Immediate maternal complications associated with thrombocytopenia among women delivering at a tertiary hospital in Southwestern Uganda

Background: Thrombocytopenia is a serious threat both to the mother and the fetus world over. We established the prevalence and associated immediate maternal complications of thrombocytopenia among women delivering at Kampala International University Teaching Hospital (KIUTH) so as to help us draw a platform for provision of appropriate interventions.Methods: A prospective cross-sectional study involving 386 women was conducted in the months of May 2019 to August 2019. Questionnaires and laboratory result forms were used to obtain the data. Data analyses were conducted using STATA version 14.2.Results: The prevalence of thrombocytopenia was 15.8%. Significant immediate maternal outcomes were placenta abruption which was higher among women with thrombocytopenia (44.3%) than those with no thrombocytopenia (2.2%; p<0.001) and postpartum haemorrhage which was higher among those with thrombocytopenia (45.9%) than those with no thrombocytopenia (6.8%; p<0.001).Conclusions: Thrombocytopenia is a serious obstetric issue worth paying extra attention at this facility

Surgery of COVID-19-infected patients in Africa: A scoping review

Objective: The aim of this scoping review was to highlight the nature and scope of research andpublications about surgery in COVID-19-infected patients in Africa in order to inform guidelinesapplicable in Africa. Methods: We considered peerreviewed and gray literature from PubMed, Google Scholar, and Word Health Organization COVID-19 online databases published from February 1, 2020, to February 28, 2021, about surgery for/in COVID-19-infected patients. The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Results: Of 530 studies screened, only 11 (2.08%) were foundeligible, including 4 cohort studies, 3 cross-sectional studies, 2 letters to the editor, 1 case series, and 1 review. The key emphasis areas by the eligible studies were vaccination, testing prior to surgery, clinical guidelines to reduce complications related to COVID-19 among infected patients, and protection of the surgical team. Conclusion: There is a dearth of studies on surgery in COVID-19-infected patients in Africa. There is an urgent need for more reports and publications from the African experiences so as to inform contextualized guidelines for surgical care in low-resource settings during the COVID-19 pandemic

Use of face masks to limit the spread of the COVID-19 among western Ugandans: Knowledge, attitude and practices

Background The world is grappling with an ever-changing COVID-19 pandemic using preventive measures such as personal hygiene, face masks, restrictions on travel and gatherings in communities, in addition to a race to find a vaccine. The purpose of this study was to evaluate the knowledge, attitudes and practices of the western Uganda community on the proper use of face masks to mitigate the spread of COVID-19. Methods A cross-sectional study using a structured questionnaire was carried out from 1st July to 10th July 2020 among western Ugandans of the consent age of 18 years and above. Data was analysed using Stata version 14.2. Results Among the respondents (n = 1114), the mean age was 30.7 (SD 11.1), 51% were males, 53.9% married and 43% had attained secondary education. Most participants (60.1%, n = 670) had satisfactory knowledge on the use of face masks and participants at a tertiary education level [AOR 2.6 (95% CI: 1.42–4.67; p = 0.002)] were likely to have satisfactory knowledge than participants who had not education. On attitude, most respondents (69.4%) were confident enough to correctly put on a face mask; 83.4% believed that a face mask can protect against COVID-19 and 75.9% of respondents had never shared their face mask. The majority of respondents (95.2%) agreed to wearing face masks in public places was important to protect themselves against COVID-19; 60.3% reported washing their hands before wearing and after removing the face mask. Unfortunately, 51.5% reported removing the face mask if they needed to talk to someone. Conclusion Despite the satisfactory knowledge, good attitude and practices, there is still much more to be done in terms of knowledge, attitude and practices among participants. Government, non-governmental organizations and civil society should improve sensitization of populations on how to behave with face masks while talking to avoid the spread of the COVID-19 among western Ugandans

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

Misconceptions on COVID-19 Risk Among Ugandan Men: Results From a Rapid Exploratory Survey, April 2020

© Copyright © 2020 Kasozi, MacLeod, Ssempijja, Mahero, Matama, Musoke, Bardosh, Ssebuufu, Wakoko-Studstil, Echoru, Ayikobua, Mujinya, Nambuya, Onohuean, Zirintunda, Ekou and Welburn. Background: Transmission of COVID-19 in developing countries is expected to surpass that in developed countries; however, information on community perceptions of this new disease is scarce. The aim of the study was to identify possible misconceptions among males and females toward COVID-19 in Uganda using a rapid online survey distributed via social media. Methods: A cross-sectional survey carried out in early April 2020 was conducted with 161 Ugandans, who purposively participated in the online questionnaire that assessed understandings of COVID-19 risk and infection. Sixty-four percent of respondents were male and 36% were female. Results: We found significant divergences of opinion on gendered susceptibility to COVID-19. Most female respondents considered infection risk, symptoms, severe signs, and death to be equally distributed between genders. In contrast, male respondents believed they were more at risk of infection, severe symptoms, severe signs, and death (52.7 vs. 30.6%, RR = 1.79, 95% CI: 1.14–2.8). Most women did not share this perception and disagreed that males were at higher risk of infection (by a factor of three), symptoms (79% disagree), severe signs (71%, disagree), and death (70.2% disagree). Overall, most respondents considered children less vulnerable (OR = 1.12, 95% CI: 0.55–2.2) to COVID-19 than adults, that children present with less symptoms (OR = 1.57, 95% CI: 0.77–3.19), and that there would be less mortality in children (OR = 0.92, 95% CI: 0.41–1.88). Of female respondents, 76.4% considered mortality from COVID-19 to be different between the young and the elderly (RR = 1.7, 95% CI: 1.01–2.92) and 92.7% believed young adults would show fewer signs than the elderly, and 71.4% agreed that elderly COVID-19 patients would show more severe signs than the young (OR = 2.2, 95% CI: 1.4, 4.8). While respondents considered that all races were susceptible to the signs and symptoms of infection as well as death from COVID-19, they considered mortality would be highest among white people from Europe and the USA. Some respondents (mostly male 33/102, 32.4%) considered COVID-19 to be a “disease of whites” (30.2%). Conclusion: The WHO has identified women and children in rural communities as vulnerable persons who should be given more attention in the COVID-19 national response programs across Africa; however, our study has found that men in Uganda perceive themselves to be at greater risk and that these contradictory perceptions (including the association of COVID-19 with “the white” race) suggest an important discrepancy in the communication of who is most vulnerable and why. Further research is urgently needed to validate and expand the results of this small exploratory study

Anxiety, Anger and Depression Amongst Low-Income Earners in Southwestern Uganda During the COVID-19 Total Lockdown

Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda. Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three (n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents. Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression (r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger (r = 0.254, P < 0.001); anxiety and depression (r = 0.153, P = 0.015) and anger and depression (r = 0.153, P = 0.015). Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males

COVID-19-related mental health burdens: Impact of educational level and relationship status Among low-Income earners of Western Uganda

Objective: The study aimed to investigate the relationship between mental health with the level of education, relationship status, and awareness on mental health among low-income earners in Western Uganda. Methods: This was a cross-sectional descriptive study carried out among 253 participants. Anxiety, anger, and depression were assessed using a modified generalized anxiety disorder (GAD-7), Spielberger\u27s State-Trait Anger Expression Inventory-2, and Beck Depression Inventory item tools, respectively. Results: The majority of our respondents were male (n = 150/253, 59.3), had a secondary level of education (104/253, 41.1), and were single (137/253, 54.2). No formal education and primary education (r2 = 47.4% and 6.4%, respectively) had a negative correlation with awareness of mental health care. In addition, no formal education had a positive correlation with anger and depression (r2 = 1.9% and 0.3%, respectively). Singleness in this study had a negative correlation with awareness of mental health care, anger, and depression (r2 = 1.9, 0.8, and 0.3%, respectively), and a positive correlation with anxiety (r2 = 3.9%). Conclusion: It is evident that education and relationship status influenced awareness on mental health care and mental health state among low-income earners in Western Uganda during the first COVID-19 lockdown. Therefore, policymakers should strengthen social transformation through the proper engagement of low-income earners in this COVID-19 era

Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern Uganda

Background. Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in developing countries, but its attributes are not completely assessed in various hospital settings. The aim of this study was to determine the proportion of mortality, the comorbidities, and factors associated with in-hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital, Eastern Uganda. Methods. This was a hospital-based analytical and descriptive prospective cohort study conducted in the nutritional unit of Jinja Regional Referral Hospital. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Descriptive statistics were used to each of the independent factors, and comorbidities were subjected to chi-squared test followed by logistic regression analysis to assess its association incidence of mortality among children. All independent variables with p values ≤ 0.05 were entered into a multivariate model for factors and comorbidities independently. Factors and comorbidities with p values ≤ 0.05 were considered as associates of mortality among children. Results. Of the 338 children under 5 years of age enrolled, 49 (14.5%) died, although the majority of children were diagnosed with dehydration, 128 (37.9%); pneumonia, 127(37.6%); and malaria, 87(25.7%). Anemia (aRR=2.9, 95% CI: 1.23-6.62, p=0.01), bacteremia (aRR=10.0, 95% CI: 3.62-29.01, p=0.01), HIV (aRR=4.8, 95% CI: 1.42-16.30, p<0.01), TB (aRR=4.3, 95% CI: 1.28-14.49, p<0.02), and shock (aRR=60.9, 95% CI: 9.05-410.28, p<0.01) were the comorbidities significantly associated with a likelihood of mortality. Conclusions. The mortality among children under 5 years of age admitted with severe acute malnutrition is still high (14.5% versus 5%). The comorbidities are significantly associated with mortality. The clinicians are recommended to follow-up closely patients with severe acute malnutrition and to focus on the critical comorbidities identified

Pain assessment following open hemorrhoidectomy under local anesthesia versus saddle block: a multicenter randomized controlled trial

Abstract Background There is disparity in evidence on pain assessment post open hemorrhoidectomy (OH) using local anesthesia and its use in developing countries compared to developed countries. Therefore, we conducted this study to assess the occurrence of postoperative pain following open hemorrhoidectomy under local anesthesia versus saddle block for uncomplicated 3rd or 4th degree hemorrhoids. Methods This was a prospective equivalence randomized, double blind controlled trial conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. Pain severity was assessed at 2, 4 and 6 h post open hemorrhoidectomy using visual analogue scale (VAS). Data was analysed using SPSS version 26 at a p < 0.05 as statically significant using visual analogue scale (VAS). Results We recruited 58 participants in this study who underwent open hemorrhoidectomy under local anesthesia or saddle block (29 participants per group). The sex ratio was of 1.15 of female to male and a mean age of 39 ± 13. VAS was found to be different at 2 h post OH compare to other time of pain assessment but not statically significant by area under the cover (AUC) (95% CI = 486–0.773: AUC = 0.63; p = 0.09) with a none significance by Kruskal–Wallis’s test (p:0.925). Conclusion Local anesthesia was found to be having a similar pain severity occurrence in post operative period among patients undergoing open hemorrhoidectomy for primary uncomplicated 3rd or 4th degree hemorrhoids. Close monitoring of pain in postoperative period is mandatory especially at 2 h to assess need of analgesia. Trial registration Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 8th October, 2021

Use of face masks to limit the spread of the COVID-19 among western Ugandans: Knowledge, attitude and practices.

BackgroundThe world is grappling with an ever-changing COVID-19 pandemic using preventive measures such as personal hygiene, face masks, restrictions on travel and gatherings in communities, in addition to a race to find a vaccine. The purpose of this study was to evaluate the knowledge, attitudes and practices of the western Uganda community on the proper use of face masks to mitigate the spread of COVID-19.MethodsA cross-sectional study using a structured questionnaire was carried out from 1st July to 10th July 2020 among western Ugandans of consent age of 18 years and above. Data was analysed using Stata version 14.2.ResultsAmong the respondents (n = 1114), the mean age was 30.7 (SD 11.1), 51% were males, 53.9% married and 43% had attained secondary education. Most participants (60.1%, n = 670) had satisfactory knowledge on the use of face masks and participants at a tertiary education level [AOR 2.6 (95% CI: 1.42-4.67; p = 0.002)] were likely to have satisfactory knowledge than participants who had not education. On attitude, most respondents (69.4%) were confident enough to correctly put on a face mask; 83.4% believed that a face mask can protect against COVID-19 and 75.9% of respondents had never shared their face mask. The majority of respondents (95.2%) agreed wearing face masks in public places was important to protect themselves against COVID-19; 60.3% reported washing their hands before wearing and after removing the face mask. Unfortunately, 51.5% reported removing the face mask if they needed to talk to someone.ConclusionDespite the satisfactory knowledge, good attitude and practices, there is still much more to be done in terms of knowledge, attitude and practices among participants. Government, non-governmental organizations and civil society should improve sensitization of populations on how to behave with face masks while talking to avoid the spread of the COVID-19 among western Ugandans