Human Pelvis Height is Associated with Other Pelvis Measurements of Obstetric Value

In low resource settings, perinatal death remains a major challenge, yet some of the key anthropometric measures used for screening have been found to be inappropriate. These calls for additional anatomically related measurements to act as a basis for the design of: easy-to-use, low technology accurate tools to enhance obstetric care quality in these settings. This study set out to determine the associations between the various pelvis anthropometric measurements of obstetric importance with pelvis height. The study made use of 30 complete rearticulated Adult pelvic bonesets of known sex. The some of the thirteen measurements made on each boneset included: Pelvis height, Sacral Anterior Orientation (SAO), pubic bone length, total pelvis height and inlet medial-lateral diameter. All measurements were taken thrice and the average used for comparisons with pelvis height. The non-parametric Mann-Whitney test and multilevel regression analysis test to control for gender was used. Pelvis height had significant associations with SAO (-0.36, P<0.01), pubic bone length (0.41, P<0.01), total pelvis height (0.21, P=0.04) and inlet medial-lateral  diameter (0.46, P=0.02). Additional significant associations were observed with the diameters of the mid and outlet diameters of the birth canal. Pelvis height had significant associations with: total pelvis height and inletmedial-lateral diameter of the pelvis and the measurements related to the mid and outlet diameters of the birth canal. This study provides initial  evidence to support further evaluation of pelvis height as an additional tool for the assessment of the human birth canal.Key words: Pelvis height, Pelvimetry, Childbirth low resource setting

Challenges Facing Surgical Training in the Great Lakes Region in Sub-Saharan Africa: a Review Article

Background: There is a severe shortage of health workers in sub-Saharan Africa yet this subcontinent experiences a significant proportion of the world’s disease burden. This shortage is further reflected in the lack of personnel for surgical sub specialities such as orthopaedics, paediatrics, neurology and urology to mention but a few.Objective: This review therefore sought to summarize the current literature on the state of surgical training in sub Saharan Africa, discuss the  challenges faced and the possible ways to overcome these challengesMethods: We performed online searches of electronic databases i.e. PUBMED, MEDLINE and African Journals online that feature many African Journals not index by the ‘regular’ databases.Results: The searches returned 88 articles and 24 of which were included in the review, we present results focused on; training capacity and methods, scope of practice, technology and surgery, and low research capacity and output.Conclusion: The future of surgical training in Africa will depend on the ability of the leadership to create or and adopt innovative educational technologies, recruit and retain trainers and attract trainees on one hand and on the other, the growth of demand for quality surgical care in the great lakes regions. For those that have excelled in training need to build on those successes and share their stories.Keywords: Surgical Training, challenges, sub- Saharan Afric

Improving Recruitment of surgical trainees and Training of Surgeons in Uganda

Background: The surgical work output in Uganda is qualitatively and quantitatively inadequate. The number of surgeons is estimated at 100 for a population of over 26 million Ugandans. Thispaper reports on how to improve recruitment of surgical trainees and training of surgeons in Uganda, focusing on perceptions of potential trainees, trainers, and medical administrators.Methods: This was cross sectional, descriptive study sampled at least 50% of each of the relevant category of interviewees. Self-administered questionnaire and focus group discussions were used tocollect data, which was analyzed manually using a master sheet. It was approved by the Ethics and Research Committee.Results: Paediatrics and Public Health were rated as the disciplines of choice for postgraduate training in Uganda. The reasons why potential trainees would shy away from specialized surgical training were excessive workload, risk of catching HIV/AIDS, low financial returns and a poorlearning environment. The major bottlenecks in surgical training, which were cited, included inadequate number of scholarships, inadequate supervision by trainers, inadequate facilities and poor work conditions for trainers.Conclusion: The remedies to this complex problem revolve round providing more resources, (human, materials, money), improving supervision by the trainers, advocacy for an evidence basedcurriculum content and availing more funding into the Medical Education sector to improve Human Resource for Health development

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

Student and tutor perception of a new problem based learning curriculum at Faculty of Medicine, Makerere University

Background: The Makerere University Faculty of Medicine started the implementation of the Problem Based Learning/Community Based Education and Service curriculum for incoming students in the academic year 2003/2004. It undertook an intense preparatory period of 2 years before implementation, which included sensitizing, and training tutors to take their new role. Objectives: To evaluate student and tutor perception of the New PBL Curriculum at the Faculty of Medicine and to evaluate tutors perception of how well the students were doing.Methods: The study was at the end of the first semester, after seventeen weeks of the new curricula implementation. A 19-item questionnaire was self-administered by the students. An open discussion led by one of the investigators followed that questionnaire filling session. A 5-point likert scale was used to rate the different aspects. A different questionnaire was administered to the 35 academic staff that had tutored the twenty tutorial groups of eight to ten students each. The data collected from the two questionnaires was analyzed using SSPS software. The Faculty Research Committee approved the study.Results: Out of 180 students, 135 students filled in the questionnaire. In addition 25 tutors out of 35 filled in their questionnaire. The tutors’ facilitation of the tutorials was rated highly by the students. Students’ rated their (students’) participation in the tutorial process as excellent. The students rated access to learning resources as inadequate and they were anxious as to whether they were learning enough. On the other hand the tutors were satisfied with the depth and scope of the discussions by the students. The majority of the tutors thought it was the right move to introduce PBL. They were however concerned about sustainability of the novel educational reform (PBL).Conclusion: The students perceived the new method as acceptable. They expressed anxiety and uncertainly as to whether they were learning enough. And whereas the students were not sure they were learning enough, the tutors were satisfied with the depth of knowledge exhibited by the students. To sustain the reform tutors’ concerns and fears ought to be addressed

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

Is a PhD a necessary requirement for lecturers in a`Medical School? Report of a survey

Background: Makerere University introduced a new policy1 on the minimum qualification for appointment to a lecturer teaching position and eligibility for subsequent promotions. The highlight of the policy is a requirement for a PhD or equivalent as the minimum qualification necessary for appointment to a lecturer position and above.As a result of this policy fewer and fewer members have shown interest or indeed joined the Faculty of Medicine teaching staff roll.Objectives: This study set out to investigate the perception of the faculty and the impact of the policy on staffing.Methods: Literature review, oral and a questionnaire interviews were used to gather data. Participants included current members of teaching staff (of biomedical sciences and clinical disciplines) postgraduate students and visiting overseas academic staff and adjunct staff employed by the Ministry of Health at teaching hospitals.Data collected was analyzed and summarized in tabular form.Results: A PhD or equivalent is required as a minimum qualification to join academic positions at lecturer level and above at Faculty of Medicine and subsequent promotion to higher positions. There was a significant lag in promotions and recruitment in the Faculty of Medicine compared to counterparts employed by the Uganda Ministry of Health at the teaching hospitals. Participants expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from other universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions.Conclusion: Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion.University policy makers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as minimum requirement for teaching at a Medical School

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

Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University – Uganda Virus Research Institute research and training programme

Background: The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between 08-2008 and 12-2019, to inform programmes seeking to build Africa’s health research expertise. Methods: : Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in 03-04/2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement. Results: : By 12-2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leaders) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons were: i) Efficient administration provides a conducive environment for high quality research; ii) Institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; iii) Strong international and multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and iv) Mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges. Conclusions: : Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges