Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study.

BACKGROUND: Sub-Saharan Africa suffers from a dual burden of infectious and non-communicable diseases. There is limited data on causes and trends of admission and death among patients on the medical wards. Understanding the major drivers of morbidity and mortality would help inform health systems improvements. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda. METHODS AND RESULTS: The medical record data base of patients admitted to Mulago Hospital adult medical wards from January 2011 to December 2014 were queried. A detailed history, physical examination and investigations were completed to confirm the diagnosis and identify comorbidities. Any histopathologic diagnoses were made by hematoxylin and eosin tissue staining. We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization. Survival was calculated from the date of admission to the date of death or date of discharge. Cox survival analysis was used to identify factors associate with in-hospital mortality. We used a statistical significance level of p<0.05. A total of 50,624 patients were hospitalized with a median age of 38 (range 13-122) years and 51.7% females. Majority of patients (72%) had an NCD condition as the primary reason for admission. Specific leading causes of morbidity were HIV/AIDS in 30% patients, hypertension in 14%, tuberculosis (TB) in 12%), non-TB pneumonia in11%) and heart failure in 9.3%. There was decline in the proportion of hospitalization due to malaria, TB and pneumonia with an annual percentage change (apc) of -20% to -6% (all p<0.03) with an increase in proportions of admissions due to chronic kidney disease, hypertension, stroke and cancer, with apc 13.4% to 24%(p<0.001). Overall, 8,637(17.1%) died during hospitalization with the highest case fatality rates from non-TB pneumonia (28.8%), TB (27.1%), stroke (26.8%), cancer (26.1%) and HIV/AIDS (25%). HIV-status, age above 50yrs and being male were associated with increased risk of death among patients with infections. CONCLUSION: Admissions and case fatality rates for both infectious and non-infectious diseases were high, with declining trends in infectious diseases and a rising trend in NCDs. Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease

Atypical presentation of colon adenocarcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Adenocarcinoma of the colon is the most common histopathological type of colorectal cancer. In Western Europe and the United States, it is the third most common type and accounts for 98% of cancers of the large intestine. In Uganda, as elsewhere in Africa, the majority of patients are elderly (at least 60 years old). However, more recently, it has been observed that younger patients (less than 40 years of age) are presenting with the disease. There is also an increase in its incidence and most patients present late, possibly because of the lack of a comprehensive national screening and preventive health-care program. We describe the clinicopathological features of colorectal carcinoma in the case of a young man in Kampala, Uganda.</p> <p>Case presentation</p> <p>A 27-year-old man from Kampala, Uganda, presented with gross abdominal distension, progressive loss of weight, and fever. He was initially screened for tuberculosis, hepatitis, and lymphoma, and human immunodeficiency virus/acquired immunodeficiency syndrome infection. After a battery of tests, a diagnosis of colorectal carcinoma was finally established with hematoxylin and eosin staining of a cell block made from the sediment of a liter of cytospun ascitic fluid, which showed atypical glands floating in abundant extracellular mucin, suggestive of adenocarcinoma. Ancillary tests with alcian blue/periodic acid Schiff and mucicarmine staining revealed that it was a mucinous adenocarcinoma. Immunohistochemistry showed strong positivity with CDX2, confirming that the origin of the tumor was the colon.</p> <p>Conclusions</p> <p>Colorectal carcinoma has been noted to occur with increasing frequency in young adults in Africa. Most patients have mucinous adenocarcinoma, present late, and have rapid disease progression and poor outcome. Therefore, colorectal malignancy should no longer be excluded from consideration only on the basis of a patient's age. A high index of suspicion is important in the diagnosis of colorectal malignancy in young African patients.</p

HIV, tuberculosis, diabetes mellitus and hypertension admissions and premature mortality among adults in Uganda from 2011 to 2019: is the tide turning?

BACKGROUND: The growing burden of diabetes mellitus (DM) and hypertension (HTN) on the background of endemic Human Immuno-deficiency Virus (HIV) and tuberculosis (TB) is a concern in low- and middle-income countries. We aimed to describe annual trends in admissions, mortality rates and premature mortality (years of potential life lost-YPLLs) due to HIV, tuberculosis (TB), diabetes mellitus (DM) and hypertension (HTN) in Uganda. METHODS: We conducted a retrospective cohort study, retrieving electronic records of adults admitted to Mulago and Kiruddu national referral hospitals medical wards between 1st January 2011 and 31st December 2019. We used STATA BE 17.0 and GraphPad Prism 8.0.2 to compute total admissions, inpatient crude mortality rates, and YPLLs; and demonstrate trends using Mann-Kendall test. RESULTS: Of 108,357 admissions, 55,620 (51.3%) were female, 15,300 (14.1%) were recorded in 2012, and 22,997 (21.2%) were aged 21-30 years. HIV, TB, DM and HTN accounted for 26,021 (24.0%); 9537 (8.8%); 13,708 (12.7) and 13,252 (12.2%) of all admissions, respectively. Overall inpatient mortality was 16.7% (18,099/108,357), 53.5% (9674/18,099) were male, 21.5% (3898) were aged 31-40 years and 2597 (14.4%) were registered in 2013. HIV, TB, DM and HTN accounted for 35.6% (6444), 14.6% (2646), 9.1% (1648) and 11.8% (2142) of all deaths, respectively. Total admissions (Kendall's tau-B = - 0.833, p < 0.001) and deaths declined (Kendall's tau-B = - 0.611, p = 0.029). A total of 355,514 (mean = 20.8 years, SD 30.0) YPLLs were recorded, of which 54.6% (191,869) were in males; 36.2% (128,755) were among those aged 21-30 years and were recorded in 2012 (54,717; 15.4%). HIV, TB, DM and HTN accounted for 46.5% (165,352); 19.5% (69,347); 4.8% (16,991) and 4.5% (16,167) of YPLLs, respectively. Proportionate contribution of HIV to deaths and YPLLs declined, remained stagnant for TB; and increased for both DM and HTN. CONCLUSION: TB and HIV account for higher though declining, while DM and HTN account for lower albeit rising morbidity and premature mortality among adult medical patients in Uganda. TB prevention and treatment; and DM/HTN service integration in HIV care should be optimized and scaled up

Prevalence of hepatitis B virus (HBV) infection among Makerere University medical students

Background: Medical students in the course of their clinical work are at risk of acquiring hepatitis B virus (HBV) infection or transmitting it to their patients. HBV immunization for medical students in Uganda is recommended but not strictly enforced. It is important to assess the prevalence of HBV infection in medical students in order to improve on the interventions to control this infection among them. Objectives: The objective of the study was to assess the seroprevalence rates of HBsAg and anti-HBc among clinical and preclinical medical students. Methods: This was a cross-sectional study done over three months from November 2000 to January 2001 among Makerere University Medical students. A random sample of medical students was recruited from both the pre-clinical and clinical years. Blood samples from each participant were tested for HBsAg and anti-HBc. Results: The overall prevalence was 11.0% for HBsAg and 65.9% for anti HBc. Nine pre-clinical students (12.2%) were positive for HBsAg compared to 11 (10.2%) clinical students. This difference was not statistically significant. However, clinical students were more likely to have been exposed to HBV with 86 (79.6%) testing positive for anti-HBc compared to 34 (45.9%) among preclinical students (p-valu

Prevalence of hepatitis B virus (HBV) infection among Makerere University medical students

BACKGROUND: Medical students in the course of their clinical work are at risk of acquiring hepatitis B virus (HBV) infection or transmitting it to their patients. HBV immunization for medical students in Uganda is recommended but not strictly enforced. It is important to assess the prevalence of HBV infection in medical students in order to improve on the interventions to control this infection among them. OBJECTIVES: The objective of the study was to assess the seroprevalence rates of HBsAg and anti-HBc among clinical and pre-clinical medical students. METHODS: This was a cross-sectional study done over three months from November 2000 to January 2001 among Makerere University Medical students. A random sample of medical students was recruited from both the pre-clinical and clinical years. Blood samples from each participant were tested for HBsAg and anti-HBc. RESULTS: The overall prevalence was 11.0% for HBsAg and 65.9% for anti HBc. Nine pre-clinical students (12.2%) were positive for HBsAg compared to 11 (10.2%) clinical students. This difference was not statistically significant. However, clinical students were more likely to have been exposed to HBV with 86 (79.6%) testing positive for anti-HBc compared to 34 (45.9%) among pre-clinical students (p-value <001). Risk factors associated HBV infection included having a sexual relationship, accidental needlestick injuries, and unprotected exposure to patients' body fluids. CONCLUSION: Medical students need to be offered more sensitization and support regarding prevention of HBV infection including vaccination and the use of universal precautions for infection control

Inter-religious Cooperation for HIV Prevention in Uganda: A Study among Muslim and Christian Youth in Wakiso District

Inter-religious cooperation has been recommended to address various issues for the common good. Muslims and Christians in Uganda are working together on HIV prevention in this spirit. A study was done to compare HIV prevalence and HIV-risk behaviors between Muslims and Christians. A total of 2,933 Christian and 1,224 Muslim youth between 15–24 years were interviewed and tested for HIV. The HIV prevalence was significantly lower among Muslims (2%) compared to Christians (4%). Muslims were more likely to be circumcised, avoid drinking alcohol and avoid having first sex before 18 years. These behaviors which may have led to lower HIV infections among Muslims are derived from Islamic teachings. Muslim religious leaders need to continue to emphasize these teachings. Christian religious leaders may need to consider strengthening similar teachings from their faith tradition to reduce new HIV infections among their communities. Muslims and Christians working together as good neighbors, in the spirit of inter-religious cooperation, can generate evidence-based data that may assist them to improve their HIV prevention interventions. By sharing these data each community is likely to benefit from their cooperation by strengthening within each religious tradition those behaviors and practices that appear helpful in reducing new HIV infections

Inter-religious Cooperation for HIV Prevention in Uganda: A Study among Muslim and Christian Youth in Wakiso District

Abstract: Inter-religious cooperation has been recommended to address various issues for the common good. Muslims and Christians in Uganda are working together on HIV prevention in this spirit. A study was done to compare HIV prevalence and HIV-risk behaviors between Muslims and Christians. A total of 2,933 Christian and 1,224 Muslim youth between 15-24 years were interviewed and tested for HIV. The HIV prevalence was significantly lower among Muslims (2%) compared to Christians (4%). Muslims were more likely to be circumcised, avoid drinking alcohol and avoid having first sex before 18 years. These behaviors which may have led to lower HIV infections among Muslims are derived from Islamic teachings. Muslim religious leaders need to continue to emphasize these teachings. Christian religious leaders may need to consider strengthening similar teachings from their faith tradition to reduce new HIV infections among their communities. Muslims and Christians working together as good neighbors, in the spirit of inter-religious cooperation, can generate evidence-based data that may assist them to improve their HIV prevention interventions. By sharing these data each community is likely to benefit from OPEN ACCESS Religions 2011, 2 708 their cooperation by strengthening within each religious tradition those behaviors and practices that appear helpful in reducing new HIV infections

Factors associated with carcinoma of the oesophagus at Mulago Hospital, Uganda

Background: In Uganda, as in many other parts of the world cancer of the oesophagus (CAE) is on the rise. Squamous cell carcinoma and adenocarcinoma are the common subtypes. Risk factors for this cancer have been identified but not studied systematically in Uganda. Identification of these factors would enable establishment of preventive measures. Objective To determine the prevalence, histological features and associated factors for CAE among patients referred to the endoscopic unit of Mulago hospital, Kampala, Uganda. Methods: We performed a 1-year cross-sectional study in 2004 and 2005 of all patients presenting for oesophageal-gastro-duodenoscopy (EGD) at Mulago Hospital. Demographic characteristics, behavioural practices, endoscopy findings and histology results where biopsies were performed were collected using a study tool. Data analysis was done using STATA 8® statistical package Results: Two hundred nineteen patients were enrolled in the study, three were excluded because they could not tolerate the endoscopy procedure. Fifty five (19%) of the 287 had histologically proven CAE. Squamous cell carcinoma was found in 100% of tumours of the upper third, 91% middle third, and 73% lower third of the oesophagus. Four patients had a histological diagnosis of adenocarcinoma of the oesophagus. Factors that were associated with CAE included age (OR 1.63, CI 1.34-1.98, p value <0.001), smoking (OR 3.63, CI 1.82-7.23, p value <0.001) and gender (OR 2.17, CI 1.07-4.41, p value 0.032). Conclusion: Many patients referred for EGD in Uganda had esophageal cancer most of which were.squamous cell type. Smoking, male gender and older age were risk factors. Preventive measures should target stopping smoking