Knowledge and Practice of Breast Self Examination among Female Students in a Sub Saharan African University

Background: Breast cancer is the most common cancer among women in many parts of Africa. Facilities for screening and early detection are extremely limited yet early diagnosis improves survival. This study explored the practice of Breast Self Examination among female university students as a means of screening and early detection in a low resources environment.Subjects and Methods: A cross sectional descriptive study at a Sub Saharan university. A call for volunteers to the study was made; a pretested standardised questionnaire was used for data collection. The process was limited to an interview and a physical examination. IRB approval was granted before the study began.Results: A total of 320 participants volunteered, 314 were recruited. The majority were aged between 21 and 25. The range was between 19 to 31 years. There was a high awareness of Breast self Examination (BSE) of 81.5%, 30% had ever performed a BSE, 14% performed it regularly, 8% knew the correct monthly timing, the technique was accurately demonstrated by 1% of participants. 4.8 were found to have breast lumps.Conclusion: There is a likelihood of most young women in the country practicing BSE inadequately. There is a need for widespread BSE campaigns emphasizing the correct technique and a need to evaluate BSE efficacy. The prevalence of breast lumps among young women attending this university was comparable to other community prevalence studies in this age group

Prevalence of HIV/AIDS among Breast Cancer Patients and the associated Clinico-pathological features

Introduction: There is uncertainty as to the exact interaction between HIV and Breast Cancer. Available studies are inconclusive about any relation whether causal or protective and the number of patients in these studies small.Objective: To determine the prevalence of HIV among confirmed incidentbreast cancer cases and to describe the associated clinico-pathologicalfeatures.Design: Analytical cross sectional studyMethods: Over a period of 6 months consecutively eligible patients wererecruited from the Mulago Hospital breast clinic. Breast lesions were biopsied and blood withdrawn for HIV sero-survey. Collected data wasdouble entered into Epidata version v 3.1.1, exported to STATA 10.0 foranalysis.Results: Sixty two breast cancer patients consented to participate in thestudy and of these, 22(35.48%) were positive for HIV compared to HIVprevalence in the general population of 6-7%. All the participants werefemale. The mean age of HIV negative subjects was 45 years (range:21-80 years) and for HIV positive subjects was 32.4 years (range 18-52years). There was a signifi cant association between HIV status and age,BMI and CD4 Counts as well as for histological grade and stage (P< 0.024).Conclusion: The prevalence of HIV among the studied breast cancer group was signifi cantly higher than that in the general population. HIV was associated with poor prognostic factors. A high index of suspicion of the co-existence of these two diseases in a context of high HIV prevalence is warranted. Future studies should explore for a causal association

Knowledge, attitude and practices of staffs towards Post-exposure Prophylaxis for HIV infection at Mulago Hospital in Uganda

The use of anti-human immunodeficiency virus (HIV) drugs after occupational exposure to HIV is a proven method of preventing some HIV infection and there is record that these drugs are being used in treatment of post exposure infection to HIV. This then raises the issues of the impact of such treatment on the staffs. The objective of the study was to asses the level of knowledge attitudes and practices of (PEP) against HIV among surgical staffs. 190 questionnaires were sent to staffs in the department of surgery but One twenty nine (68%) was returned. Questionnaires contained items related to awareness of occupational exposure to HIV and 0.77% had experience of its use in the department and 100% noted that there was no specific policy in relation to PEP in the Surgery Department at mulago Hospital. In relation to attitude staff believe strongly that PEP reduces risks to HIV infection but were also not willing to test for HIV after exposure

Boda-boda injuries a health problem and a burden of disease in Uganda: A tertiary hospital survey

Background: Injury and deaths due to road traffic crashes are a major public health problem in developing countries. Boda bodas (motorcycles) are a practical and a sought after economic activity in Uganda’s capital and cities. The injuries related to boda bodas contribute significantly to the number road traffic injuries seen at Mulago hospitals, taking out significant resources including consumables and the health worker time. This study investigated the pattern of injuries, mortality and estimate cost of care.Methods: A prospective descriptive observational study over a 9 months period was carried out at Mulago Hospital and Complex, Accident and Emergency wards. The Study population was patients involved in Boda Boda related road traffic crushes. Consecutive patients presenting on every 3rd day were selected. Research Ethics committee approval was sought before the study was commenced.Results: A total of 124 patients presented with injuries that warranted at least an overnight stay at the Accident and Emergency ward. Out of the just over 2000 admissions, the majority were males (sex ratio F: M 1:3.5) There was one fatality. Injuries were in 7 categories namely Head, chest, abdominal, pelvic, spinal and soft tissues and extremity fractures. Helmet use in this study was 22%, an improvement from previous nearly zero percent. The estimated cost of care per injured patient was USD 300.Conclusion: Boda Bodas continue to be a major cause or agent of road traffic injuries and a significant economic burden. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws

Thyroid Dysfunction among Young Adults in Uganda

Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population.Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee.Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH (1.67) with a high fT4 (22.31) and one with a low TSH (0.03). The mean age of participants was 23 years, there were slightly more males 1.3:1.Conclusion: The prevalence of thyroid dysfunction in this cohort was low but falls in the range found elsewhere. These findings could inform the criteria of screening asymptomatic otherwise young health adults

Age at First Child Birth as a Risk Factor of Breast Cancer among Ugandan Women at a Tertiary Hospital: A Case Control Study

Background: Breast Cancer in Uganda is the third commonest cancer in women after cancer of the cervix and Kaposi’s sarcoma. The incidence of Breast Cancer in Uganda has nearly tripled from 1961 to 2006. It has beenconsidered a neglected disease but the reasons to why there is an increase in its incidence have not been fully explained. Studies show that age at first full term child birth has been associated with risk of developing breastcancer in the Caucasian population.Objective: To establish whether age at first full term child birth is  associated with development of breast cancer among Ugandan women.Method: A case control study was conducted over a six months period from November 2011 to April 2012 with patients confirmed with breast cancer as cases and controls without breast cancer. The sampling were convenient and interview questionnaire were administered, and clinical examinations done .The main predictor were age at first full term child birth and the outcome were histologically confirmed breast cancer. Data were analysed using stata 10; using logistic regression models, p-value of less than 0.05 was considered significant.Results: Over all, 183 women were enrolled, (93 cases and 93 controls). The mean age at first full term child birth was 19.8 years. The histological subtype was ductal carcinoma. No association were found between age at first full term child birth and risk of breast cancer adjusted OR 0.3 (0.1-2.4), p=0.239.Conclusion: No associations were found between age at first term child birth and risk for breast cancer disease among this group of Ugandan women.Key words: Breast Cancer, Age at First Birth, Ugand

Sonographic correlation of thyroid nodules with ultrasound aided fine needle non aspiration cytology

Objectives: To describe the sonographic patterns of thyroid nodules in patients undergoing thyroid ultrasound, to correlate sonographic characteristics of thyroid nodules to ultrasound aided fine needle non aspiration(US-FNNA) cytology and to determine the sensitivity and specificity of Ultrasound in characterising thyroid nodules.Design: Cross sectional study.Setting: The department of Radiology at Mulago Teaching and National Referral Hospital in Kampala Uganda. The Hospital is a 1,500-bed unit providing tertiary diagnostic, curative, rehabilitative, preventive and teaching services. Patients were recruited from both Medical and Surgical outpatient thyroid clinics.Subjects: All patients with thyroid nodules > 5 mm and who consented to have US aided-FNNA were enrolled consecutively.Results: One hundred and eighty one (181) participants were enrolled and final diagnoses were concluded in 177 of the participants (analysed) while four participants were excluded due to inadequate samples. The participants' age range was 19 to 83 years (mean age - 42 years ) and 93% were females. Five percent (n=9) were malignant, 18% suspiscious (n=34) and benign (n=134). The sonographic characteristics that were significantly correlated with final cytology diagnosis were a taller than wide AP diameter, micro-calcifications, heterogeneous and hypoechoic echo-patterns. Heterogeneous, hypoechoic and central vascularity had the highest sensitivity while wider than tall, anteroposterior diameter, no lymphadenopathy, and macro/no calcifications had the highest specificity.Conclusion: Sonographic features of micro-calcifications, taller than wide AP diameter, central vascularity and hypoechogenicity warrant US-FNNA. A bigger study correlating thyroid sonography with histological diagnosis is recommended

Gastric cancer diagnosis and treatment guidelines 2008: Uganda Cancer Working Group

In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention. However a better understanding of how it arises (risk factors) will be important in informing prevention and treatment strategies. The Uganda cancer-working group intends that this information is disseminated to wider readership in the region as part of the strategy of improving Oncological care service in the region

Cancer of the breast: 5-year survival in a tertiary hospital in Uganda

The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22–85 years, with a median of 45 years and peak age group of 30–39 years. Twenty-three percent had early disease (stages 0–IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was ‘not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan–Meier) for early disease were 74 and 39% for advanced disease (P=0.001). The overall 5-year survival was 56%, which is lower than the rates in the South African blacks (64%) and North American whites (82–88%)

Knowledge and Practice of Breast Self Examination among Female Students in a Sub-Saharan African University

Background: Breast cancer is the most common cancer among women in many parts of Africa. Facilities for screening and early detection are extremely limited yet early diagnosis improves survival. This study explored the practice of Breast Self Examination among female university students as a means of screening and early detection in a low resources environment. Subjects and Methods: A cross sectional descriptive study at a Sub Saharan university. A call for volunteers to the study was made; a pretested standardised questionnaire was used for data collection. The process was limited to an interview and a physical examination. IRB approval was granted before the study began. Results: A total of 320 participants volunteered, 314 were recruited. The majority were aged between 21 and 25. The range was between 19 to 31 years. There was a high awareness of Breast Self Examination (BSE) of 81.5%, 30% had ever performed a BSE, 14 % performed it regularly, 8% knew the correct monthly timing, the technique was accurately demonstrated by 1% of participants. 4.8 were found to have breast lumps. Conclusion: There is a likelihood of most young women in the country practicing BSE inadequately. There is a need for widespread BSE campaigns emphasizing the correct technique and a need to evaluate BSE efficacy. The prevalence of breast lumps among young women attending this university was comparable to other community prevalence studies in this age group