Abdominal surgical site infection incidence, risk factors, and antibiotic susceptibility at a university teaching hospital in western Uganda: A cross-sectional study

Background: Surgical site infection (SSIs) is a global burden that contributes towards morbidity and mortality of patients undergoing abdominal surgeries. There is paucity of data on SSIs in resource constrained Uganda to guide antibiotic protocols.This study aimed to determine the incidence of SSIs, risk factors, common causative bacteria and their susceptibility patterns amongst patients undergoing abdominal surgeries at Kampala International University Teaching Hospital (KIUTH), Uganda.Methods: Cross-sectional observational cohort study involving culture and sensitivity of pus swabs from surgical sites of consented consecutive patients. Laboratory tests were performed at the United States Army Research Laboratory on Infectious Diseases (USAMRIID). Data was analysed using SPSS 20.0. Chi-square and binary logistic regression analyses were performed at 95% confidence interval, regarding pResults: Of the 138 patients, 17.4% (n=24) developed SSIs. The risk factors for SSIs were comorbidity with diabetes mellitus, cancer without enrolment for anti-cancer treatment, pre-operative white blood cell count >11.0×109 cells/L, and HB Conclusions: The prevalence of SSIs in the present study was higher than previously reported. P. aeruginosa, E. coli, S. aureus, MRSA, and K. pneumoniae were the leading cause of SSIs. These bacteria demonstrated multiple drug resistance.Keywords: antibiotic resistance, surgical site infection, sepsis, risk-factors, Uganda</p

Prevalence and Factors Associated with Cervical Premalignant Lesions in Women 25-65 Years Attending ynaecology Clinic at Kampala International University Teaching Hospital

The prevalence of cervical premalignant lesions and factors associated with progression into cervical cancer are poorly documented in Uganda. Knowledge of those at risk is mandatory to guide clinical practice and preventive policy formulation. In this Cross-sectional descriptive and analytical study of consecutively recruited participants, we determined the prevalence and factors associated with cervical premalignant lesions amongst women aged 25-65 years attending the gynecology clinic at Kampala International University Teaching Hospital, using investigator administered survey questionnaire between February 2017 and May 2017. We cystopathologically analyzed Pap smear samples obtained from study participants for positivity and grades of cervical premalignant lesions. We then conducted bivariate and multivariate analyses using STATA 14.0, to determine factors significantly associated with positivity and different grades of cervical premalignant lesions. Ethical clearance was obtained from Mbarara University of Science and Technology Research and Ethics Committee (IRB N0. 09/10-16).Of 315, cervical premalignant lesions were prevalent in 22% (n=69) with high grade squamous intra epithelial lesions (HSIL) comprising 13%. Those with history of tobacco smoking were twice more likely to test positive for cervical premalignant lesions (aPR 2.12; 95% CI [1.03-4.39]). Females who had ever screened before for cervical premalignant lesions were 1.7 times more likely to turn out positive compared to those who had never (aPR 1.71; 95%CI [1.01- 2.91]). Participants with presumed financial ability to pay for a pap test were 65% less likely to test positive for cervical premalignant lesions as compared to those who were financially not able to pay for pap test (aPR 0.35; 95% CI [0.15-0.83]. The prevalence of cervical premalignant lesions of 22% was higher compared to that reported in earlier studies. Tobacco smoking and prior history of screening were independent factors significantly associated with positivity for cervical premalignant lesions. Government and stakeholders should incorporate cessation of tobacco smoking campaigns into cervical cancer screening programs and prioritize the poor who cannot afford the Pap test.</p

Lower Back Pain as an Occupational Hazard Among Ugandan Health Workers

Background: Lower back pain is a public health concern affecting 70–85% of the world's population. There is paucity of published data on the prevalence, disability and risk factors for lower back pain among health workers in Uganda.Objective: To determine the frequency rate (note that is it implicit that frequency is a rate like incidence so including rate seems redundant here. This is bounded by zero and infinity. In contrast, prevalence is bounded by 0 and 1 and is thus a proportion not a rate) of lower back pain and its associated risks amongst health professionals in the Arua District of Uganda.Methods: Cross-sectional descriptive study of 245 consecutive participants conducted during February-April 2020. We stratified risks as individual or work related and analyzed the data using IBM SPSS version 25. Chi-square was used to measure the significance of association between categorical variables at 95% confidence interval, regarding a p ≤ 0.05 as significant.Results: The mean age of participants was 40.87 years ± 8.74 (SD), with female predominance (69.8%). Majority were either general nurses or midwives (64.9%) and more than half had practiced for over 6–10 years. The frequency rate of lower back pain was 39.6% (n = 97). Individual factors associated with LBP were; cigarette smoking (X2 = 33.040; P ≤ 0.001), alcohol consumption (X2 = 13.581; P ≤ 0.001), age (X2 = 14.717; P = 0.002), and female gender (X2 = 4.802; P = 0.028). The work related factors significantly associated with lower back pain were: being a nurse/midwife (X2 = 9.829; P = 0.007), working in the outpatient department (X2 = 49.752; P ≤ 0.001), bending (X2 = 43.912; P ≤ 0.001), lifting (X2 = 33.279; P X2 = 40.096; P ≤ 0.001), being in awkward positions (X2 = 15.607; P= X2 = 21.999; P ≤ 0.001).Conclusion: The frequency rate of low back pain was high amongst health workers and its main associated individual and work related factors could have been prevented. Health workers should strike a balance between caring for their personal back-health and meeting clients' needs while manually handling patients. Ergonomic structuring, job organization, back health care courses and use of assistive equipment could reduce such occupational hazards in our low resourced settings.</p

Ugandan Men Exposed to Intimate Partner Violence: A Cross-Sectional Survey of Nationally Representative Data

Although women typically constitute the largest proportion of the population who experience the deleterious effects of intimate partner violence (IPV), understanding the bidirectional nature of IPV is important for developing nuanced prevention initiatives. This study examines data from the 2016 Ugandan Demographic and Health Survey. Participants were selected from households in all the 15 regions in Uganda using a two stage sampling design. A total of 2858 men who were in a heterosexual union or separated/divorced were included in the analysis. Univariate and multivariable logistic regression analyses were performed with the aim of identifying associations between selected demographic variables and male exposure to all forms of IPV combined, psychological violence, physical violence and sexual violence. The prevalence of lifetime IPV and during the 12 months preceeding the survey respectively was 43.6 and 30.5% in all forms, with 35.9 and 24.8% reporting psychological, 20.2 and 11.9% for physical and 8.2 and 5.7% sexual violence. The key factors associated with all forms of IPV were being afraid of their wife/partner most of the time (OR = 5.10, 95% CI 2.91, 8.96) controlling behaviour of the intimate partner (OR = 3.80, 95% CI 2.84, 5.07), bi-directional violence against the partner (OR = 3.20, 95% CI 2.49, 4.12), alcohol consumption by the intimate partner (OR = 1.85, 95% CI 1.40, 2.45). The factors associated with males who experience IPV appear to be modifiable and may warrant consideration for inclusion in programs supporting both males and females who experience IPV

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

BackgroundIncreasing traumatic brain injury (TBI) has paralleled the need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes of such patients is mandatory to guide treatment protocols.ObjectiveTo determine the 30-day clinical outcomes and predictor variables for patients with extra-axial hematomas at Mulago National Referral Hospital in Uganda.MethodsProspective observational cohort study of 109 patients with computed tomography (CT) confirmed extra-axial hematomas. Ethical clearance was obtained from the School of Medicine Research and Ethics Committee of College of Health Sciences, Makerere University (REC REF. 2018-185). Admitted patients were followed-up and reassessed for Glasgow Outcome Scale (GOS) and final disposition. Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p ResultsThe overall proportion of favorable outcome was 71.7% (n = 71), with 42.3% (n = 11) and 81.7% (n = 58) for ASDH and AEDH, respectively (p = 0.111). Factors associated with a favorable outcome were admission systolic BP > 90 mmHg [IRR = 0.88 (0.26–0.94) 95%CI, p = 0.032), oxygen saturation > 90% [IRR = 0.5 (0.26–0.94) 95%CI, p = 0.030] and diagnosis AEDH [IRR = 0.53 (0.30–0.92) 95%CI, p = 0.025). Moderate TBI [IRR = 4.57 (1.15–18.06) 95%CI, p = 0.03] and severe TBI [IRR = 6.79 (2.32–19.86) 95%CI, p ConclusionThe study revealed that post resuscitation GCS, systolic BP, oxygen circulation, and diagnosis of AEDH at admission are the most important determinants of outcome for patients with extra-axial intracranial hematomas. These findings are valuable for the triaging teams in resource-constrained settings.</p

Self-reported involvement in road traffic crashes in Kenya: A cross-sectional survey of a nationally representative sample

BackgroundRoad traffic crashes (RTCs) are a global public health burden whose resulting morbidity and mortality disproportionately impact low- and middle-income countries with stressed health systems. There is a paucity of published studies that evaluate the sociodemographic distribution of RTCs using nationally representative samples from the African region.AimTo examine population-wide associations between sociodemographic factors and involvement in RTCs in Kenya. Methods Data were obtained from the 2014 Kenyan Demographic Health Survey, representing all 47 counties in Kenya, from May to October of 2014. We estimated the prevalence of RTCs and utilized logistic regression for bivariate and multivariable analyses to determine the sociodemographic factors associated with RTCs. Study variables included age, place of residence, household wealth index, educational attainment, and history of alcohol consumption. We computed odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).ResultsA higher prevalence was reported among men (8.76%) versus women (3.22%). The risk factors among men included being 20-34 years of age, living in a rural area (OR 1.38, 95% CI 1.09, 1.74), drinking alcohol (OR 1.33, 95% CI 1.11, 1.59), and having not higher than a primary (OR 1.90, 95% CI 1.19, 3.03) or secondary (OR 1.68, 95% CI 1.04, 2.71) education. The strongest risk factors for women included the being aged 45-49 (OR 2.30, 95% CI 1.44, 3.67) and 20-24 years (OR 1.81, 95% 1.17, 2.79) as well as being in the fourth wealth quintile (OR 1.83, 95% CI 1.15, 2.91).ConclusionMen and the most economically productive age groups were more likely to report being involved in RTCs. Strategies to reduce the occurrences of RTCs should prioritize the most vulnerable sociodemographic groups.</p

Efficacy of extended focused assessment with sonography for trauma using a portable handheld device for detecting hemothorax in a low resource setting; a multicenter longitudinal study

Introduction: Chest trauma is one of the most important and commonest injuries that require timely diagnosis, accounting for 25-50% of trauma related deaths globally. Although CT scan is the gold standard for detection of haemothorax, it is only useful in stable patients, and remains unavailable in most hospitals in low income countries. Where available, it is very expensive. Sonography has been reported to have high accuracy and sensitivity in trauma diagnosis but is rarely used in trauma patients in low income settings in part due to lack of the sonography machines and lack of expertise among trauma care providers. Chest X-ray is the most available investigation for chest injuries in low income countries. However it is not often safe to wheel seriously injured, unstable trauma patients to X-ray rooms. This study aimed at determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting.Methods: This was an observational longitudinal study that enrolled 104 study participants with chest trauma. Informed consent was obtained from all participants. A questionnaire was administered and eFAST, chest X-ray and tube thoracotomy were done as indicated. Data were analysed using SPSS version 22. The sensitivity, specificity, predictive values, accuracy and area under the curve were determined using thoracostomy findings as the gold standard. Ethical approval for the study was obtained from the Research and Ethics Committee of Kampala International University Western Campus REC number KIU-2021-53.Results: eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy.Conclusion: This study revealed that eFAST was more sensitive at detecting haemothorax among chest trauma patients compared to chest X-ray. All patients presenting with chest trauma should have bedside eFAST for diagnosis of haemothorax.</p

Penile ring entrapment and strangulation: A case report at Kampala International University Teaching Hospital in Western Uganda

IntroductionPenile ring entrapment during self-sexual satisfaction is one of the rare cases in general and urologic surgery. When the penile shaft is entrapped in a metal ring, one risks possible complete loss of distal penis to strangulation and gangrene. We present management of a case of entrapped penile ring with penile strangulation in resource limited set up amidst absence of management guidelines. The case has been reported in line with SCARE criteria (1).Presentation of caseA 43-year-old male presented after 72 h of pilot ball bearing ring penile insertion for sustainability of an erection, with 24 -h history of painful penile swelling and acute urine retention. The patient had history of using recreational drugs and erectile dysfunction with evidence of high-grade penile injuries at presentation. The ring was cut using electrically powered angled grinder, with full penile recovery on conservative management in eight months of follow up.DiscussionEntrapped penile ring is clinically diagnosed but establishing incentive of insertion is difficult just like identifying a correct technique to remove it. Entrapped ring obstructs blood and lymphatic flow leading to oedema and ischaemia with associated penile tissue injuries. High grade penile injuries or penile amputation are sequels of delayed ring removal and good outcomes are tangible through timely multidisciplinary approach.Conclusion​​​​​​​Eroticism and erectile dysfunctions are known incentive to using penile rings to sustain erection. Delayed ring removal results in its entrapment and penile strangulation and related complications. Timely removal of ring requires multidisciplinary approach and local management protocols.</p

Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Background: Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda.Objective: We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda.Methods: We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without.Results: Most patients (92.9%) were male aged 18-30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236-9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574-65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541-19.554]; P = 0.009) were significant predictors of mortality.Conclusion: Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings

Mothers of Soldiers in Wartime: A National News Narrative

National news media represent mothers of US combat soldiers in the Iraq War as archetypal good mothers, that is, mothers who continue their maternal work even after their children are deployed. However, not all mothers are depicted as the archetypal patriotic mother, i.e., a good mother who is also stoic and silent about the war and her child\u27s role in it. Mothers of soldiers are portrayed as good mothers who sometimes also voice their attitudes about the war effort. The maternal attitudes ranged from complete support for the war to opposition to the war but support for the soldiers. The findings suggest a picture of wartime motherhood that is more nuanced than the historical image of the patriotic mother suggests