Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation

Background. Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods. This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results. One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation

Assessing Uptake of COVID-19 Preventive Measures among Persons Aged 13-80 Years during Lockdown in Wakiso, Uganda: A Cross-Sectional Study

Background: The unprecedented spread of COVID-19 presents a serious public health concern. However, uptake of COVID-19-related preventive behaviors remains unknown. This study aimed to investigate current uptake of COVID-19 preventive measures and their associated factors in Wakiso, Uganda. Subjects and Method: A cross-sectional study was conducted in Wakiso, Uganda from April to September 2020. A total of 1,014 study subjects aged 13–80 years in the population health survey (PHS) who self-reported following any of the COVID-19 preventive behavioral strategies during lockdown was selected.  The dependent variable was COVID-19 preventive measures. Independent variables were gender, age, education, marital status, religion, occupation. The data were collected by questionnaire and analyzed using Modified Poisson regression test. Results: Female (aPR=1.48; 95% CI= 1.34 to 1.62; p<0.001), construction and mechanics workers (aPR=1.23; 95% CI= 1.10 to 1.38; p<0.001), housework (aPR= 0.72; 95% CI= 0.64 to 0.81; p <0.001), and students (aPR=0.58; 95% CI= 0.45 to 0.74; p<0.001) were associated with staying at home. Aged 45-54 years old (aPR=0.55; 95% CI= 0.50 to 0.61; p<0.001), more than 55 years (aPR=0.80, 95% CI= 0.66 to 0.97; p= 0.022), and housework (aPR=1.18; 95% CI= 1.03 to 1.35; p= 0.015) were associated with sanitize often. Conclusion: Female, construction and mechanic workers, housework, and student are associated with staying at home and it is statistically significant. Aged 45-54 and more than 55 years old, housework were associated with sanitize often and it is statistically significant. Keywords: preventive measures, COVID-19, Wakiso, Uganda Correspondence: Alex Daama. Africa Medical and Behavioral Sciences Organization (AMBSO). Plot 7441, Nansana, Hoima Road, Wakiso, Uganda P.O Box 25974. Email: [email protected]. Mobile: +256702347102 Journal of Health Promotion and Behavior (2021), 06(02): 153-162 DOI: https://doi.org/10.26911/thejhpb.2021.06.02.0

Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country

Background: There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. Methods: We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered. Results: Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control. Conclusion: Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.Medicine, Faculty ofNon UBCAnesthesiology, Pharmacology and Therapeutics, Department ofReviewedFacult

Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally.

BackgroundOne of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown.MethodsA survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May-June 2019.ResultsNo providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance).ConclusionsNo providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers

A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage

IntroductionPostpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often practiced using mannequin-based simulation. Mannequin-based simulation presents challenges in global health, particularly in low- or middle-income countries. We developed a novel multiplayer screen-based simulation in a virtual world enabling the practice of team coordination with PPH. We used this simulation with learners in Mulago, Uganda. We hypothesized that a multiplayer screen-based simulation experience would increase learner confidence in their ability to manage PPH.MethodsThe study design was a simple pre- and a post-intervention survey. Forty-eight interprofessional subjects participated in one of nine 1-h simulation sessions using the PPH software. A fifteen-question self-assessment administered before and after the intervention was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor.ResultsCombined confidence scores increased significantly overall following the simulation experience and individually in each of the three categories of Bloom’s Taxonomy: affective, cognitive, and psychomotor.ConclusionWe provide preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning that may be used effectively in global health education and training. Interestingly, despite our intervention being screen-based, our subjects showed improved confidence in their ability to perform psychomotor tasks. Although there is precedent for mental rehearsal improving performance, further research is needed to understand this finding

Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda

Objectives This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns.Design Population-based, cross-sectional household survey.Setting Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda.Participants A total of N=2014 males aged 13–80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314).Measures Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as ‘no physical and/or sexual IPV’, ‘physical’ versus ‘sexual violence only’, and ‘physical and sexual violence’. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into ‘none’, ‘low’ and ‘high’. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours.Results The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion.Conclusion This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic

Anesthesia Provider Training and Practice Models: A Survey of Africa.

BACKGROUND:In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. METHODS:Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. RESULTS:One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). CONCLUSIONS:Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts