Factors affecting the organization and management of emergency mass casualty events public health institutions: Lazio Region ARES experience

Background: Mass Casualty Events also referred to as Disasters, are those occurrences causing damage, ecological disruption, loss of human life or destruction of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.Methods: The study was carried out in Rome between 2008/2009 while based at Sapienza University Departmento Esperimentale at Policlinico emergency hospital. Data was collected by interviews from key professional informants in the organization and management of disasters in Lazio region referred to as Azienda Regionale di Emergenza Sanitaria (ARES) using interview guides, questionnaires and focused group discussions. Additional data on identified sites and installations was collected by the observational survey method (transect  visits/walks) around Rome installations that the authority considers prone to disasters including tourist parks and public parks, hotels, stadia, train stations and Vaticans. Observations were analyzed qualitatively. This study was approved through the institutional review board of Rome University through the Departimento Medicina Esperimentale and Departmento d’Emergenza Accetazzione (DEA). Results: Disaster Management was found to be prioritized always and effectively represented for ready intervention by prepared pre- organized multi- agency teams at every site visited. These on- scene project squads comprised a representation from the armed forces, police, fire department, medical and ambulance service all under a unified command of leadership with a specified job description. Factors identified were: Political will, human resource planning, appropriate communication utilization, time management and sufficient preparedness for disasters in Region Lazio.Conclusion: Disaster Management is a necessity since liability to disasters is open to all to humanity around the world. Factors affecting disaster management enable an efficient fore casting and prompt response to avoid worsening that chaotic situation upon disaster intervention in any affected community.Keywords: Disasters, Calamity, Catastrophes, Mass emergency Casualty events, Organizatio

Iodine Excess is a Risk Factor for Goiter Formation

Background: Goiters have been associated with iodine deficiency. Although universal salt iodization in Uganda achieved a household coverage of 95%by 2005, goiter rates are still high. This study investigated the association between iodine excess and goiter.Methods: In a case control study, urinary iodine levels, complete blood count, T3, T4 and TSH levels were determined.Results: We recruited, 60 goiter and 63 non goiter patients. The median urine iodine level for goiter patients was significantly higher than in non-goiter controls. Urinary iodine excretion was sufficient in 43%, more than sufficient in 31% and excess in 10% of cases. There was an association between excess urinary iodine levels and goiter.Conclusion: Urinary iodine excess was significantly associated with occurrence of goiter.Key Words: Iodine excess, Goiter, Sub Saharan Afric

Surgical Audit of Vesico-Vaginal Fistulae Repairs by on the Job Trained Medical Officers in a Rural Hospital, Kagando, Western Uganda.

Background: For each maternal death in Africa there are fifteen mothers who suffer from some form of birth related injury, where the most devastating form is the vesicovaginal fistulae (VVF).Teachings in most training centres recommend that repair of these fistulae should be done by consultants. This study aimed at evaluating the outcome of VVF repairs done by on the job trained rural based medical officers in a rural setting.Methods: This was a retrospective cohort study using data obtained from a review of patient hospital records for the period 2000-2005. Details of patient management including the patient’s state of continence on discharge were noted. A successful operation was defined as the patientgoing home continent.Results: The majority of the repairs done by medical officers were successful (52/70, 74%). Medical officers had more success with the repair of small defects (RR 1.69 CI 1.11-2.58). The repairs done by medical officers in the presence of consultants were more likely to succeed (RR 3.19 CI 1.90-5.53).Conclusion: Medical officers in rural African hospital settings can be trained to successfully repairsmall vesicovaginal fistulae

Use of HIV-Related Services and Modern Contraception among Women of Reproductive Age, Rakai Uganda

Voluntary counseling and testing (VCT) and HIV care (HIVC) can be an opportunity for reproductive health messages and services integration. The objective of this study is to assess the association between uptakeof HIV-related services and use of modern contraception among reproductive-age women. Data are derived from community cohort data, where HIV+ respondents were referred to the Rakai Health Sciences program’s HIVC clinic. Use of modern contraceptive and VCT receipt were by self-report. Multinomial logistic regression was used to estimate relative risk ratios (RRR) of contraception use by HIVC and VCT. Receipt of VCT was significantly associated with higher use of condoms for FP, adj.RRR 1.78 (1.07, 2.95), and other modern contraceptives, adj.RRR=1.56(1.15, 2.11). Increasing level of HIVC was associated with decreasing level of unmet need for contraception. Use of condoms for family planning is common among HIV-relatedservices attendees. Utilization of other modern contraceptive methods needs to be increased (Afr J Reprod Health 2010; 14[4]: 91-101)

Surgical need among the ageing population of Uganda

Background: Uganda’s ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgi- cally-treatable conditions is unknown. Objectives: To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. Methods: A cluster randomized sample representing the national population of Uganda was enumerated. The previously vali- dated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any sur- gically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation.   Results: The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1-34.3). This extrapolates to 694,722 (95%CI, 552,279-857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes.Conclusion: There is disproportionately high need for surgical care among the ageing population of Uganda with approximate- ly 700,000 consultations needed.Keywords: Surgical need, ageing population, Uganda

Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions

Background: Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce. Objective: In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda. Methods: In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda). Findings: Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated. Conclusions: Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor

Surgical need among the ageing population of Uganda

Background: Uganda\u2019s ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgically-treatable conditions is unknown. Objectives: To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. Methods: A cluster randomized sample representing the national population of Uganda was enumerated. The previously validated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any surgically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation. Results: The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1-34.3). This extrapolates to 694,722 (95%CI, 552,279-857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes. Conclusion: There is disproportionately high need for surgical care among the ageing population of Uganda with approximately 700,000 consultations needed. DOI: https://dx.doi.org/10.4314/ahs.v19i1.54 Cite as: Tran TM, Fuller AT, Butler EK, Muhumuza C, Ssennono VF, Vissoci JR, et al. Surgical need among the ageing population of Uganda. Afri Health Sci. 2019;19(1). 1778-1788. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

<p>Abstract</p> <p>Background</p> <p>Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.</p> <p>Methods</p> <p>This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.</p> <p>Results</p> <p>Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.</p> <p>Conclusions</p> <p>Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.</p