Fort Portal Hospital

Abstract Background The integration of palliative care into public health services is a global priority, but it remains uneven in low-income settings. This study evaluated palliative care unit attendance, utilisation relative to need, and the model of care at Fort Portal Regional Referral Hospital (FPRRH) between 2019 and 2025. Methods A retrospective descriptive case study was conducted at FPRRH, a referral‑level hospital serving the Rwenzori subregion of Uganda. Facility records and palliative care unit documentation were reviewed to quantify patient attendance by diagnosis and age group, estimate the proportion of patients receiving specialist palliative care relative to those likely to need it, and describe the unit’s model of care. Data sources included HMIS 008 registers (2019–2024), the EAFYA electronic medical records system (2024/2025), and District Health Information System (DHIS2) reports. Attendance was analysed using descriptive statistics, and the model of care was derived through thematic analysis of reported activities. Results Between July 2019 and June 2025, 1,773 patients attended the palliative care unit. Of these, 959 (54.1%) had cancer and 814 (45.9%) had non‑cancer diagnoses. Overall, 89% of cancer patients accessed the unit compared with 5.1% of sickle cell disease patients and 1.4% of those with HIV‑related complications. Children comprised 6% of attendees. Attendance increased in 2024–2025, primarily driven by outpatient visits (73.6%). Across the hospital, 4,807 patients were identified as potentially requiring palliative care, of whom 1,108 (23%) accessed services. The hospital‑based model emphasised symptom control, collaborative care planning, psychosocial support, care continuity, and mentorship. Conclusion FPRRH has made measurable progress in integrating specialist palliative care, achieving higher coverage than commonly reported national and global estimates. Persistent gaps include low paediatric access, limited inpatient utilisation, and under‑representation of non‑cancer conditions. The hospital’s model offers a replicable framework for strengthening palliative care in referral hospitals.

The high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay from date of admission to date of final admission outcome, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda. We conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fitted linear and logistic regression models with length of stay and in-hospital mortality as key outcomes. Out of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1-6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score <-3SD (51/168, 30%). Among children with pulmonary TB who initiated anti-tuberculosis therapy (ATT) either during hospitalisation or within seven days prior to hospitalisation; cough (134/143, 94%), fever (111/143, 78%), and dyspnoea (78/143, 55%) were common symptoms. Children with TB meningitis commonly presented with fever (17/24, 71%), convulsions (14/24 58%), and cough (13/24, 54%). The median length of hospital stay was 8 days (IQR 5-15). Of the 199 children with known in-hospital outcomes, 34 (17.1%) died during hospitalisation. TB meningitis was associated with in-hospital mortality (aOR = 3.50, 95% CI = 1.10-11.17, p = 0.035), while male sex was associated with reduced mortality (aOR = 0.33, 95% CI = 0.12-0.95, p = 0.035). Hospitalisation in the urban hospital predicted a 0.48-day increase in natural log-transformed length of hospital stay (ln-length of stay) (95% CI 0.15-0.82, p = 0.005), but not age, sex, HIV, malnutrition, or TB meningitis. In-hospital mortality was high, and significantly driven almost four times higher by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children.

BACKGROUND: The burden of pediatric TB is high in Uganda. Our objective was to evaluate predictors of mortality during TB treatment among children at an urban and a rural referral hospital.METHODS: We designed a historical cohort study of TB cases at Mulago National Referral Hospital, Kampala; and Fort Portal Regional Referral Hospital, Fort Portal, Uganda, in children aged <15 years from 2016 to 2021. We used Kaplan-Meier models to estimate survival and fit multivariable Cox regression models to determine mortality hazards during TB treatment.RESULTS: We identified 1,658 children diagnosed with TB from 2016 to 2021. Of 1,623 children with known treatment outcomes, 127/1,623 (7.8%) died during TB treatment, 1,298/1,623 (78.3%) completed treatment, 150/1,623 (9.2%) were lost to follow-up, and two children failed treatment. Using Kaplan-Meier functions, the median time to death was 27 days following treatment initiation. In adjusted Cox models, predictors of mortality included HIV (aHR 1.68, 95% CI 1.01-2.81), moderate malnutrition (aHR 2.22, 95% CI 1.18-4.16), and severe malnutrition (aHR 2.92, 95% CI 1.75-4.87).CONCLUSION: Mortality was high at an urban and a rural referral hospital among children who initiated TB treatment from 2016 to 2021, with the majority of deaths occurring during the intensive phase of TB treatment. Malnutrition and HIV were significant predictors of death during treatment.

Introduction: The performance management concept is not new but has undergone a relatively slow development in the Ugandan health sector and lacks documented proof of practice. Performance management is a continuous process of identifying, measuring and developing the performance of individuals and aligning performance with the strategic goals of the organization. Aim of the study: The study aimed to improve the performance of health workers through established performance management practices in health facilities of Bunyangabu district in order to inform and benchmark interventions. Methodology: A before and after study design was employed to conduct this study. Both qualitative and quantitative research methods were used to collect data from selected health facilities in Bunyangabu district, interventions which included, training, support supervision and mentor-ship were used. Pre and post intervention data was collected and analyzed using excel, stata, and epi info computer software . Findings: The baseline analysis showed that up to 25% of the health managers were not aware of the recommended performance management practices, 45% able to set performance targets, 20% had job descriptions, 30%had conducted appraisals and only 15% knew about the rewards and sanctions. 85% could not state the vision or mission of the organizations.The interventions applied during the study including training in performance management improved the level of awareness among participants from 75% to 95% in six months, knowledge on target setting from 15-80%, knowledge on Job description from 20-62%, knowledge in performance appraisal from 30-70%, and knowledge in rewards and sanctions from 15 – 70%. The raise in knowledge was associated with an improvement in key health service delivery indicators; staff attendance 62-88%, eMTCT retention on ART 79-88%, PNC at 6weeks 26-53%, HTS linkage 89-97%, and ART coverage 92.5 – 99.7%.The study of associations indicated that the performance management was associated with health facility performance as follows performance planning (r=.757; P = 0.001), performance monitoring (r=.692) ; P=0.001), and functional rewards and sanctions committees (r=.66843); P=0.000). Conclusion: The study concludes that there is a knowledge gap among health facility managers about performance management.The study also concludes that inclusion of performance management in routine support supervision is associated with improved quality of health services and Continuous monitoring and mentor-ships influence performance among health workers. Keywords: health staff, individual performance management, standardized staff performance management systems, accredited facilities, performance planning, performance monitoring, performance appraisal, rewards and sanctions DOI: 10.7176/PPAR/13-3-04 Publication date: April 30 th 2023

Abstract Background: Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) associated with high mortality and morbidity including amputations of lower extremities; and a high economic burden especially in low-income countries like Uganda. The aim of this study was to identify the factors associated with severity of DFU and assess the anatomical distribution of DFU among patients in Uganda. Methodology: This was a multicenter cross-sectional study conducted in 7 selected referral hospitals in Uganda. 117 patients with DM type 1 and 2 and foot ulcers were enrolled for this study from January to March 2021. Using the Wagner classification, patients were categorized as less severe DFU (grade 1 and grade 2) and severe DFU for grade 3 and above. A pre tested questionnaire was used to collect data. Data were analyzed using STATA Version 14 with significance at 95% and p-value of &lt;0.05. Results: Out of 117 patients with DFU, 70 (59.8%) had severe DFU and 47 (40.2%) had less severe DFU. Mean age in years was 57.5 (SD15.2) among all study participants in general. The right foot was affected in (47.9%) of cases and the most frequent ulcer was found on the plantar of the foot (44.4%). Majority of the patients had one ulcer (50.4%) and the most frequent ulcer size was &gt;5 cm (47.9%). Majority (61.5%) of the participants were female. Majority of participants, 90 (76.9%) also had uncontrolled blood sugars and 27(29.1%) had normal glycemia Severity of DFU was 3.4 more prevalent among patients with mild neuropathies (p=0.003), and 2.7 more prevalent for those with moderate neuropathies (p=0.005). Also, severity of DFU was 1.5 more prevalent in patients with an ulcer 5-10 cm of diameter (p=0.047) and 2.5 more prevalent in those with foot ulcer of more than 10 cm of diameter (p=.000). Conclusion:The study showed that most of the DFU patients have severe diabetic foot ulcer and uncontrolled glycemia. Neuropathies and ulcers more than 5cm wide are precipitating factors to severity of DFU and, therefore, early management is important to reduce the burden of the disease.

Tackling antimicrobial resistance (AMR) is particularly challenging in low-resource settings such as Fort Portal Regional Referral Hospital (FPRRH) in Western Uganda. Specific knowledge of local AMR epidemiology is required to inform evidence-based improvement of antibiotic stewardship measures in the hospital. To address this, we combined existing antimicrobial susceptibility testing (AST) from FPRRH, with whole genome sequencing (WGS) of 41 Staphylococcus aureus isolates (2017–2019). AST revealed 73 % (30 of 41) of isolates were resistant to one or more antibiotics and 29 % (12 of 41) were multi-drug resistant (MDR). Resistance phenotypes were largely explained by the presence of antibiotic resistance genes in WGS data. Five isolates were methicillin-resistant S. aureus (MRSA) and MDR. Although all isolates were susceptible to clindamycin, a 24 % carriage of erm genes suggests potential for rapid development of resistance. We inferred a population structure for the S. aureus isolates by comparing their core genomes. Twenty isolates formed a tight cluster corresponding to multilocus sequence typing clonal complex (CC) 152, a CC found to be particularly prevalent in northern Africa. The frequency of genes associated with methicillin, chloramphenicol and ciprofloxacin resistance were significantly lower among CC152 strains than non-CC152 strains; thus, in keeping with previous work, we find that CC152 is almost exclusively methicillin-sensitive S. aureus (MSSA). Also, in agreement with other studies, we observed that the occurrence of Panton–Valentine leukocidin toxin-encoding genes was significantly higher among CC152 strains than non-CC152 strains. However, we also observed that the coagulase gene was over-represented in this CC, further defining the virulence strategy of this important pathogen. By generating detailed information about the epidemiology of circulating S. aureus and their antibiotic susceptibility, our study has provided, for the first time, data on which evidence-based infection and AMR interventions at FPRRH can be based.

Observations of wild chimpanzees ( Pan troglodytes schweinfurthii) were conducted in Kibale National Park, Uganda, at the sites of Sebitoli and Ngogo. We report the first two cases of cleft lip in wild chimpanzees. Additionally, some other chimpanzees in the Sebitoli community show facial dysplasia and congenital anomalies, such as patches of depigmented hairs and limb defects. Cleft lip has been documented in several species of nonhuman primates, but much remains unknown about the occurrence of cleft lip and cleft palate in great apes, probably because such malformations are rare, wild apes are difficult to monitor and observe, and severe cases associated with cleft palates render suckling impossible and lead to early death of infants. The genetic basis of such defects in great apes warrants investigation, as does the possibility that environmental toxins contribute to their etiology in Kibale in ways that could affect humans as well.

Background: Febrile illness due to malaria remains a public health challenge in resource-poor countries despite concerted control efforts. Objectives: To establish a baseline database of P. falciparum distribution among febrile patients treated with chloroquine, fansidar, and quinine in Bushenyi. Methods: Standard parasitology and statistics (α=0.01) methods were adopted in the analysis of data collected from 35,000 files of febrile patients who attended clinics in Bushenyi district, Uganda in the year 2005 after the first-line malaria treatment changed from chloroquine to artemisinin-based combination. Results: There was 78.2% (27,384 of 35000) malaria prevalence among the studied 35000 febrile patients’ files, while the percentage distribution of P. falciparum among 27,384 malaria patients included; 42.8% males and 57.1% females in Kitagata Hospital; 45.1% males and 54.9% females in Comboni Hospital and 39.8% males and 60.3% females in Ishaka Adventist Hospital. Females aged 41-50 and 21-30 in Ishaka Adventist Hospital had an overall prevalence of 69.5% and 68.7%, followed by 68.4% and 64.8% from participants aged 41-50 and 21-30 in Kitagata Hospital. The highest P. falciparum prevalence among males less than 10 years old was 54.2% in Comboni and 52.4% in Kitagata. Overall malaria prevalence between January-December 2005 was highest (72.6%) in Ishaka; 34.4% in Kitagata and 22.3% in Comboni hospitals respectively. Malaria prevalence was significantly (p&lt;0.01) dependent on age, sex, and season. Conclusion: In this retrospective study, P. falciparum pre-dominated (78.2%) malaria patients were treated with chloroquine, fansidar, and quinine. This may serve as a database for prospective evaluation of malaria prevalence in the same location. Socio-demographic and poor socio-economic status significantly (p&lt;0.01) influenced malaria spread in Bushenyi. The cause of P. falciparum malaria persistence among the studied population despite treatment warrants further investigation. Keywords: Plasmodium falciparum, malaria patients, anti-malaria, Bushenyi,