girls, Assertiveness, secondary education, Kampala, Uganda

Short Message Service (SMS)-Based Intervention to Improve Treatment Adherence among HIV-Positive Youth in Uganda: Focus Group Findings

This paper presents one of the first qualitative studies to discuss programmatic barriers to SMS-based interventions for HIV-positive youth and discusses pathways through which youth perceive them to work. We conducted six focus groups with 20 male and 19 female HIV-positive youths in two clinics in Kampala, Uganda. We find that youth commonly use SMS as over 90% of this study’s youths knew how to read, write and send messages and almost three-fourths of them had phones. Youth strongly felt that the success of this intervention hinged on ensuring confidentiality about their HIV-positive status. Key programmatic challenges discussed where restrictions on phone use and phone sharing that could exclude some youth. Participants felt that the intervention would improve their adherence by providing them with needed reminders and social support. Youths’ suggestions about intervention logistics related to content, frequency, timing and two-way messages will be helpful to practitioners in the field