Surgical Mortality at a Mission Hospital in Western Uganda

Background: Audit of Surgical mortality seeks to focus on improvement in the process of surgical care and not on individual surgical ability. Audit of surgical mortality was conducted to establish the factors associated with the surgical deaths in Virika Hospital to propose ways of improvement.Methods: The study was conducted in Virika Mission Hospital in Western Uganda, a 155 bed capacity hospital with a surgical bed capacity of 32 located in rural Uganda.Individual case file review of the fourty three surgical deaths from 1st July 2008 to 31st June 2009 was conducted. Additional data was retrieved from hospital admission register, operation registers, and death certificate books.Results: The operation death rate was 1.3%, all were emergencies, and 82.6% were done under general anaesthesia and17.4% died on table. The laparotomy death rate was 12.5%, Herniorrhaphy 0.9%, drainage of pus 1.4% and wound suture 0.4%. Surgery was delayed due to lack of blood in only one case but there was no record of lack of any resource for delaying surgery. Surgical conditions were: Injuries 39.5%, Intestinal perforations 30.2%, Intestinal obstruction 20.9% and others 9.3%. The hospital had no high dependency unit and no intensive care unit. No postmortem was conducted in all cases.Conclusion: Overall the Audit identified client, provider, administrative and community-related factors that need to be addressed collectively to reduce surgical mortality in Virika hospital.Audit of surgical mortality should be part of the health workers’ general approach to making more information available in a meaningful way for continuous improvement of surgical services

Aerobic Bacterial Causes of Secondary Peritonitis and Their Antibiotic Sensitivity Patterns among HIV Negative Patients with Non-traumatic Small Bowel Perforations in Mbarara Regional Referral Hospital

Back ground: Intra-abdominal infections are commonly encountered in surgical practice and represent a major cause of morbidity and mortality. The most common aetiology is contamination of the peritoneal space by endogenous micro-flora among patients with gastro intestinal perforations. Inappropriate antibiotic therapy of secondary peritonitis may result in poor patient outcomes. The selection of an appropriate empirical antibiotic agent can be challenging amidst limited laboratory infrastructure and the emerging resistance to commonly prescribed antibiotics. This study was aimed at determining the aerobic bacterial causes of secondary peritonitis and their antibiotic sensitivity patterns among HIV negative patients with non-traumatic small bowel perforations in Mbarara Regional Referral Hospital so as to guide initial empirical treatment.Methods: This was a cross-sectional study in which 87 consenting patients with non-traumatic small bowel perforation confirmed at laparotomy, on the emergency ward of Mbarara Regional Referral Hospital were enrolled consecutively from September 2011 to May 2012. HIV testing and peritoneal fluid analysis was done for all patients enrolled into the study.Results: Majority of patients had either Klebsiella spp (37.9%) or Escherichia coli (26.4%) on peritoneal fluid culture, while 12 (13.8%) had no growth at all. Four patients (4.6%) had more than one organism cultured. Most of the organisms were susceptible to Ceftriaxone followed by Ciprofloxacin and Gentamycin. Peritoneal fluid gram stain showed gram negative bacilli in 79.3% of the cases while peritoneal fluid ZN stain did not demonstrate any AAFBs. All patients tested HIV negative.Conclusions: The results indicated that secondary peritonitis among HIV negative patients with non-traumatic small bowel perforation at MRRH was mainly due to Klebsiella spp and E. coli which were mainly sensitive to cephalosporins, quinolones and aminoglycosides.Key words: Aerobic, Bacteria, Secondary, Peritonitis. Antibiotic. Sensitivity, HIV negative, Bowel,Perforatio

Ileosigmoid Knotting in Pregnancy: A case Report Seen in Uganda

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Factors associated with redundant sigmoid colon at Mulago Hospital, Kampala

Background: Sigmoid Volvulus is the most common form of Volvulus of the gastrointestinal tract and in Uganda; this condition is one of the top causes of intestinal obstruction. It is associated with a pre-existing redundant sigmoid colon which has a narrow attachment of the sigmoid mesentery to the posterior abdominal wall. The objectives of this study was to establish the demographic, dietary and socio-economic factors associated with redundant sigmoid.Methods: A case-control study comparing demographic, dietary and socio economic factors between 68 patients diagnosed with redundant sigmoid colon, and 136 controls in Mulago Hospital from May to December 2006 was undertaken.Results: The majority (64.7%) of the patients with redundant sigmoid colon were aged between 30 and 70 years with a male to female ratio of 5:1. Statistically significant association was observed between redundant sigmoid colon and consumption of cereals, fruits and fats (OR 1.5-2.9, P=O.OO) and irregular bowel habits (OR = 4.9, P = 0.00). The majority (57.4%) of cases of cases were peasants. There was no statistically significant association between sex and redundant sigmoid colon (P = 0.45; 95% C.I = 0.6 – 2.8). Neither was there a statistically significant association between the level of education and redundant sigmoid colon (P = 0.07; 95% C.I = 0.6 – 0.9)Conclusions: Redundant sigmoid colon was common among the young and middle age groups and predominantly occurred in males. There was an association between redundant sigmoid colon and consumption of cereals, fruits and fats. People with irregular bowel habits were about five times more likely to have redundant sigmoid colon than those who had regular bowel habits. Majority of patients with redundant sigmoid colon were of low socioeconomic status

Aetiology and Treatment Outcome of Non-traumatic Small Bowel Perforations at Mbarara Hospital in South-Western Uganda

Background: Non-traumatic small bowel perforation (SBP) is the most common form of gastrointestinal perforation in sub-Saharan Africa. Although SBP is a surgical emergency associated with complications, information regarding its aetiology is scanty in Uganda. This study was aimed at determining the aetiology and document treatment outcomes of non-traumatic small bowel perforations in South-western Uganda. Methods: This was a descriptive case series of 87 consenting patients with non-traumatic SBP confirmed at laparotomy, on the emergency ward of Mbarara University Teaching Hospital. They were enrolled from September 2011 to May 2012. Specimens for blood culture, stool microscopy, HIV testing and tissue biopsies at the site of perforation were collected and analyzed. Patient follow-up was done till discharge. Results: Of the 78 biopsies performed, 66(84.6%) had histological features suggestive of typhoid perforations while 12(15.4%) had features of non-specific inflammation. Salmonella typhi was isolated in 13(15.0%) out of the 87 patients. Isolates were susceptible to Ceftriaxone and Ciprofloxacin. All patients tested HIV negative. Ascaris lumbricoides were seen in two patients. Re-laparotomy was done in four patients with new perforations, two with anastomotic breakdown and two with intra-abdominal abscesses. Wound sepsis was observed in 25(28.7%). Average length of hospital stay was 13 days. Some 10(11.5%) patients died. Conclusions: Most cases of non-traumatic SBP in south western Uganda are associated with Salmonella infection. There is need to enhance laboratory capacity to detect typhoid and preventive measures should be instituted in the general population

Anatomical variations of the sternal angle and anomalies of adult human sterna from the Galloway osteological collection at Makerere University Anatomy Department

Background: Anatomical variations of the sternal angle and anomalies of the sternum are unique happenings of major clinical significance. It is known that misplaced sternal angles may lead to inaccurate counting of ribs and create challenges with intercostal nerve blocks and needle thoracostomies. Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. These sternal variations and anomalies are rarely reported among Africans. The aim of this study was to determine the anatomical variations of the sternal angle and anomalies of the sternum among adult dry human sterna at the Galloway osteological collection, Makerere University, Uganda. Materials and methods: This was a descriptive cross sectional study in which quantitative and qualitative data were collected. The study examined 85 adult human sterna at the Department of Anatomy, Makerere University. Univariate and bivariate analyses were done using SPSS 21.0 for Windows. Results: Over 40% (36/85) of the specimens had variations in size, location and fusion of the sternal angle. There was no significant difference in the mean size of the sternal angle in males at 163.4 ± 6.7o compared with 165.0 ± 6.4o in females (p = 0.481). Of the 85 specimens examined, only 21 (24.7%) had a xiphoid process. The most frequent sternal anomalies were bifid xiphoid process 42.9% (9/21) and sternal foramen 12.9% (11/85). Conclusions: Sternal variations and anomalies are prevalent in the Galloway osteological collection and there is need for increased awareness of these findings as they may determine the accuracy of clinical and other procedures in the thoracic region.  

The Potential of Citizen-Driven Monitoring of Freshwater Snails in Schistosomiasis Research

Schistosomiasis is a tropical parasitic disease affecting more than 200 million people worldwide, predominantly in Africa. The World Health Organization recently highlighted the importance of targeted control of the freshwater snails acting as intermediate hosts for the parasites causing schistosomiasis. However, because of a shortage of trained experts and resources, detailed information on spatiotemporal snail distributions, which is needed for targeted control measures, is often missing. We explore the potential of citizen science to build these much-needed datasets through fine-grained, frequent snail sampling. We trained a network of 25 citizen scientists to weekly report on snail host abundances in 77 predefined water contact sites in and around Lake Albert (western Uganda). Snail abundance, together with marked GPS locations, water chemistry parameters, and photographs of the identified snails are recorded and submitted using the freely available mobile phone application KoBoToolbox. Trained researchers then engage in remote, semi-automatic validation of the submissions, after which there is an opportunity to provide targeted feedback to the citizen scientists. Five months after the operationalisation of the network, a total of 570 reports were submitted and personalized feedback was given, resulting in lasting improvements in subsequent reporting and snail genus identification. The preliminary results show the possibility of citizen science to independently obtain reliable data on the presence of schistosome snail hosts. We therefore argue that citizen-driven monitoring on a high spatiotemporal resolution could help to generate the much-needed data to support local targeted snail control measures in remote and/or resource-limited environments

Mandatory anatomy dissection, effect on examination performance

Regular class attendance is evidence of professionalism. This has led to mandatory class attendance in many disciplines including anatomy. However, there is paucity of data on the effect of mandatory class attendance on student performance in resource-limited settings. The objective of this study was to determine the effect of mandatory attendance of anatomy dissections on student’s practical exams. This was an audit of undergraduate first year health professional students performance on the practical summative Steeplechase exam for the anatomy of limbs in two consecutive academic years at Makerere University. The second lot of first year students in the study had all their scheduled anatomy dissection sessions roll called to confirm their attendance that was the intervention arm in the study. The data was analysed with STATA statistical computing software version 13. Some of the tests run on this data included independent samples t test and Regression analysis. The overall performance of students in the academic year varied with roll call and was significantly lower than that in the previous academic year without roll call (mean difference -8.04 95% CI -10.76 to -5.31). Significant reductions in performance were also observed with type of student sponsorship (P<0.01) and the program they were pursuing (P<0.01). Roll calling had the largest effect on student performance demonstrated by the 0.23 standard deviation reduction in performance of students. This study shows that mandatory attendance of anatomy dissections leads to a reduction in the student’s performance on practical anatomy examinationsKeywords: Anatomy dissection, class attendance, examination performanc

UPGro Hidden Crisis Research Consortium. Survey 1 Country Report, Uganda

Statistics on the functionality of water points from the Hidden Crisis project in Uganda are presented. The survey, undertaken in 2016, was focussed on boreholes equipped with handpumps (HPBs) within the 112 districts of Uganda. A stratified two stage random sampling approach was adopted and 10 districts identified to sample. A tiered definition of functionality was applied, and all which enabled more nuanced definitions to be reported: The results from the survey indicate: • 55% of HPBs were working on the day of the survey (compared to national figure of 86% for rural water supply ) • 34% of HPBs passed the design yield of 10 litres per minute • 23% passed the design yield and also experienced < 1 month downtime within a year. • 18% passed the design yield and reliability criteria and also water quality criteria The results of the survey indicate the utility of carrying out more detailed assessments of functionality to help unpack national statistics. A linked survey of the performance of the water management arrangements at water points showed that for 70% of the sites water management arrangements were judged to be weak