Faculty of Medicine

Permanent URI for this community

http://localhost:4000/handle/20.500.14270/5

Browse

Now showing 1 - 20 of 129

Structural validity and reliability of the integrated conflict and violence scale
(Taylor & Francis, 2009-09-07) Mutto, Milton; Lawoko, Stephen; Bangdiwala, Shrikant
The study validated structure stability, reliability and sub-scale distinctiveness of integrated conflict and violence scale (ICVS) and was cross-sectional; war-affected grade 5 school children participated. ICV internal factorial validity and reliability were evaluated; eigenvalue size and scree plots were used for factor selection. A variable retention factor load threshold of 40.30 was used: Cronbach’s a tests confirmed reliability increments. Pair-wise Pearson correlation tests evaluated sub-scale distinctiveness. Gulu University granted ethical clearance. A total of 280 grade 5 children from 50 primary schools participated: 53% of them were males. Two factors accounted for 100% of variability in attitudes; 18 variables were retained. Expelled variables were: ‘If I catch some one stealing my sugar cane I will fight’ and ‘a bully should be forgiven’. Sub-scale internal consistency reliability coefficients were 0.73 and 0.65, respectively and distinctiveness correlation coefficient was 70.06. The ICVS was validated using standard criteria. Emerging two-factor scale has acceptable psychometric properties especially factorial structure, internal consistency and sub-scale distinctiveness.
New Biologically Active Compounds from 1, 3-Diketones
(Research Journal of Chemical Sciences, 2011-06-07) George, Mulongo; Jolocam, Mbabazi; Odongkara, B.; Twinomuhwezi, H; Mpango, G.B.
The ready availability of cyclohexanones and the enhanced reactivity at their α-positions render them starting materials of choice in the present study. The synthesis of new compounds of antimicrobial activity was undertaken by the coupling of aromatic amines with 5,5-dimethyl cyclohexan-1,3-dione (dimedone). The products were refluxed with N–benzyl-N-phenylhydrazine in acetic acid. The structures of the products were elucidated using micro- and IR-spectral analyses. They were confirmed using 1H NMR at 60MHz and TMS as internal standard. The diketone derivatives were tested for their biological activity against gram-positive Cocci and Bacilli, and gram-negative Bacilli. The study showed that the derivatives gave a wide range of activity from inactive to highly active, which proves it to be of fresh pharmaceutical interest. Key words: Dimedone, Antimicrobial activity, Gram-positive Cocci and Bacilli, Gram-negative Bacilli
Domestic violence in Gulu, Northern Uganda.
(COSECSA/ASEA, 2012-04) Kitara, D.L.; Odongkara, B.M.; Anywar, D.A.; Atim, P.; Amone, C.; Komakech, D.
Background: When guns fell silent in the post conflict northern Uganda, another form of physical injuries has come in place, Domestic Violence also commonly referred to as Gender based violence. This injury from violence leading to physical trauma is one of the leading public health problems in this region. We describe the occurrence and reasons for admission due to domestic violence to surgical ward of Gulu Hospital. Methods: A prospective observational study was conducted in Gulu Hospital over a period of two years (January 2008 to December 2009) using a prepared proforma designed to capture physical injuries admitted. Only patients that met the inclusion criteria for domestic injuries were registered. Informed consent and ethical approval was obtained from the committee of the Hospital. Results: Of 1880 patients registered with trauma, 454 were due to domestic violence (24.1%) and was the commonest form of physical trauma and mainly occurred in December and June and were lowest in February and March. Its frequency of occurrence was followed by boda boda injuries (21.4%). The majority of victims were females (73.6%) with a female to male ratio of 2.84:1.0 Conclusion: Domestic violence was commonest cause of trauma in Gulu Hospital. More females were affected than males. December and June had the highest incidence. It is a public health problem in the region which drains hospital resources.
Risk factors for road traffic accidents in Gulu Municipality , Uganda .
(East African Medical Journal, 2012-10) Pebalo, F. P.; Kwikiriza, N. M.; Kiyita, C.; Mahaba, T.; Muwanga, E.; Tinka, A. A.; Robert, H. T.; Tuhairwe, E.; Odongo-Aginya, E. I.
Background: Currently Road Traffic Accidents (RTA) are ranked tenth among the leading causes of death and ninth among all leading causes of disability worldwide. There has been no published study on RTA in Gulu municipality. There is a high frequency of RTA in Gulu municipality with poor road design and inadequate knowledge on road safety precaution among road users. Objectives: To establish the causes of Road Traffic Accidents (RTA), establish the safety measures in place to protect road users to avoid RTA and establish people mostly involved and the mechanism of RTA. Design: A cross-sectional study Settings: Four divisions of Gulu Municipality; Layibi, Laroo, Pece and Bardege. Subjects: Two hundred and forty-two participants including pedestrians, drivers of different categories of vehicles, motorcyclists and bicyclists locally known as bodaboda and the police were interviewed. Results: Most respondents reported RTA as a problem in Gulu municipality (96%),causing death (48%), financial constraint due to medical treatment (41%) and disability(11%). The following causes of RTA were identified; reckless driving and riding (49%), poor road design (24%), drug abuse (15%) and over loading (12%). According to police records of January to September 2009 RTA involved pedestrians (36.34%), passengers (25.80%), motorcyclists (24.88%), pedal cyclists (11.52%) and drivers (3.68%). Conclusion: RTAs is a substantial burden in Gulu municipality in Northern Uganda with reckless driving or riding, poor road design, overloading, double parking, inadequate road safety signs and knowledge, were major risk factors. Efforts to reduce RTA in Gulu municipality should aim at addressing these problems.
Nodding syndrome in Ugandan children—clinical features, brain imaging and complications: a case series
(BMJ Open, 2013-04-08) Idro, Richard; Opoka, Robert Opika; Aanyu, Hellen T; Piloya-Were, Theresa; Namusoke, Hanifa; Musoke, Sarah Bonita; Nalugya, Joyce; Bangirana, Paul; Mwaka, Amos Deogratius; White, Steven; Chong, Kling; Atai-Omoruto, Anne D; Mworozi, Edison; Nankunda, Jolly; Kiguli, Sarah; Aceng, Jane Ruth; Tumwine, James K; Kakooza-Mwesige, Angelina
Objectives: Nodding syndrome is a devastating neurological disorder of uncertain aetiology affecting children in Africa. There is no diagnostic test, and risk factors and symptoms that would allow early diagnosis are poorly documented. This study aimed to describe the clinical, electrophysiological and brain imaging(MRI) features and complications of nodding syndrome in Ugandan children. Design: Case series. Participants: 22 children with nodding syndrome brought to Mulago National Referral Hospital for assessment. Outcome measures: Clinical features, physical and functional disabilities, EEG and brain MRI findings and a staging system with a progressive development of symptoms and complications. Results: The median age of symptom onset was 6 (range 4–10) years and median duration of symptoms was 8.5 (range 2–11) years. 16 of 22 families reported multiple affected children. Physical manifestations and complications included stunting, wasting, lip changes and gross physical deformities. The bone age was delayed by 2 (range 1–6) years. There was peripheral muscle wasting and progressive generalised wasting. Four children had nodding as the only seizure type;18 in addition had myoclonic, absence and/or generalised tonic–clonic seizures developing 1–3 years after the onset of illness. Psychiatric manifestations included wandering, aggression, depression and disordered perception. Cognitive assessment in three children demonstrated profound impairment. The EEG was abnormal in all, suggesting symptomatic generalised epilepsy in the majority. There were different degrees of cortical and cerebellar atrophy on brain MRI, but no hippocampal changes. Five stages with worsening physical, EEG and brain imaging features were identified: a prodrome, the development of head nodding and cognitive decline, other seizure types, multiple complications and severe disability. Conclusions: Nodding syndrome is a neurological disorder that may be characterised as probably symptomatic generalised epilepsy. Clinical manifestations and complications develop in stages
High Anion Gap Metabolic Acidosis among Children with Nodding Syndrome (NS) in Northern Uganda: Case Series
(British Journal of Medicine & Medical Research, 2013-11-25) Kitara, David Lagoro; Mwaka, Amos Deogratious; Kigonya, Edward
Aims: To conduct a hormonal and biochemical studies on 10 patients with diagnosis of probable Nodding Syndrome (NS). Study Design: A cross-sectional study Place and Duration of Study: Atanga Health Center III in Pader District in Northern Uganda in September 2012. Methodology: We recruited consecutively 10 children with probable Nodding Syndrome who had been admitted for symptomatic management of seizures, injuries resulting from falls and nutritional rehabilitation. History, physical examinations, biophysical measurements (anthropometry) and blood investigations including serum electrolytes, liver function tests, thyroid hormones and vitamin D assays. Ethical approval was obtained from Gulu University Institutional Review Committee. Results: All children had severely low serum calcium and bicarbonate levels and a high Anion Gap. Thyroid hormones and vitamin D assays were largely normal. Conclusion: Children with Nodding Syndrome undergoing treatment for seizure control and nutritional rehabilitation have high Anion Gap metabolic acidosis.
Age at menarche in relation to nutritional status and critical life events among rural and urban secondary school girls in post-conflict Northern Uganda
(BMC Women's Health, 2014-05-09) Odongkara Mpora, Beatrice; Piloya, Thereza; Awor, Sylvia; Ngwiri, Thomas; Laigong, Paul; Mworozi, Edison A; Hochberg, Ze’ev
Background: Menarche age is an important indicator of reproductive health of a woman or a community. In industrial societies, age at menarche has been declining over the last 150 years with a secular trend, and similar trends have been reported in some developing countries. Menarche age is affected by genetic and environmental cues, including nutrition. The study was designed to determine the age at menarche and its relation to childhood critical life events and nutritional status in post-conflict northern Uganda. Methods: This was a comparative cross-sectional study of rural and urban secondary school girls in northern Uganda. Structured questionnaires were administered to 274 secondary school girls, aged 12– 18 years to determine the age at menarche in relation to home location, nutritional status, body composition and critical life events. Results: The mean age at menarche was 13.6±1.3 for rural and 13.3±1.4 years for urban dwelling girls (t= −1.996, p=0.047). Among the body composition measures, hip circumference was negatively correlated with the age at menarche (r =−0.109, p=0.036), whereas height, BMI and waist circumference did not correlate with menarche. Paternal (but not maternal) education was associated with earlier menarche (F = 2.959, p = 0.033). Childhood critical life events were not associated with age at menarche. Conclusions: Age at menarche differed among urban and rural dwelling school girls and dependent on current nutritional status, as manifested by the hip circumference. It was not associated with extreme stressful childhood critical life events. Keywords: Menarche age, Nutritional status, Body composition, Stress, Uganda
Physical growth, puberty and hormones in adolescents with Nodding Syndrome; a pilot study
(Bio Med Central, 2014-11-28) Piloya-Were, Theresa; Odongkara-Mpora, Beatrice; Namusoke, Hanifa; Idro, Richard
Background: Nodding syndrome is an epidemic symptomatic generalized epilepsy syndrome of unknown cause in Eastern Africa. Some patients have extreme short stature. We hypothesized that growth failure in nodding syndrome is associated with specific endocrine dysfunctions. In this pilot study, we examined the relationship between serum hormone levels and stature, bone age and sexual development. Results: We recruited ten consecutive children, 13 years or older, with World Health Organization defined nodding syndrome and assessed physical growth, bone age, development of secondary sexual characteristics and serum hormone levels. Two children with incomplete results were excluded. Of the eight remaining, two had severe stunting (height for age Z [HAZ] score <-3) and three had moderate stunting (HAZ score between-3 and-2). The bone age was delayed by a median 3(range 0-4) years. Serum growth hormone levels were normal in all eight but the two patients with severe stunting and one with moderate stunting had low levels of Somatomedin C (Insulin like Growth Factor [IGF1]) and/or IGF binding protein 3 (IGFBP3), mediators of growth hormone function. A linear relationship was observed between serum IGF1 level and HAZ score. With the exception of one child, all were either pre-pubertal or in early puberty (Tanner stages 1 and 2) and in the seven, levels of the gonadotrophins (luteinising and follicle stimulating hormone) and the sex hormones (testosterone/oestrogen) were all within pre-pubertal ranges or ranges of early puberty. Thyroid function, prolactin, adrenal, and parathyroid hormone levels were all normal. Conclusions: Patients with nodding syndrome may have dysfunctions in the pituitary growth hormone and pituitary gonadal axes that manifest as stunted growth, delayed bone age and puberty. Studies are required to determine if such endocrine dysfunction is a primary manifestation of the disease or a secondary consequence of chronic ill health and malnutrition and if so, whether targeted interventions can improve outcome. Keywords: Nodding syndrome, Epilepsy, Growth, Puberty, Hormones
Pertussis Prevalence and Its Determinants among Children with Persistent Cough in Urban Uganda
(PLOS ONE, 2015-04-15) Kayina, Vincent; Kyobe, Samuel; Katabazi, Fred A; Kigozi, Edgar; Okee, Moses; Odongkara, Beatrice; Babikako, Harriet M.; Whalen, Christopher C.; Joloba, Moses L.; Musoke, Philippa M.; Mupere, Ezekiel
Background We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. Methods In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting 14 days were enrolled and evaluated for pertussis using DNA polymerase chain re action (PCR) and ELISA serology tests. Results Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12–18)) and 81 (20% (95%CI: 16–24)) by PCRandELISA,respectively among449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination cover age of 94%inthis agegroup. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316(70%)didnot. Among133children that hadacoughinghouse hold member, sexof child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24 41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having acaretaker with >40 years of age were the factors associated with pertus sis. Age <23months wasthree times more likely to be associated with pertussis compared to age 24–59months(OR2.97(95%CI:1.07–8.28)). Conclusion Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.
Perceptions, attitude and use of family planning services in post conflict Gulu district, northern Uganda
(Bio Med Central, 2015-08-11) Orach, Christopher Garimoi; Otim, George; Aporomon, Juliet Faith; Amone, Richard; Okello, Stephen Acellam; Odongkara, Beatrice; Komakech, Henry
Background: Northern Uganda was severely affected by two decades of civil war that led to the displacement and encampment of an estimated 1.6 million inhabitants. The objective of this study was to assess community perspectives, attitude and factors that influence use of family planning (FP) services in post conflict Gulu district. Methods: We conducted a cross sectional study using multistage sampling technique. All three counties in the district were purposely selected. Two sub-counties per county and four parishes per sub-county were randomly selected. A total of 24 parishes (clusters) and 21 adult heads of households per cluster were randomly selected and interviewed. In total, 500 adults 117 males (23.4 %) and 383 females (76.6 %) were interviewed. We conducted 8 focus group discussions and 6 key informant interviews with family planning managers and service providers. Quantitative data were entered in EPI data and analyzed using STATA version 12. Qualitative data were analyzed manually using thematic content analysis. Results: Contraceptive prevalence rate was 47.5 %. Communities perceive FP as acceptable, beneficial and geographically, temporally and financially accessible. Factors associated with FP use included age 26–35 years (AOR 1.92, 95 % CI 1.18-3.10, p =0.008), and 36–45 years (AOR 2.27, 95 % CI 1.21-4.25, p=0.010), rural residence (AOR =0.41, 95 % CI 0.24-0.71, p =0.001), cohabitation (AOR= 2.77, 95 % CI 1.15-6.65, p =0.023), and being a farmer (AOR 0.59, 95 % CI 0.35-0.97, p=0.037). The main reason for non-use of family planning was fear of side effects 88.2 %. The main source of FP services was government health facilities 94.2 %. Conclusion: Use of family planning is relatively high and communities view FP services as acceptable, beneficial and accessible. Family planning use is mainly determined by age, residence, occupation and marital status. Fear of side effects is the main impediment to FP use. There is need to increase awareness and effectively manage side effects of family planning in the settings. Keywords: Family planning services, Accessibility, Attitudes, Perceptions, Utilization, Post conflict, Northern Uganda
Primary Uterine Perforation with Tcu 380a Intrauterine Device: A Case Report of 32 Years Old Lady in Gulu Hospital
(JOURNAL OF CASE REPORTS, 2015-09-20) Pebolo, Francis Pebalo; Ocaya, Anthony
Introduction: Intrauterine device (IUD) is one of the most frequent methods of modern contraception due to its cost effectiveness and low complication rate. Uterine perforation is among the most serious complication associated with IUD insertion. The incidence of perforation is between 1.3 and 1.6 per 1000 insertion. Objective: To describe a case of primary uterine perforation by TCu 380A intra-uterine device. Method: We report a case of primary uterine perforation in a 32-year-old para 4 lady. She had TCu 380A intrauterine device inserted for contraception. She had sharp lower abdominal pain during the insertion and presented one month post-insertion with persistent lower abdominal pain and pain and increased frequency of passingurine. Result: Ultrasound scan showed an empty endometrial cavity but IUD was noted in right adnexal region. An elective exploratory laparatomy showed IUD embedded into the myometrium just visibly seen in the vesico-uterine peritoneal reflection. Conclusion: Uterine perforation by IUD is a rare but potentially dangerous complication of IUD insertion. Health workers should have high index of suspicion for possible uterine perforation and vesicle involvement if a patient presents with history of persistent lower abdominalpain and urinary symptoms
Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis
(Journal of Fungi, 2017-05-29) Bongomin, Felix; Harris, Chris; Foden, Philip; Kosmidis, Chris; Denning, David W.
We evaluated the expression of biomarkers of innate and adaptive immune response in correlation with underlying conditions in 144 patients with chronic pulmonary aspergillosis (CPA). Patients with complete medical and radiological records, white cell counts, and a complete panel of CD3, CD4, CD8, CD19, and CD56 lymphocyte subsets were included. Eighty-four (58%) patients had lymphopenia. Six (4%) patients had lymphopenia in all five CD variables. There were 62 (43%) patients with low CD56 and 62 (43%) patients with low CD19. Ten (7%) patients had isolated CD19 lymphopenia, 18 (13%) had isolated CD56 lymphopenia, and 15 (10%) had combined CD19 and CD56 lymphopenia only. Forty-eight (33%) patients had low CD3 and 46 (32%) had low CD8 counts. Twenty-five (17%) patients had low CD4, 15 (10%) of whom had absolute CD4 counts <200/μL. Multivariable logistic regression showed associations between: low CD19 and pulmonary sarcoidosis (Odds Ratio (OR), 5.53; 95% Confidence Interval (CI), 1.43–21.33; p = 0.013), and emphysema (OR, 4.58; 95% CI; 1.36–15.38; p = 0.014), low CD56 and no bronchiectasis (OR, 0.27; 95% CI, 0.10–0.77; p = 0.014), low CD3 and both multicavitary CPA disease (OR, 2.95; 95% CI, 1.30–6.72; p = 0.010) and pulmonary sarcoidosis (OR, 4.94; 95% CI, 1.39–17.57; p = 0.014). Several subtle immune defects are found in CPA.
Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda
(Taylor & Francis, 2017-12-15) Mukunya, David; Tumwine, James K; Nankabirwa, Victoria; Ndeezi, Grace; Odongo, Isaac; Tumuhamye, Josephine; Tongun, Justin Bruno; Kizito, Samuel; Napyo, Agnes; Achora, Vincentina; Odongkara, Beatrice; Tylleskar, Thorkild
Background: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding. Methods: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software (https://opendatakit.org). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. Results: Almost half [48.2%, 95% confidence interval (CI) (44.3–52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breast feeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73–33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41–2.88)], home delivery [AOR 1.43 95% CI (1.04–1.97)] and mother being responsible for initiating breastfeed ing as compared to a health worker or relative [AOR 1.73 95% CI (1.33–2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30–0.96)] to delay initiation of breastfeeding as compared to those with no education. Conclusion: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.
Prevalence and Factors Associated with Contraceptive Use among HIV-Infected Women of Reproductive Age Attending Infectious Disease Clinic at Gulu Regional Referral Hospital, Northern Uganda
(BioMed Research International, 2018-06-10) Bongomin, Felix; Chelangat, Mercy; Eriatu, Anthony; Onen, Bruno Chan; Cheputyo, Priscilla; Godmercy, Stephen A.; Ekuk, Eddymond; Idony, Francis; Obol, James Henry
Background. Reproductive planning by HIV-infected women is essential, as it helps to prevent transmission of HIV to their unborn babies. Integrating contraceptive services to routine HIV care signifcantly increases the use of modern contraceptive methods, thus reducing vertical transmission of HIV. Objectives. To determine the prevalence and factors associated with contraceptive use among HIV-infected women attending Infectious Disease Clinic (IDC) at Gulu Regional Referral Hospital (GRRH) in Northern Uganda. Methodology. A hospital-based cross-sectional study was performed. We used simple random sampling to recruit HIV-infected women receiving routine care from IDC, GRRH, into our study. Sample size was estimated using modifed Kish-Leslie formula and semistructured questionnaire was used for data collection. Data was entered into EpiData version 3.1 and analysed using Stata v11.0. We used logistic regression model to assess the associations and any factor with p≤0.05 was considered statistically signifcant. Results. Te prevalence of contraceptive use was found to be 36% (95% CI 31 – 40%). Factors which promoted contraceptive use were as follows: being married (aOR=2.68, 95% CI 1.54-4.65, p<0.001) and monthly income of $35 -250 (aOR= 2.38, 95% CI: 1.39- 4.09, p=0.002). Factors that hindered contraceptive use were having no child (nulliparity) (aOR= 0.16; 95% CI: 0.05-0.49; p=0.002) and age range of 31-49 years (aOR= 0.53; 95% CI: 0.33 - 0.84; p=0.007). Conclusion. In this study, just over a third of sexually active HIV-infected women reported use of modern contraceptives. Tis is a low level of usage and, therefore, clinicians and stakeholders should sensitise HIV-infected women on the importance of contraceptive use in the fight against HIV/AIDS and encourage them to use contraceptives to avoid vertical transmission of HIV through unintended pregnancy.
Use of a modified bubble continuous positive airway pressure (bCPAP) device for children in respiratory distress in low- and middle-income countries: a safety study
(Taylor & Francis, 2018-06-18) Bjorklund, Ashley R.; Odongkara Mpora, Beatrice; Steiner, Marie E.; Fischer, Gwenyth; Davey, Cynthia S.; Slusher, Tina M.
Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low- and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP set-ups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate–severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (P < 0.0001) improvement in their TAL score, respiratory rate and O2 sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials. Abbreviations: ACU, acute care unit; bCPAP, bubble continuous positive airway pressure; BUBBLES, bCPAP used beyond babies in low economic settings; cmH2 O, cm of water; CPAP, continuous positive airway pressure; LMIC, low- and middle-income countries; OR, odds ratio; O2 sat, oxygen saturation; RR, respiratory rate; SD, standard deviation; SEAL-bCPAP, simplified ear plug adapted low-cost bCPAP; TAL score, modified TAL clinical score
Isavuconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A retrospective comparison of rates of adverse events
(Mycoses, 2018-12-13) Bongomin, Felix; Maguire, Niamh; Moore, Caroline B.; Felton, Timothy; Rautemaa-Richardson, Riina
Background: Long-term oral triazole antifungal therapy is the cornerstone of man agement for patients with chronic pulmonary aspergillosis (CPA). Itraconazole is the first-line choice of treatment. Voriconazole, posaconazole or isavuconazole can be used as alternative treatments in case of resistance or intolerance. All of these can cause significant adverse drug reactions. Objectives: To evaluate how CPA patients tolerate voriconazole and isavuconazole after prior triazole therapy. Methods: We performed a retrospective observational study at the UK National Aspergillosis Centre. Medical records for all consecutive CPA patients started on isa vuconazole and voriconazole during an observation period of 12 and 6 months re spectively were analysed. Results: During this study period, 20 patients were started on isavuconazole and 21 patients on voriconazole. Adverse events were seen in 18 of 21 (86%) the patients in the voriconazole group and 12 of 20 (60%) in the isavuconazole group (P = 0.02). For those who developed adverse events to these agents, the rates of discontinuation of therapy were comparable (ie 10/18 [56%], voriconazole vs 8/12 [67%], isavucona zole; P = 0.54). Five (25%) patients in the isavuconazole group who were intolerant to other triazoles tolerated the standard dose of isavuconazole. Conclusions: Compared with isavuconazole, adverse events were significantly higher in CPA patients commenced on voriconazole. Isavuconazole may be an option for those patients who are intolerant to other triazoles.
A low-cost intervention to promote immediate skin-to-skin contact and improve temperature regulation in Northern Uganda
(African Journal of Midwifery and Women’s Health, 2019-03-14) Nissen, Eva; Svensson, Kristin; Mbalinda, Scovia; Brimdyr, Kajsa; Waiswa, Peter; Odongkara, Beatrice Mpora; Hjelmstedt, Anna
Background Uninterrupted skin-to-skin contact between mothers and newborns during the first hour after birth has been reported to be 2% in Uganda. Aims To investigate if a low-cost intervention targeting the behaviors of hospital staff would increase skin-to-skin contact and to investigate whether skin-to-skin contact stabilised temperature in the newborn. Methods The study had a quasi-experimental, before and after design. The sample included 110 in the pre-intervention group, and 93 in the post-intervention group. Data collection included observations of skin-to-skin contact and temperature measurements. Data were also collected from medical records and interviews. Findings No infants had skin-to-skin contact before the intervention, whereas the proportion was 54.8% after the intervention. Infants who received skin-to-skin contact (n=51) and infants who did not receive skin-to-skin contact (n=146) increased in temperature; however, infants who received skin-to-skin contact were significantly warmer after 5 minutes and remained so at 60 minutes. Conclusions The intervention increased the practice of skin-to-skin contact, which was found to be safe in regard to temperature stabilisation. Key words: ■ Low‑cost intervention ■ Newborn temperature ■ Observation ■ Skin‑to‑skin contact ■ Uganda
Cor pulmonale complicating chronic pulmonary aspergillosis with fatal consequences: Experience from Uganda
(Medical mycology case reports, 2019-07-04) Bongomin, Felix; Kwizera, Richard; Atukunda, Angella; Kirengaa, Bruce J.
Cor pulmonale is a rare complication of pulmonary aspergillosis (CPA). A 45-year-old Ugandan male with a history of recurrent community-acquired pneumonias was admitted with symptoms of progressive difficulty in breathing, chronic productive cough, non-exertional left sided chest pain and progressive weight loss occurring over a 12-month period. Chest CT scan and echocardiography confirmed the diagnosis of CPA with an asper gilloma complicating bronchiectasis, complicated with cor pulmonale. However, this was previously clinically misdiagnosed as PTB.
Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda
(Springer Nature, 2019-08) Mukunya, David; Tumwine, James K.; Ndeezi, Grace; Tongun, Tumuhamye, Josephine; Vincentina; Kizito, Samuel; Napyo, Agnes; Achora. Vincentina; Odongkara, Beatrice; Arach, Agnes Anna; Arach, Agnes Anna
Aim To assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira district, Northern Uganda. Subjects and methods In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP package. We also conducted multivariable logistic regression to assess factors associated with home births. Results A third of mothers (n=308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a health facility was pro-rich with a concentration index of 0.10 [95% CI(0.05–0.14)]. Upondecomposing the concentration index, the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95% CI (1.8–5.3)], precipitate labor [AOR 4.18, 95% CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)]. Conclusion There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births should prioritize poorer mothers and those in rural areas. Keywords Inequity .Homebirths .Uganda .Post-conflict .Healthfacilitybirth . Hospitaldelivery
Infant behaviour and maternal adaptation after uninterrupted skin-to-skin contact for 1 hour following birth in northern Uganda
(AJM, 2019-09-25) Svensson, Kristin; Mbalinda, Scovia; Nissen, Eva; Odongkara, Beatrice Mpora; Waiswa, Peter; Hjelmstedt, Anna
Background/aims Uninterrupted skin-to-skin contact in the first hour after birth increases the chance of exclusive breastfeeding, a practice which improves health outcomes for both mothers and neonates. This study aimed to compare mother–infant pairs who had or did not have skin-to-skin contact 1 hour after birth and investigate infant behaviour and maternal adaptation as a result. Methods This study investigated the impact of skin-to-skin contact on a number of health indicators after birth of both mother and child. Two groups were included: 51 mother–infant pairs with skin-to-skin contact and 152 with no skin-to-skin contact, who were observed for 1 hour after birth. Mothers were interviewed at discharge and at 14 weeks postpartum about their sociodemographic background, ability to interpret their infant’s signals and interaction with the infant, their own health and their infant’s health and feeding. The Student’s t-test and Chi squared test were used to assess the associations between the groups and sociodemographic characteristics. The Cramer’s V test was used to assess the effect size for variable latch on. Factor analysis was conducted on statements from interviews on mothers’ feelings regarding motherhood. Results More infants latched on in the skin-to-skin contact group and the first breastfeeding was more often directed by the infants, compared to the no skin-to-skin contact group. Mothers in the skin-to-skin contact group were less likely to need help to breastfeed and tended to be more confident that they could provide sufficient milk for their child. They were also more likely to breastfeed longer and took no initiative to supplement the infant during the hospital stay, while mothers in the non-skin-to-skin contact group did so. More mothers in the skin-to-skin contact group believed that their infant could comfort itself. conclusions The results suggest benefits to uninterrupted skin-to-skin contact between mothers and newborns 1 hour after birth in regard to initiation of breastfeeding, intended time to breastfeed, maternal self-confidence and infant self-regulation. Interventions to promote skin-to-skin contact should be implemented in this setting. Key words: Breastfeeding; Breastfeeding self-efficacy; Feelings about motherhood; Infant interaction; Interpretation of infant cues; Skin-to-skin contact

Browse

Browsing Faculty of Medicine by Issue Date

Results Per Page

Sort Options