Case series on testicular torsion: an educational emergency for sub-Saharan Africa

Testicular torsion remains a common surgical emergency of adolescent males presenting with sudden onset of intense scrotal pain in Africa. While the magnitude of testicular torsion is not known it has been identified as a cause of male infertility. Testicular loss in Africa is directly related to delay in surgery and the referral patterns at the point of first contact with health workers. This paper sets out to demonstrate the importance of the patient's age in the diagnosis of testicular torsion. A surgical audit was made of patients records collected over the last 30 years, for presentation of testicular related symptoms and analyzed to identify changes in the patterns of diagnosis over time and in different countries. There were 305 records found, for patients with an age range of 9-56 years. There were 195/305 (64%) with orchitis and 110/305 (36%) with testicular torsion. Testicular torsion is more common under the age of 18 years while orchitis was more common after 18 years of age (rho = - 0.834, p value > 0.001 one tailed). This paper supports the development of educational interventions that promote the use of age in a simple diagnostic rule of the thumb for communities and lower cadre health workers in low resource settings.Pan African Medical Journal 2013; 14:1

Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in Ugandan mothers

Introduction: Fetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth  related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers.Methods: This was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12.  Results: It was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week  after the 25th week of pregnancy. Significant associations were observed between the rate of fetal  head descent with: maternal height (Adj Haz ratio 0.93 P<0.01) and maternal pelvis height (Adj Haz ratio 1.15 P<0.01). Conclusion: The significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional  decision support tool for screening mothers in low resource settings.Key words: Pelvis height, antenatal diagnosis, childbirth

Influence of maternal pelvis height and other anthropometric measurements on the duration of normal childbirth in Ugandan mothers

In low resource settings, maternal anthropometry may complicate time based  monitoring of childbirth. We set out to determine the effect of maternal  anthropometry and foetal birth weight on the duration of childbirth. Birth related secondary data from 987 mothers with pregnancies of ≥ 37 weeks, singleton baby and a normal childbirth were obtained. This data was analysed for regression coefficients and Interclass correlations coefficients (ICCs). The mean duration of childbirth was 7.63hours. Each centimetre increase in maternal pelvis height led to a 0.56hours increase for the first stage (P<0.01), 0.05hours reduction for second stage (P<0.01), and 0.46hours increase in total duration of childbirth (p<0.01). For each centimeter increase in maternal height there was a 0.04hours reduction in the first stage (P=0.01) and a 0.005hours increase in second stage (P=0.03). The ICCs with respect to geographical site were 0.40 for stage 1, 0.27 for stage 2 and 0.21 for stage 3. Additional modeling with tribe of mother did not change the ICCs. Maternal pelvis height and maternal height were found to have a significant effect on the duration of the different stages of normal childbirth. Additional study is needed into the public health value of the above measurements in relation to childbirth in these settings.Key words: Humans; anthropometry; childbirth; pelvis height

Perceptions of orthopaedic medicine students and their supervisors about practice-based learning: an exploratory qualitative study

Background: Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country’s understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital. Methods: This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their rotation in the emergency ward of Mulago hospital and 6 of their supervisors. Interviews were audio-recorded, transcribed, and then imported into Atlas ti 8.3 for analysis. The data were coded and grouped into themes relating to perceptions of practice-based learning, general inductive analysis was used. The general inductive approach involved condensing the raw textual data into a brief and summary format. The summarized format was then analyzed to establish clear links between the perceptions of practice-based learning and the summary findings derived from the raw data. Results: The mean age of the students was 23±1.5 years. Four out of the six supervisors were Orthopaedic officers while the remaining two were principal Orthopaedic officers, four out of the six had a university degree while the other two were diploma holders. The main themes arising were hands-on skills, an unconducive learning environment, the best form of learning, and having an undefined training structure. Particularly, the perceptions included the presence of too many students on the wards during the rotation, frequent stock-outs of supplies for learning, and supervisors being overwhelmed caring for a large number of patients. Conclusion: Barriers to satisfactory practice-based learning were overcrowding on the wards and insufficient training materials. To improve practice-based learning, adequate learning materials are required and the number of students enrolled needs to be appropriate for the student – supervisor ratio

A mixed methods approach to prioritizing components of Uganda’s eHealth environment

Introduction: Globally the use of information and communication technologies (ICTs) in healthcare,  eHealth, is on the increase. This increased use is accompanied with several challenges requiring uniformly understood and accepted regulations. Developing such regulations requires the engagement of all stakeholders. In this manuscript we explored the priorities of various eHealth stakeholders in Uganda to inform the eHealth policy review process.Methods: We used a Delphi approach during the initial programmed plenary of a consultative workshop in which participants were asked to identify and post their topmost priority related to eHealth under one of the seven components of the eHealth environment as described in the WHO national eHealth toolkit. We used an additional qualitative analytical method to further group the participant sorted priorities into sub clusters to support additional interpretation using the toolkit.Results: The components of the eHealth environment ranked as follows with respect to descending number of postings: information services and applications (36 postings), information and technology standard (31 postings), leadership and governance (22 postings), strategic planning (21 postings), infrastructure(14 postings), financial management (2 postings) and others (6 postings).Conclusion: Uganda's eHealth environment is in the developing and building up stage (II). In this environment the policy and implementation strategy should strengthen linkages in core systems, create a foundation for investment, ensure  legal certainty and create a strong eHealth enabling environment.Key words: Information and communications technologies, policy, eHealt

Occurrence of spina bifida in the Makerere University Galloway collection: an osteological anatomical study

Spina bifida is one of the commonest neural tube defects. Though food fortification with folic acid has been reported to reduce spina bifida, the incidence of spina bifida and the benefits of taking folic acid have not been documented in many developing countries including Uganda. This study set out to determine the incidence of spina bifida and related skeletal neural tube defects in the skeletons currently housed in the Galloway skeletal collection at Makererere University College of Health Sciences, Anatomy department with the aim of using the data to extrapolate on the usefulness of food fortification with folic acid. This was a descriptive cross sectional study on 226 skeletons in the Galloway osteological collection examined by an experienced anatomist for features of neural tube defects that ranged from non-fusion of the spinal arches to total absence of vertebral structures. Of the skeletons examined 43/226 (19%) had spina bifida. Of these 38/43 (88%) were male, suggesting a higher incidence of spina bifida in males than in the females. Overall 55.2% of the skeletons were within the age range of 20-55 years. This historical study highlights possible differences in the maternal micro nutrient status in the early months of pregnancy for various African populations as shown by the differences in the prevalence rates of minor spina bifida defects in the Galloway osteological collection. There is need for baseline studies on folic acid levels during pregnancy and the various local dietary sources of folic acid for Africans.Key words: Neural tube defects, osteolog

The role of community engagement in promoting research participants' understanding of pharmacogenomic research results: Perspectives of stakeholders involved in HIV/AIDS research and treatment.

Community engagement (CE) is praised to be a powerful vehicle in empowering communities with knowledge and skills to make informed decisions for better health care. Several CE approaches have been proposed to improve participants' and research communities' understanding of genomic research including pharmacogenomic information and results. However, there is limited literature on how these approaches can be used to communicate findings of pharmacogenomic research to communities of people living with HIV. This study explored stakeholders' perspectives on the role of community engagement in promoting understanding of pharmacogenomic research results among people living with HIV. We adopted a qualitative approach that involved 54 stakeholders between September 2021 and February 2022. We held five focus group discussions among 30 community representatives from five research institutions, 12 key informant interviews among researchers, and 12 in-depth interviews among ethics committee members. A thematic approach was used to analyze the results. Five themes merged from this data and these included (i) benefits of engaging communities prior to returning individual pharmacogenomic research results to participants. (ii) Obtaining community consensus on the kinds of pharmacogenomic results to be returned. (iii) Opinions on how pharmacogenomic research information and results should be communicated at community and individual levels. (iv) Perceived roles of community stakeholders in promoting participants' understanding and utilization of pharmacogenomic research results. (v) Perceived challenges of engaging communities when returning individual results to research participants. Stakeholders opined that CE facilitates co-learning between researchers and research communities. Researchers can adapt existing CE approaches that are culturally acceptable for meaningful engagement with minimal ethical and social risks when communicating pharmacogenomic research results. CE approaches can facilitate understanding of pharmacogenomic research and findings among research participants and communities. Therefore, if creatively adapted, existing and new CE approaches can enable researchers to communicate simple and understandable results of pharmacogenomic research

Musculoskeletal disorders among nursing staff: a comparison of five hospitals in Uganda

Abstract Introduction: Low and middle income countries have severe nursing staff shortages which is associated with risk of poor quality of patient car

Mandatory anatomy dissection, effect on examination performance

Regular class attendance is evidence of professionalism. This has led to mandatory class attendance in many disciplines including anatomy. However, there is paucity of data on the effect of mandatory class attendance on student performance in resource-limited settings. The objective of this study was to determine the effect of mandatory attendance of anatomy dissections on student’s practical exams. This was an audit of undergraduate first year health professional students performance on the practical summative Steeplechase exam for the anatomy of limbs in two consecutive academic years at Makerere University. The second lot of first year students in the study had all their scheduled anatomy dissection sessions roll called to confirm their attendance that was the intervention arm in the study. The data was analysed with STATA statistical computing software version 13. Some of the tests run on this data included independent samples t test and Regression analysis. The overall performance of students in the academic year varied with roll call and was significantly lower than that in the previous academic year without roll call (mean difference -8.04 95% CI -10.76 to -5.31). Significant reductions in performance were also observed with type of student sponsorship (P<0.01) and the program they were pursuing (P<0.01). Roll calling had the largest effect on student performance demonstrated by the 0.23 standard deviation reduction in performance of students. This study shows that mandatory attendance of anatomy dissections leads to a reduction in the student’s performance on practical anatomy examinationsKeywords: Anatomy dissection, class attendance, examination performanc