Exploring healthcare providers' perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study.

INTRODUCTION The burden of childhood mortality continues to be born largely by low-income and middle-income countries. The critical postdischarge period has been largely neglected despite evidence that mortality rates during this period can exceed inpatient mortality rates. However, there is a paucity of data on the paediatric discharge process from the perspective of the healthcare provider. Provider perspectives may be important in the development of an improved understanding of the barriers and facilitators to improving the transition from hospital to home. OBJECTIVES To explore healthcare providers' and facility administrators' perspectives of the paediatric discharge process with respect to: (1) current procedures, (2) barriers and challenges, (3) ideas for change, (4) facilitators for change and (5) the importance of discharge planning. DESIGN A qualitative exploratory approach using focus groups (14) and in-depth interviews (7). SETTING This study was conducted at seven hospitals providing paediatric care in Uganda. RESULTS Current discharge procedures are largely based on hospital-specific protocols or clinician opinion, as opposed to national guidelines. Some key barriers to an improved discharge process included caregiver resources and education, critical communication gaps, traditional practices, and a lack of human and physical resources. Teamwork and motivation to see improved paediatric transitions to home were identified as facilitators to implementing the ideas for change proposed by participants. The need for a standardised national policy guiding paediatric discharges, implemented through education at many levels and coupled with appropriate community referral and follow-up, was broadly perceived as essential to improving outcomes for children. CONCLUSIONS Although significant challenges and gaps were identified within the current health system, participants' ideas and the identified facilitators provide a significant basis from which change may occur. This work can facilitate the development of sustainable and effective interventions to improve postdischarge outcomes in Uganda and other similar settings

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%)

On-site construction of a point-of-care low-field MRI system in Africa

PurposeTo describe the construction and testing of a portable point-of-care low-field MRI system on site in Africa. MethodsAll of the components to assemble a 50 mT Halbach magnet-based system, together with the necessary tools, were air-freighted from the Netherlands to Uganda. The construction steps included individual magnet sorting, filling of each ring of the magnet assembly, fine-tuning the inter-ring separations of the 23-ring magnet assembly, gradient coil construction, integration of gradient coils and magnet assembly, construction of the portable aluminum trolley and finally testing of the entire system with an open source MR spectrometer. ResultsWith four instructors and six untrained personnel, the complete project from delivery to first image took approximately 11 days. ConclusionsAn important step in translating scientific developments in the western world from high-income industrialized countries to low- and middle-income countries (LMICs) is to produce technology that can be assembled and ultimately constructed locally. Local assembly and construction are associated with skill development, low costs and jobs. Point-of-care systems have a large potential to increase the accessibility and sustainability of MRI in LMICs, and this work demonstrates that technology and knowledge transfer can be performed relatively seamlessly.Radiolog

Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria.

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed

Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria.

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Takayasu's arteritis (pulseless disease) in Uganda

We report herein the case of a 23 year old woman who was referred to Mulago National Referral and Faculty of Medicine Makerere University Teaching Hospital because of sudden collapse, left sided weakness and headache for management. The patient underwent a battery of investigations but died five days after admission. The post mortem findings were extensive infarction of the right cerebrum extending from parietal to occipital lobes. There was thickening of the wall and complete obliteration of the right common carotid artery. The left common carotid artery was severely stenosed with marked thickening of the wall. The left subclavian artery was thickened and completely obliterated. Microscopically there was intimal thickening by fibrous connective tissue and infiltrate of chronic inflammatory cells in the walls of the three affected branches of the oarta. These gross and microscopic features were compatible with Takayasu's arteritis (TA)

Takayasu's arteritis (pulseless disease) in Uganda

We report herein the case of a 23 year old woman who was referred to Mulago National Referral and Faculty of Medicine Makerere University Teaching Hospital because of sudden collapse, left sided weakness and headache for management. The patient underwent a battery of investigations but died five days after admission. The post mortem findings were extensive infarction the right cerebrum extending from parietal to occipital lobes. There was thickening of the wall and complete obliteration of right common carotid artery. The left common carotid artery was severely stenosed with marked thickening of the wall. The subclavian artery was thickened and completely obliterated. Microscopically there was intimal thickening by fibrous connective tissue and infiltrate of chronic inflammatory cells in the walls of the three affected branches of the oarta. These gross microscopic features were compatible with Takayasu's arteritis (TA). African Health Sciences Vol.4(3) 2004: 185-18