Clinical Presentation and Bacteriology of Diabetic Foot Ulcers at Mulago Hospital: A Prospective Case Series Study.

Background: Diabetic foot ulcer is a common cause of mortality among patients admitted to Mulago hospital. Peripheral neuropathy and peripheral arterial disease are the major risk factors for diabetic foot ulceration and the severity of these two conditions may determine treatment options and ulcer outcomes. General objective: The study assessed the clinical presentation of foot ulcers in diabetic patients and identified the common bacterial isolates from diabetic foot ulcers and their susceptibility patterns. Methods: This was a prospective study involving 60 consecutive patients with diabetic foot ulcers admitted to the endocrinology unit at Mulago hospital between July and December 2010. Patients were recruited after the provision of written informed consent. Deep tissue swabs from the ulcers were then taken at debridement for both aerobic and anaerobic cultures and susceptibility tests using standard microbiological methods. Results: Of the 60 patients, 57% had neuroischemic foot ulcers, 18% had neuropathic ulcers, 18% had ischemic ulcers and 7% had unclassified ulcers. 98.3% of the samples grew 93 aerobic bacteria and no anaerobe was isolated. Polymicrobial infection occurred in 41% of samples of which 10% had mixed growth. 80.6% of the isolates were Gram-negative aerobes, mainly E.coli  Klebsiella, Pseudomonas, and Proteus while eighteen (19.4%) were Gram-positive, mainly Staphylococcus aureus and Enterococcus faecalis. The prevalence of MuMultidrug-resistant organisms (MDRO) was 84% and Methicillin-resistant staphylococcus aureus (MRSA) was 60% while Extended-spectrum beta-lactamases (ESBL) was 43.5%. Conclusion: Diabetic foot ulcers were mostly neuroischemic with moderate neuropathy severity. Infection was mostly due to aerobic Gram-negative organisms with a high prevalence of MDRO, ESBL, and MRSA. Most isolates were susceptible to vancomycin, imipenem, and ciprofloxacin. Recommendation: Deep tissue culture and sensitivity tests should be done to make appropriate antibiotic choices for diabetic patients with foot ulcers

Diabetes and Pre-Diabetes among Persons Aged 35 to 60 Years in Eastern Uganda : Prevalence and Associated Factors

Background: Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and prediabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa. Methods: A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call (R) Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG >= 6.1 mmol L-1 (World Health Organization (WHO) criteria or >= 5.6mmol L-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L-1, or being on diabetes treatment. Results: The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95% CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95% CI 7.3-10.2) using WHO criteria and 20.2% (95% CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95% CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95% CI 0.4-0.9; APRR 0.6, 95% CI 0.4-0.8; APRR 0.5, 95% CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs. Conclusions: There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary

COVID-19 vaccine acceptance among high-risk populations in Uganda

Background: Immunization is an important strategy for controlling the COVID-19 pandemic. COVID-19 vaccination was recently launched in Uganda, with prioritization to healthcare workers and high-risk individuals. In this study, we aimed to determine the acceptability of COVID-19 vaccine among persons at high risk of COVID-19 morbidity and mortality in Uganda. Methods: Between 29 March and 14 April 2021, we conducted a cross-sectional survey consecutively recruiting persons at high risk of severe COVID-19 (diabetes mellitus, HIV and cardiovascular disease) attending Kiruddu National Referral Hospital outpatient clinics. A trained research nurse administered a semi-structured questionnaire assessing demographics, COVID-19 vaccine related attitudes and acceptability. Descriptive statistics, bivariate and multivariable analyses were performed using STATA 16. Results: A total of 317 participants with a mean age 51.5 ± 14.1 years were recruited. Of this, 184 (60.5%) were female. Overall, 216 (70.1%) participants were willing to accept the COVID-19 vaccine. The odds of willingness to accept COVID-19 vaccination were four times greater if a participant was male compared with if a participant was female [adjusted odds ratio (AOR): 4.1, 95% confidence interval (CI): 1.8–9.4, p  = 0.00]. Participants who agreed (AOR: 0.04, 95% CI: 0.01–0.38, p  = 0.003) or strongly agreed (AOR: 0.04, 95% CI: 0.01–0.59, p  = 0.005) that they have some immunity against COVID-19 were also significantly less likely to accept the vaccine. Participants who had a history of vaccination hesitancy for their children were also significantly less likely to accept the COVID-19 vaccine (AOR: 0.1, 95% CI: 0.01–0.58, p  = 0.016). Conclusion: The willingness to receive a COVID-19 vaccine in this group of high-risk individuals was comparable to the global COVID-19 vaccine acceptance rate. Increased sensitization, myth busting and utilization of opinion leaders to encourage vaccine acceptability is recommended

Prevalence of abnormal glucose regulation by age category.

<p>Prevalence of abnormal glucose regulation by age category.</p

Speaking in Foreign Language Learning in Primary School

Background: Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and prediabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa. Methods: A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call (R) Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG &gt;= 6.1 mmol L-1 (World Health Organization (WHO) criteria or &gt;= 5.6mmol L-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG &gt;6.9mmol L-1, or being on diabetes treatment. Results: The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95% CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95% CI 7.3-10.2) using WHO criteria and 20.2% (95% CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95% CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95% CI 0.4-0.9; APRR 0.6, 95% CI 0.4-0.8; APRR 0.5, 95% CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs. Conclusions: There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary