Post-operative nausea and vomiting at Mulago Hospital

Background: Postoperative nausea and vomiting (PONV) are among the most common adverse events related to surgery and anaesthesia and despite modern anaesthetic and surgical techniques the incidence of PONV remains at 20-30%. The aim of this study was to determine the prevalence and factors associated with postoperative nausea and vomiting.Methods: This was a prospective study. Precoded data were analyzed and for categorical variables data were summarized as proportions and presented using tables, histograms and pie charts. Continuous variables were analyzed by separating means using independent samples T-test. In the univariate analysis, Odds ratio together with 95% confidence interval was calculated to test for the association between the possible risk factors and outcome variables. Multivariate analysis was done using logistic regression model to determine prognostic factors of postoperative nausea and vomiting.Results: One hundred eighty two patients aged 10 years and above met the inclusion criteria. They had fasted 6 hours prior to the operation and undergone both general anaesthesia and surgery. Patients who had medical and surgical conditions that led to nausea and vomiting were excluded. 53% of the patients were males and 43% were females. The prevalence of PONV was 40.7% within 24 hours after surgery. Factors that were statistically significantly (p value < 0.05) associated with PONV following univariate analysis included : age group 20 to 30 years, female gender, history of PONV, intra-operative use of Pethidine, type of operation (orthopaedic surgery) and postoperative use of Pethidine. Independent predictors of PONV include; age group of 20 to 30 years, history of PONV, and the type of operation.Conclusion: Predictors of PONV within 24 hours include age group of 20 to 30 years, history of PONV and the orthopaedic surgery

Early Outcome of Delayed Management of Supracondylar Humeral Fractures in Children in Rwanda

Background: Supracondylar fractures of humerus are the most common in children especially in the first decade of life. They demand proper  management to keep functional and cosmetic of the elbow. The incidence of Lagrange &Rigault stage IV fractures is low among the supracondylarfractures of humerus. Different modalities of treatment have been proposed and used for this type of fractures. Among different techniques, the open reduction and fixation with K-wire pinning method was used for this study. The aim of this study was to evaluate the early outcome of open reduction and internal fixation with K-wires pinning of Lagrange &Rigault stage IV supracondylar fractures in children in Rwanda.Results: Fifty three cases were recruited and 46 of them have completed the follow up for that analyzed. The male sex and the left limb were more frequent in this study. The early functional outcome was studied using the flexion and extension measuring the range of motion and the anatomical outcome was studied measuring the Bauman’s angles. The combination of both range of motion and Bauman’s angles gave the Flynn criteria which was conclusive: Excellent 34.8%, Good 39.1%, Fair 10 (21.7%) and Poor 4.3%. But following the Flynn criteria these results were grouped into two categories such as satisfactory with 95.7% and unsatisfactory with 4.3%. There was no influence of delay on the outcome in this study (P-value: 0. 270) while the persistence of edema on discharge day was however strongly associated with poor outcome measures (p=0.01).Conclusion: The results from this study showed that open reduction and internal fixation with Kwires cross pinning is still effective method to treat Lagrange &Rigault stage IV supracondylar humerus fractures in children especially in delayed management and in the setting where there isnot intensifier imaging. There are different causes of delay of surgery at each level of health care delivery in Rwanda, but the delayed management did not increase the rate of complications following open reduction and internal fixation in Lagrange &Rigault Stage IV supracondylar humerus fractures in children.Key words: Outcome, Delayed Management, Supracondylar, Humeral, Fractur

Prevalence, Indications, Levels and Outcome Limb amputations at University Teaching Hospital-Butare in Rwanda

Background: Amputation is one of the oldest surgical procedures with artificial limbs identified from over 2000 years ago. Amputation is still often viewed as a failure of treatment but can be the treatment of choice and life saving procedure for severe trauma, vascular disease and tumors. The aim of this study was to determine the prevalence, indications and levels of limb amputation at the University Teaching Hospital Butare (UTH-B) from 1st January 2009 to 31st March, 2012.Methods: The records of 107 limb amputations performed in patients admitted at UTH-B over a period of 2 years and 3 months were reviewed.Results: Out of 3466 operated cases in Surgery Department, there were 107 limb amputations accounting for 3.08% of all operations performed during the study period. Females accounted for 29.9% cases. The mean age was 44.7±21.5 years. The commonest indication was gangrene in43.95% especially dry gangrene with 22.43%.The most common level was below knew amputation (BKA) with 37.38% of cases. The outcome of the 107 patients amputated: 87.9% had uneventful recovery, 7.5% were re-operated and 4.7% died.Conclusion: The prevalence of limb amputation was 3.08% with the commonest indication as gangrenes most often secondary to peripheral vascular disease. Below knee amputation was the most performed  procedure. The majority (87.9%) of the patients had uneventful recovery. The postoperative mortality rate was 4.7%.Key words: Limb, Amputation, Prevalence, Indications, Levels, outcom

Scaling up a surgical residency program in Rwanda

Background: Beginning in 2012, the Government of Rwanda implemented the Human Resources for Health (HRH) program to enhance capacity building in the Rwandan health education sector. Through this program, surgical training at University of Rwanda (UR) has expanded. The aim of this presentation is to describe the scaling up of the UR surgical residency programMethods: We performed a descriptive analysis of the UR surgical residency program after initiation of the Rwanda HRH Program.Results: Through the HRH Program, faculty from US institutions supplements the existing Rwandan educational infrastructure to increase the teaching capacity in Rwanda. Intake of surgical trainees more than doubled within the first year of the program. Service-based surgical training has changed to competency-based training through curriculum development, dedicated academic days and surgical education within firms. Lectures remain a dominant feature of the educational program, but more focus is placed on bedside teaching and peer-education. Shortage of operative space and a tremendous number of emergency patients overwhelm public teaching hospitals posing a challenge towards providing residents with a broad spectrum of operative experiences, especially elective surgical cases.Conclusion: Through this program, the ursurgical residency program has greatly expanded. Over time, the quantity and quality of surgical residents is expected to increase

Gastric Outlet Obstruction among Adult Patient at Two Rwandan Referral Hospitals: Etiology. H. pylori Infection and Outcomes

No Abstract

Colorectal cancer in patients from Uganda: A histopathological study

No Abstract. Keywords: Colorectal cancer, HNPCC, Endoscopy, Uganda, Histopathology, Lynch syndrome

Gender-based violence and its determinants during the COVID-19 lockdown in a low-income country: a cross-sectional survey

Background:Coronavirus disease 2019 (COVID-19) is a recent global pandemic associated with multidimensional health-related effects. In the fight against the spread of this novel pandemic, the majority have been living under restrictive conditions during its related lockdown that has created a conducive environment for gender-based violence (GBV). Our study aimed to ascertain the burden and determinants of GBV during the COVID-19 pandemic-related lockdown and curfew (CPLC) in Uganda.Methods:We conducted a quantitative descriptive cross-sectional study in Bushenyi-Ishaka municipality, southwestern Uganda in May, 2020. This study involved 339 adult participants regardless of their gender or ethnicity. Only 12 potential respondents declined to participate in this survey.Results:The prevalence of GBV during the CPLC was 42 per cent. The majority (57%) of victims were women. More than half (54%) of the victims and survivors of GBV attributed the violence to the lockdown. The determinants of GBV included being married, using substances of abuse and having financial problems.Conclusion:The prevalence of GBV skyrocketed during the CPLC in Uganda when compared to the period prior to the pandemic. Women were significantly more affected in all aspects of GBV. Therefore, we recommend developing targeted behavioural change communication strategies based upon our findings.NWO481.20.1.3

Pattern and clinical management of penile cancer in Rwanda

Introduction: Penile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease.Objective: This study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. Patients and methods: From January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected.Results: Over 18 consecutive months, 30 male patients were enrolled. The mean age was 60 years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV- positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital.Conclusion: Penile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease

Post-operative Nausea and Vomiting at Mulago Hospital

Background : Postoperative nausea and vomiting (PONV) are among the most common adverse events related to surgery and anaesthesia and despite modern anaesthetic and surgical techniques the incidence of PONV remains at 20-30%. The aim of this study was to determine the prevalence and factors associated with postoperative nausea and vomiting. Methods : This was a prospective study. Precoded data were analyzed and for categorical variables data were summarized as proportions and presented using tables, histograms and pie charts. Continuous variables were analyzed by separating means using independent samples T-test. In the univariate analysis, Odds ratio together with 95% confidence interval was calculated to test for the association between the possible risk factors and outcome variables. Multivariate analysis was done using logistic regression model to determine prognostic factors of postoperative nausea and vomiting. Results : One hundred eighty two patients aged 10 years and above met the inclusion criteria. They had fasted 6 hours prior to the operation and undergone both general anaesthesia and surgery. Patients who had medical and surgical conditions that led to nausea and vomiting were excluded. 53% of the patients were males and 43% were females. The prevalence of PONV was 40.7% within 24 hours after surgery. Factors that were statistically significantly (p value < 0.05) associated with PONV following univariate analysis included : age group 20 to 30 years, female gender, history of PONV, intra-operative use of Pethidine, type of operation (orthopaedic surgery) and postoperative use of Pethidine. Independent predictors of PONV include; age group of 20 to 30 years, history of PONV, and the type of operation. Conclusion : Predictors of PONV within 24 hours include age group of 20 to 30 years, history of PONV and the orthopaedic surgery