Predictors of In-Hospital Mortality Among Under-Five Children with Severe Acute Malnutrition in South-Western Uganda

Background Severe acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM. Methods This was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0. Results We enrolled 122 children, median age of 15 months [IQR:11–24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14–24.08, p = 0.001). Conclusion The in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines

Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda

Ainamani HE, Rukundo GZ, Nduhukire T, Ndyareba E, Hecker T. Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda. Child and Adolescent Psychiatry and Mental Health. 2021;15(1): 22.**Background** Child maltreatment poses high risks to the mental health and cognitive functioning of children not only in childhood but also in later life. However, it remains unclear whether child maltreatment is directly associated with impaired cognitive functioning or whether this link is mediated by mental health problems. Our study aimed at examining this research question among children and adolescents in Uganda. **Methods** A sample of 232 school-going children and adolescents with a mean age of 14.03 (SD = 3.25) was assessed on multiple forms of maltreatment using the Maltreatment and Abuse Chronology Exposure—Pediatric Version (pediMACE). Executive functions were assessed by the Tower of London task and working memory by the Corsi Block Tapping task, while mental health problems were assessed using theChild PTSD Symptom Scale for PTSD and the Center for Epidemiological Studies Depression Scalefor Children (CES-DC). **Results** In total, 232 (100%) of the participant reported to have experienced at least one type of maltreatment in their lifetime including emotional, physical, and sexual violence as well as neglect. We found a negative association between child maltreatment and executive functions (β = − 0.487,p p = 0.001). Mental health problems did not mediate this relationship. **Conclusions** Child maltreatment seems to be related to lower working memory and executive functioning of affected children and adolescents even after controlling for potential cofounders. Our study indicates that child maltreatment the affects children’s cognitive functionality beyond health and well-being

Providing education and tools increases nurses’ and midwives’ assessment for puerperal sepsis in a regional referral hospital in South Western Uganda

Background: Puerperal sepsis causes at least 75,000 maternal deaths every year, mostly in low-income countries. Early identification of sepsis and initiation of sepsis care bundles are crucial the survival of patients. Education about the surviving sepsis campaign guidelines is critical for nurses to understand the indicators for sepsis that inform accurate screening and initiation of life-saving interventions. We sought to establish the effect of an education intervention and implementation of screening tools on maternal sepsis screening in a Regional Referral hospital in South Western Uganda. Methods: A pretest–posttest quasi-experimental study design was employed to determine the change in the level of knowledge regarding sepsis among a purposively selected sample of 16 midwives and 2 intern nurses. Translation of knowledge to practice was determined by pre-intervention retrospective chart review and post-intervention evaluation of the maternal sepsis screening.The statistically significant change in knowledge and practice following the educational intervention was determined by Paired t-tests and Chi-square tests using SPSS version 16. Results: There was an improvement in knowledge scores post the educational intervention from a mean score of 5.78 to 7.13. There was a statistically significant difference in the documentation of vital signs observed between the retrospective chart review and the screening done after the education intervention. Conclusion: This study demonstrated that the provision of education and sepsis screening tools created an incremental improvement in puerperal sepsis screening which is an important step toward reducing maternal mortality