Faculty of Public Health, Nursing and Midwifery

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    Aetiology and Treatment Outcome of Non-traumatic Small Bowel Perforations at Mbarara Hospital in South-Western Uganda
    (BMC, 2012-12) D. Mutiibwa; A. Lopez; G. Tumusiime; D. Riding; A. Diaz
    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 atlaparotomy, 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.
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    The Potential of Solanum Aethopicam Supplementation to Reduce the Anthropometric and Biochemical Risk Factors for Non-communicable Diseases Among Older Persons in Mukono Municipality, Uganda: A Before-and-After Study
    (BMC, 2023-10-06) Gerald Tumusiime; Elizabeth Kizito Balyejusa; Anthony Kkonde; Mildred Julian Nakanwagi; Stephen Tukwasibwe; Catherine Ndagire; Martin Mutambuka
    Background: Non-communicable diseases contribute to over 70% of all deaths globally with the majority of the deaths in low and middle-income countries. Although increased vegetable consumption is a cost-effective intervention to mitigate the burden of non-communicable diseases, little is known about African indigenous vegetables to guide their consumption, especially among older persons. This study, aimed at exploring the potential of dietary Solanum aethopicam Shum supplementation in the reduction of the risk of non-communicable diseases among older persons aged 50 years and above in Mukono municipality,Uganda. Methods: This was a before-and-after study of 100 community-dwelling older persons aged 50 years and above residing in cosmopolitan Mukono Municipality in central Uganda. The meal of each participant was supplemented with 375g of Solanum aethiopicum Shum per day for four weeks. Anthropometric and biochemical parameters were collected at baseline and at the end of the four weeks. All measurements were taken in the morning after an overnight fast. Data was entered into an Excel sheet and transferred to STATA software for analysis. All data was summarized in tables and texts. Results: Of the 100 older persons aged 50 to 88 years (mean 63 ± 10), 60% were females and on average, males were older than females. Based on the body mass index, five percent were underweight, 40% were normal, and 55% were overweight or obese at baseline. After supplementation with Solanum aethiopicum Shum, three percent were normal, 44% were normal and 53% were overweight or obese. Also, there was a mean reduction in the participants’ weight, body mass index, mid-upper arm circumference, abdominal girth, hip circumference, and C-reactive protein. Conclusion: The results suggest that supplementation of the older persons’ diet with Solanum aethiopicum Shum improves their nutrition status, and leads to a reduction in the mean weight, body mass index, mid-upper arm circumference, abdominal girth, hip circumference, and C-reactive protein levels. Dietary supplementation with Solanum aethiopicum Shum should be promoted as a potential strategy to reduce the risk of non-communicable diseases among older persons.
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    Surgical Mortality at a Mission Hospital in Western Uganda
    (Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa, 2010-08) Gerald Tumusiime
    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.
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    Once-Daily Dolutegravir-Based Antiretroviral Therapy in Infants and Children Living With HIV From Age 4 Weeks: Results From the Below 14 kg Cohort in the Randomised ODYSSEY Trial
    (Elsevier, 2022-09) Pauline Amuge; Abbas Lugemwa; Ben Wynne; Hilda A Mujuru; Avy Violari; Cissy M Kityo; Moherndran Archary; Ebrahim Variava; Ellen White; Rebecca M Turner; Clare Shakeshaft; Shabinah Ali; Kusum J Nathoo; Lorna Atwine; Afaaf Liberty; Dickson Bbuye; Elizabeth Kaudha; Rosie Mngqibisa; Modehei Mosala; Vivian Mumbiro; Annet Nanduudu; Rogers Ankunda; Lindiwe Maseko; Adeodata R Kekitiinwa; Carlo Giaquinto; Pablo Rojo; Diana M Gibb; Anna Turkova; Deborah Ford
    Background Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. Methods ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and <14 kg). Children weighing less than 14 kg starting first-line or second-line ART were enrolled in seven HIV treatment centres in South Africa, Uganda, and Zimbabwe. Randomisation, which was computer generated by the trial statistician, was stratified by first-line or second-line ART and three weight bands. Dispersible 5 mg dolutegravir was dosed according to WHO weight bands. The primary outcome was the Kaplan-Meier estimated proportion of children with virological or clinical failure by 96 weeks, defined as: confirmed viral load of at least 400 copies per mL after week 36; absence of virological suppression by 24 weeks followed by a switch to second-line or third-line ART; all-cause death; or a new or recurrent WHO stage 4 or severe WHO stage 3 event. The primary outcome was assessed by intention to treat in all randomly assigned participants. A primary Bayesian analysis of the difference in the proportion of children meeting the primary outcome between treatment groups incorporated evidence from the higher weight cohort (≥14 kg) in a prior distribution. A frequentist analysis was also done of the lower weight cohort (<14 kg) alone. Safety analyses are presented for all randomly assigned children in this study (<14 kg cohort). ODYSSEY is registered with ClinicalTrials.gov, NCT02259127. Findings Between July 5, 2018, and Aug 26, 2019, 85 children weighing less than 14 kg were randomly assigned toreceive dolutegravir (n=42) or standard of care (n=43; 32 [74%] receiving protease inhibitor-based ART). Median age was 1·4 years (IQR 0·6–2·0) and median weight 8·1 kg (5·4–10·0). 72 (85%) children started first-line ART and 13 (15%) started second-line ART. Median follow-up was 124 weeks (112–137). By 96 weeks, treatment failure occurred in 12 children in the dolutegravir group (Kaplan-Meier estimated proportion 31%) versus 21 (48%) in the standard-of- care group. The Bayesian estimated difference in treatment failure (dolutegravir minus standard of care) was –10% (95% CI –19% to –2%; p=0·020), demonstrating superiority of dolutegravir. The frequentist estimated difference was –18% (–36% to 2%; p=0·057). 15 serious adverse events were reported in 11 (26%) children in the dolutegravir group, including two deaths, and 19 were reported in 11 (26%) children in the standard-of-care group, including four deaths (hazard ratio [HR] 1·08 [95% CI 0·47–2·49]; p=0·86). 36 adverse events of grade 3 or higher were reported in 19 (45%) children in the dolutegravir group, versus 34 events in 21 (49%) children in the standard-of-care group (HR 0·93 [0·50–1·74]; p=0·83). No events were considered related to dolutegravir.
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    The Number and Determinants of Nutrient Foramina Among Dry Human Femur Bones From the East African Population: A Cross-Section Study
    (BMC, 2021) Gerald Tumusiime; Gonzaga Gonza Kirum; John Kukiriza
    Background: Nutrient foramina form important landmarks on the femur and other bones as the portal of entry for nutrient arteries. Nutrient arteries are important sources of blood supply for growing bones; and their variations may be due to congenital or acquired causes. These variations are important in anatomical comparisons, orthopaedic surgical practice and forensic medicine. Aims: This study aimed at establishing the number and determinants of the nutrient foramina among dry human femur bones from the East African population. Materials and methods: This was a cross-section study of 333 dry femur bones from the East African population, at the Galloway osteological collection of Makerere University college of health sciences. The number of nutrient foramina on the shaft of each femur, the corresponding demographic, clinical and morphometric characteristics were documented. Data were entered in an Excel sheet and exported to STATA 14 for analysis. Univariate, bivariate and multivariable analyses were performed to obtain the summary statistics and the measures of association. At all levels of analysis, a p-value of less than 0.05 was considered statistically significant. Results: Of the 333 femurs, 291 (87.4%) were from males; and 137(50.15%) were right femurs. The age ranged from 20 to 75 years with a mean age of 35 (SD± 12) years. Nutrient foramina ranged from one to four; mean of 1.4 (SD±0.5) and median of 1 (IQR: 1 to 2). Of the 333 femurs, 199 (59.8%) had one foramen, 129 (38.7%) had two foramina, four femurs had three foramina and one femur had four foramina. There was a statistically significant association between the number of nutrient foramina and the femur’s: mid-shaft circumference (p=0.014; 95%CI: 0.003 to 0.028), nationality (p=0.016; 95%CI: -0.284 to -0.030) and sex (p=0.012; 96% CI: -0.405 to -0.050). Conclusion: Nutrient foramina among femurs from the East African population range from one to four per femur, with predominantly one foramen. The key determinants of the number of foramina are: mean mid-shaft circumference, nationality and sex. These findings are significant in anatomical comparisons; forensic and orthopaedic practices. KEY WORDS: Nutrient foramina, dry human femur, East African population, morphometric characteristics.