Post-operative complications of stapled versus Ferguson hemorrhoidectomy at Mulago Hospital. A randomized comparative study

Background: Hemorrhoids are a common anorectal condition. New surgical treatments have led to a reappraisal of hemorrhoid disease over the last few decades and despite a range of treatment modalities, the options are limited in their effectiveness and can lead to a number of complications. This study set out to compare post operative complications between stapled haemorrhoidopexy (SH) and Ferguson haemorrhoidectomy (FH) for patients with Grade III and IV in Mulago National Referral and teaching Hospital.Methods: Following ethical approval 48 consenting participants with Grade III/IV hemorrhoids were randomized to either FH or SH under regional anesthesia on 1:1 allocation. Early and short term post-operative complications were analyzed. .Results: We enrolled 24 participants in each arm with equal sex allocation and mean age of 39 years with 100% follow up. There was largely no difference in early and short term complications between FH and SH save for bleeding in the short term follow up which occurred more frequently in the FH group (p-value 0.045). The bleeding was mild and did not require transfusion.Conclusion: There was no major difference in short term complication rates between SH and FH. SH is a safe alternative to FH in Mulago Hospital.Keywords: Ferguson hemorrhoidectomy. Stapled hemorrhoidopexy. Hemorrhoids.PPH, Mulago Hospital, colorectal surger

An integrated approach to emergency triage assessment and treatment in Uganda

Background: Reducing mortality among patients who present to primary referral facilities in need of emergency care requires efficient triage and immediate correct management known more commonly as Emergency Triage, Assessment and Treatment (ETAT). Integrated Management of Infectious Disease (IMID) training and on-site support (OSS) have been the tools used to build capacity among mid-level practitioners who have been found to be lacking in ETAT skills in the region.Objective: To investigate the use of Integrated Management of Infectious Disease (IMID) training and on-site support (OSS) tools to improve ETAT in health care facilities in rural Uganda.Design: Randomized mixed methods evaluation.Setting: Thirty-six facilities in Uganda were randomized 1:1 to arm A (IMID and OSS) and arm B (IMID alone).Subjects: Two mid-level practitioners, (clinical officers or senior nurses), from each facility participated in offsite IMID training. Staff at 18 facilities in arm A participated in OSS (two days each month of outreach and quality improvement for nine months).Results: Time series data on facility performance of three ETAT indicators were compared over 14 months and data on mortality among pediatric inpatients were compared across arms. Improvements differed across facilities and indicators, but steady improvement in triage occurred in arm A, with convergence across arms in the management of emergency patients. Analysis of baseline indicators and improvements demonstrated that facilities could improve their performance regardless of their starting point.Conclusion: IMID and OSS both improved the management of patients with an acute illness presenting to rural health facilities

Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda

Background : The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%–60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment. Objective : The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda. Methods : Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer's shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV. Results : The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups. Conclusion : Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers

Floristic evidence for alternative biome states in tropical Africa

The idea that tropical forest and savanna are alternative states is crucial to how we manage these biomes and predict their future under global change. Large-scale empirical evidence for alternative stable states is limited, however, and comes mostly from the multimodal distribution of structural aspects of vegetation. These approaches have been criticized, as structure alone cannot separate out wetter savannas from drier forests for example, and there are also technical challenges to mapping vegetation structure in unbiased ways. Here, we develop an alternative approach to delimit the climatic envelope of the two biomes in Africa using tree species lists gathered for a large number of forest and savanna sites distributed across the continent. Our analyses confirm extensive climatic overlap of forest and savanna, supporting the alternative stable states hypothesis for Africa, and this result is corroborated by paleoecological evidence. Further, we find the two biomes to have highly divergent tree species compositions and to represent alternative compositional states. This allowed us to classify tree species as forest vs. savanna specialists, with some generalist species that span both biomes. In conjunction with georeferenced herbarium records, we mapped the forest and savanna distributions across Africa and quantified their environmental limits, which are primarily related to precipitation and seasonality, with a secondary contribution of fire. These results are important for the ongoing efforts to restore African ecosystems, which depend on accurate biome maps to set appropriate targets for the restored states but also provide empirical evidence for broad-scale bistability

Patterns of tree species composition across tropical African forests

Aim : In this study we identified large-scale variation in tree species composition across tropical African forests and determined the underlying environmental and historical factors. Location : Tropical forests from Senegal to Mozambique. Methods : Distribution data were gathered for 1175 tree species in 455 sample sites scattered across tropical Africa, including all types of tropical forests (wet, moist, dry, and lowland to moderate elevation montane forests). The value of elevation and 19 climatic variables extracted from the BIOCLIM data set were assigned to each sample site. We determined the variation in species composition using correspondence analysis and identified the environmental correlates. We defined floristic clusters according to species composition and identified the characteristic species using indicator analysis. Results : We identified a major floristic discontinuity located at the Albertine rift that separated the dry, moist and wet forests of West and Central Africa (the entire Guineo-Congolian Region) from the upland and coastal forests of East Africa. Except for the Albertine Rift, we found no evidence to support the other proposed floristic discontinuities (Dahomey Gap etc.). We detected two main environmental gradients across tropical African forests. The rainfall gradient was strongly correlated with the variation in tree species composition in West and Central Africa. The elevation/temperature gradient highlighted the major floristic differences within East Africa and between East Africa and the Guineo-Congolian Region, the latter being most probably due to the geological disruption and associated climatic history of the East African uplift. Main conclusions : We found floristic evidence for three main biogeographical regions across the tropical African forests, and described six floristic clusters with particular environmental conditions within these regions: Coastal and Upland for East Africa, Dry and Wet-Moist for West Africa, and Moist and Wet for Central Africa.CoForChange project (http://www.coforchange.eu/