Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study.

BACKGROUND: We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. METHODS: Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. RESULTS: We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39-8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85-10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68-10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13-4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7-13 days (aHR = 0.31, 95% CI: 0.11-0.93) and being married (aHR = 0.22 (95% CI: 0.06-0.84) had protective effects for 30 and 90-day mortality respectively. CONCLUSION: Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country

Knowledge, attitudes and practices of Shisha smoking among youths in Kampala, Uganda

Background Globally tobacco use kills nearly 6 million people annually; a figure expected to increase to 8 million deaths every year by 2030. Though perceived to be safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking. Yet, this practice has gained popularity especially among youths in Kampala. The extent to which this form of tobacco consumption is practiced by the youths, their attitudes and knowledge regarding the health risks in Uganda is unknown. This study therefore aimed to establish knowledge, attitudes, practices and factors associated with shisha smoking among youths. Methods A cross-sectional study was conducted among 530 systematically selected youths aged between 18-30 years found in bars in the two divisions of Kampala between April and May 2014. Youths who are incapacitated were excluded. Three outcome variables; knowledge, attitudes and practice were assessed. Data was collected using a semi structured interviewer administered questionnaire. Descriptive statistics of key variables were generated at univariate analysis. Multivariable logistic regression analysis with Odds Ratios and corresponding 95% Confidence Intervals were used to measure associations. STATA version 12.0 was used for analysis. Results Of 530 participants, 86.4% had low knowledge, 69.2% had negative attitudes and 36.4% smoked Shisha. 75.7% smoked flavored and sweetened tobacco, 37.6% smoked on weekly basis, 92.8% smoked in the company of friends, 91.2% shared shisha pipes and 93.8% smoked in bars. A further 62.7% smoked shisha with cigarettes. Factors associated with shisha smoking included; smoking cigarettes (Adjusted Odds Ratio (AOR): 6.33, 95% CI: 4.13-9.58); positive attitude (AOR: 4.13, 95% CI: 2.65-6.44); Age (25-30 years) (AOR: 1.72, 95% CI: 1.13-2.62) and no knowledge (AOR: 0.50, 95% CI: 0.29-0.88). Conclusions Shisha smoking among youths attending bars is high with three in every ten youths smoking shisha. Targeted social mobilization would increase awareness regarding adverse health effects of shisha smoking

Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala, Uganda

This was a qualitative study that was conducted with male and female PWPDs in Kampala in 2007. Data on the challenges experienced by PWPDs in accessing SRH services were collected using in-depth interviews with 40 PWPDs and key informant interviews with 10 PWPDs’ representatives, staff of agencies supporting PWPDs and health workers.Introduction: Despite the universal right to access the same range, quality and standard of free or affordable health care and programs as provided to other persons, people with physical disabilities (PWPDs) continue to experience challenges in accessing these services. This article presents the challenges faced by PWPDs in accessing sexual and reproductive health (SRH) services in Kampala, Uganda. Methods: This was a qualitative study that was conducted with male and female PWPDs in Kampala in 2007. Data on the challenges experienced by PWPDs in accessing SRH services were collected using in-depth interviews with 40 PWPDs and key informant interviews with 10 PWPDs’ representatives, staff of agencies supporting PWPDs and health workers. All data were captured verbatim using an audio-tape recorder, entered into a Microsoft Word computer program and analyzed manually following a content thematic approach. Results: The study findings show that PWPDs face a multitude of challenges in accessing SRH services including negative attitudes of service providers, long queues at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and the perception from able-bodied people that PWPDs should be asexual. Conclusion: People with physical disabilities (PWPDs) face health facility-related (service provider and facility-related challenges), economic and societal challenges in accessing SRH services. These findings call for a need to sensitize service providers on SRH needs of PWPDs for better support and for the government to enforce the provision of PWPD-friendly services in all health facilities

Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda

Introduction:&nbsp;globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. Methods:&nbsp;a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. Results:&nbsp;we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). Conclusion:&nbsp;the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law

Additional file 1: of Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda

Afya Bora fellowship skills log book. Fellows completed the skills logbook to indicate all the skills acquired from both the didactic modules and the attachment site period