Osteosarcoma: A clinical radiological pathological study in Mulago Hospital, Kampala, Uganda

Purpose: To describe the clinical, radiological and pathological presentation of  osteosarcoma at Mulago Hospital, Kampala-Uganda.Methods: A cross sectional descriptive study was carried out between January 1999 and December 2001 at Mulago Hospital. A total of 32 Patients were recruited consecutively during this period. All patients had a clinical examination, plain radigraphs and biopsies of the affected Parts.Results: Thirty-two patients were recruited. The age range was 9-42 yrs with a M: F ratio of 1:1. 87.5% of the lesions were in the appendicular skeleton while 12.5% were in the axial skeleton. The commonest clinical presentation was pain. The commonest radiological presentation was that of a metadiaphyseal mixed density  lesion. The commonest site was the proximal tibia. Histology showed marked pleomorphic osteoblasts with osteoid formation.Conclusion: Osteosarcoma in Mulago hospital has not changed its clinical  radiological and histopathological manifestation over the years. All mixed density lesions located in the metaphysis of long bones at the knee joint in an adolescent with sharp pain should be investigated as Osteosacoma until proven otherwise.Key words: Osteosarcoma, clinical, radiology and histopatholog

Radiation Safety Awareness among Radiation Workers and Clientele At Mulago Hospital, Kampala, Uganda.

Background: All x-ray utilization in human medicine leads to exposure of the patient and personnel to radiation. Although the quantity is low in diagnostic examinations, special attention should be given to this fact in order to minimize unnecessary exposure for both groups. Exposureto ionizing radiation cannot be avoided in a medical imaging facility. Twenty-two radiation workers and fifty patients responded. The main objective of the study was to determine the level of radiation safety awareness among radiation workers (Personnel) and clientele at Mulago hospital.Methods: Subjects were interviewed using two different questionnaires each one tailored to the radiation workers and the patient (clientele). Fifty patients and twenty-two radiation workers responded. Their views were assessed using structured questionnaires. The data was analysedusing SSPS package.Results: Fifteen (68.2%) reported that they had had a sensitization introduction about radiation safety before they started working with radiation. . 18 (81.8%) thought that the radiation safetymeasures taken at the work place were inadequate. It was noted that radiation workers were well informed about radiation safety, but that the patients expressed ignorance on the subject and many were convinced that x-rays were dangerous.Conclusion: There is need for sensitization of the public on radiation safety and to allay their fears about radiation. The radiation workers should do this before patients are worked on. This requires good communication skills on the part of the radiation workers. There is also need for radiation workers to have introductory seminars on radiation safety before they start working with radiation. They also need continuous education and update on radiation safet

Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital

Background: Breast cancer is the third commonest cancer in Ugandan women. Women present late for breast cancer management which leads to high mortality rates. The objective of the study was to assess the knowledge, attitudes and practices of Ugandan women concerning breast cancer and mammography. Methods: This was a descriptive cross-sectional study where 100 women reporting to the Radiology department were interviewed. We used consecutive sampling. Interviewer-administered questionnaires were used to collect opinions of the participants. For data analysis, answers were described as knowledge, attitude, practice and they were correlated with control variables through the chi-square. Bivariate and logistic regression analyses were also used. Results: Most of the women (71%) had no idea about mammography. More than 50 % did not know about risk factors for breast cancer. The attitude towards mammography was generally negative. Regarding seeking for mammography; level of literacy, occupation and marital status were significant on bivariate analysis, however only level of literacy and employment remained the significant independent variables on logistic regression analysis. The main barrier to mammography was mainly lack of information. Conclusion: Women in this study had Page number not for citation purposes

Financial inclusion

Financial inclusion has been noted as a key driver of poverty alleviation and growth. Yet, most of the scholarly work that exists lacks a comprehensive discussion of how the poor interact with financial services and the channels through which such services can affect their livelihoods. This book offers researchers who focus on financial inclusion and African economies a one stop resource for understanding the channels of transmission for financial inclusion as well as an application of these channels through original country specific empirical papers. The book provides a back-to-basics presentation of the transmission of financial services to growth and poverty. This theoretical discussion is complemented by an empirical presentation of the various services used by the poor, with a focus on Africa. Case studies of financial inclusion in six African countries cover a broad range of topics most important to African countries and highlight the unique African setting. These empirical papers provide important learning points. Firstly, hybrid financial institutions such as cooperative financial institutions and financial social entrepreneurs are the best way to increase financial inclusion in Africa. They provide important vehicles to circumventing the restrictive and exclusive bank-based financial markets typical of African economies. Secondly, digital finance is a potent tool in improving financial access and usage in Africa, and its impact on poverty operates through both traditional and nontraditional financial instruments. Thirdly, investment in infrastructure which supports complementary markets is critical and is likely to have a greater effect on credit rationing than direct provision of credit to small businesses

Financial inclusion

Financial inclusion has been noted as a key driver of poverty alleviation and growth. Yet, most of the scholarly work that exists lacks a comprehensive discussion of how the poor interact with financial services and the channels through which such services can affect their livelihoods. This book offers researchers who focus on financial inclusion and African economies a one stop resource for understanding the channels of transmission for financial inclusion as well as an application of these channels through original country specific empirical papers. The book provides a back-to-basics presentation of the transmission of financial services to growth and poverty. This theoretical discussion is complemented by an empirical presentation of the various services used by the poor, with a focus on Africa. Case studies of financial inclusion in six African countries cover a broad range of topics most important to African countries and highlight the unique African setting. These empirical papers provide important learning points. Firstly, hybrid financial institutions such as cooperative financial institutions and financial social entrepreneurs are the best way to increase financial inclusion in Africa. They provide important vehicles to circumventing the restrictive and exclusive bank-based financial markets typical of African economies. Secondly, digital finance is a potent tool in improving financial access and usage in Africa, and its impact on poverty operates through both traditional and nontraditional financial instruments. Thirdly, investment in infrastructure which supports complementary markets is critical and is likely to have a greater effect on credit rationing than direct provision of credit to small businesses

Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low-income setting

OBJECTIVE: The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. METHODS: This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy underwent Doppler and fetal biometric assessment at 32-40 weeks of gestation. Sonographers undertook 6 weeks of training followed by onsite refresher training and audit exercises. A total of 125 images for each of the umbilical artery (UA), fetal middle cerebral artery (MCA), left and right uterine arteries (UtA), head circumference (HC), abdominal circumference (AC) and femur length (FL) were selected randomly from the EPID study database and evaluated independently by two experts in a blinded fashion using objective scoring criteria. Inter-rater agreement was assessed using modified Fleiss' kappa for nominal variables and systematic errors were explored using quantile-quantile (Q-Q) plots. RESULTS: For Doppler measurements, 96.8% of the UA images, 84.8% of the MCA images and 93.6% of the right UtA images were classified as of acceptable quality by both reviewers. For fetal biometry, 96.0% of the HC images, 96.0% of the AC images and 88.0% of the FL images were considered acceptable by both reviewers. The kappa values for inter-rater reliability of quality assessment were 0.94 (95% CI, 0.87-0.99) for the UA, 0.71 (95% CI, 0.58-0.82) for the MCA, 0.87 (95% CI, 0.78-0.95) for the right UtA, 0.94 (95% CI, 0.87-0.98) for the HC, 0.93 (95% CI, 0.87-0.98) for the AC and 0.78 (95% CI, 0.66-0.88) for the FL measurements. The Q-Q plots indicated no influence of systematic bias in the measurements. CONCLUSIONS: Training local healthcare providers to perform Doppler ultrasound, and implementing quality control systems and audits using objective scoring tools in clinical and research settings, is feasible in low- and middle-income countries. Although we did not assess the impact of in-service retraining offered to practitioners deviating from prescribed standards, such interventions should enhance the quality of ultrasound measurements and should be investigated in future studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Protocol for the Birth Asphyxia in African Newborns (Baby BRAiN) Study: a Neonatal Encephalopathy Feasibility Cohort Study

BACKGROUND: Neonatal encephalopathy (NE) is a leading cause of child mortality worldwide and contributes substantially to stillbirths and long-term disability. Ninety-nine percent of deaths from NE occur in low-and-middle-income countries (LMICs). Whilst therapeutic hypothermia significantly improves outcomes in high-income countries, its safety and effectiveness in diverse LMIC contexts remains debated. Important differences in the aetiology, nature and timing of neonatal brain injury likely influence the effectiveness of postnatal interventions, including therapeutic hypothermia. METHODS: This is a prospective pilot feasibility cohort study of neonates with NE conducted at Kawempe National Referral Hospital, Kampala, Uganda. Neurological investigations include continuous video electroencephalography (EEG) (days 1-4), serial cranial ultrasound imaging, and neonatal brain Magnetic Resonance Imaging and Spectroscopy (MRI/ MRS) (day 10-14). Neurodevelopmental follow-up will be continued to 18-24 months of age including Prechtl’s Assessment of General Movements, Bayley Scales of Infant Development, and a formal scored neurological examination. The primary outcome will be death and moderate-severe neurodevelopmental impairment at 18-24 months. Findings will be used to inform explorative science and larger trials, aiming to develop urgently needed neuroprotective and neurorestorative interventions for NE applicable for use in diverse settings. DISCUSSION: The primary aims of the study are to assess the feasibility of establishing a facility-based cohort of children with NE in Uganda, to enhance our understanding of NE in a low-resource sub-Saharan African setting and provide infrastructure to conduct high-quality research on neuroprotective/ neurorestorative strategies to reduce death and disability from NE. Specific objectives are to establish a NE cohort, in order to 1) investigate the clinical course, aetiology, nature and timing of perinatal brain injury; 2) describe electrographic activity and quantify seizure burden and the relationship with adverse outcomes, and; 3) develop capacity for neonatal brain MRI/S and examine associations with early neurodevelopmental outcomes