DIAGNOSTIC ACCURACY OF SHOCK INDEX AS SCREENING TOOL FOR PRIMARY POSTPARTUM HAEMORRHAGE AFTER CAESAREAN SECTION AMONG WOMEN AT KAWEMPE NATIONAL REFERRAL HOSPITAL -A CROSS-SECTIONAL STUDY.

Background:  Postpartum haemorrhage is the leading cause of maternal mortality globally and in sub-Saharan Africa. The shock index( ratio of the pulse to systolic pressure) is a quicker and more objective assessment tool for assessing the risk of deterioration as may occur in PPH, before apparent clinical deterioration. The diagnostic accuracy of the shock index in a Ugandan setting is not known. The objective of the study was to determine the sensitivity and specificity, positive and negative predictive values of shock index in the diagnosis of primary postpartum haemorrhage after caesarean section among women delivering at Kawempe National Referral Hospital. Methods:   A cross-sectional study design was used. The study was conducted in Kawempe National Referral Hospital among women who were delivered by a caesarean section between 1st January and 31st May 2021. A sample size of 594 was determined using formulae by Buderer. A consecutive sampling technique was used. The research assistants approached 650 participants; while 591 participants were fit for analysis. All participants were subjected to the determination of shock index at different intervals and the change in haematocrit as the gold standard for post-partum haemorrhage.   Results:  The sensitivity and specificity of the shock index at 2 hours were 40.0 and 82.8 percent respectively at a threshold of 0.8. The sensitivity and specificity were 70.0 and 54.6 percent after 24 hours when the shock index threshold of 0.7 was used. The PPV and NPV were 3.8 and 98.3 percent at 2 hours respectively while 2.6 and 99.1 percent at 24 hours. Conclusion:  The shock index is a poor screening tool for diagnosing primary postpartum haemorrhage after caesarean section. Recommendations : Shock index may not be included in routine care of post-operative mothers for early recognition of those at risk of primary postpartum haemorrhage

Widespread exposure to Crimean-Congo haemorrhagic fever in Uganda might be driven by transmission from Rhipicephalus ticks: evidence from cross-sectional and modelling studies

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral infection, present across Africa and Eurasia, which might pose a cryptic public health problem in Uganda. We aimed to understand the magnitude and distribution of CCHF risk in humans, livestock and ticks across Uganda by synthesising epidemiological (cross-sectional) and ecological (modelling) studies. METHODS: We conducted a cross-sectional study at three urban abattoirs receiving cattle from across Uganda. We sampled humans (n=478), livestock (n=419) and ticks (n=1065) and used commercially-available kits to detect human and livestock CCHF virus (CCHFV) antibodies and antigen in tick pools. We developed boosted regression tree models to evaluate the correlates and geographical distribution of expected tick and wildlife hosts, and of human CCHF exposures, drawing on continent-wide data. FINDINGS: The cross-sectional study found CCHFV IgG/IgM seroprevalence in humans of 10·3% (7·8-13·3), with antibody detection positively associated with reported history of tick bite (age-adjusted odds ratio=2·09 (1·09-3·98)). Cattle had a seroprevalence of 69·7% (65·1-73·4). Only one Hyalomma tick (CCHFV-negative) was found. However, CCHFV antigen was detected in Rhipicephalus (5·9% of 304 pools) and Amblyomma (2·9% of 34 pools) species. Modelling predicted high human CCHF risk across much of Uganda, low environmental suitability for Hyalomma, and high suitability for Rhipicephalus and Amblyomma. INTERPRETATION: Our epidemiological and ecological studies provide complementary evidence that CCHF exposure risk is widespread across Uganda. We challenge the idea that Hyalomma ticks are consistently the principal reservoir and vector for CCHFV, and postulate that Rhipicephalus might be important for CCHFV transmission in Uganda, due to high frequency of infected ticks and predicted environmental suitability. FUNDING: UCL Global Challenges Research Fund (GCRF) and Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP) under the EU Horizon 2020 Framework Programme for Research and Innovation

Clinical and Molecular Epidemiology of Crimean-Congo Hemorrhagic Fever in Humans in Uganda, 2013-2019

Crimean-Congo Hemorrhagic Fever (CCHF) is endemic in Uganda, yet its epidemiology remains largely uncharacterized. To better understand its occurrence within Uganda, case reports of patients hospitalized with CCHF between 2013 and 2019 were reviewed. Further, genome sequences of CCHF-positive RNA obtained during this period were determined for phylogenetic comparisons. We found that a total of 32 cases (75% males; CFR, 31.2%), aged between 9 to 68 years, were reported during the study period. Most cases were detected during July to December of each outbreak year (81.2%; P < 0.01) and were located along the "cattle corridor" (68.7%, P = 0.03). The most common presenting symptoms were fever (93.8%), hemorrhage (81.3%), headache (78.1 %), fatigue (68.8%), vomiting (68.8%), and myalgia (65.6%). In five patients for whom hematological data were available, varied abnormalities were observed including thrombocytopenia, leukopenia, anemia, lymphopenia, lymphocytosis, polycythemia, and microcytosis. About 56.3% (P = 0.47) of patients reported tick bites or exposure to livestock as their potential source of infection. Person-to-person transmission was suspected for two cases. Using unbiased metagenomics, we found that the viral S- and L- segments have remained conserved in Africa 2 Glade since the 1950s. In contrast, the M segment split into two geographically interspersed Glades; one that belongs to Africa 2 and another that is ancestral to Africa 1 and 2. Overall, this data summarizes information on the history and clinical presentation of human CCHF in Uganda. Importantly, it identifies vulnerable populations as well as temporal and geographic regions in Uganda where surveillance and control interventions could be focused