Kabale Hospital

HIV exposure in utero is associated with low birth weight (LBW), even in the absence of vertical transmission. To explore mechanism, we evaluated endothelial markers angiopoietin (Ang)-1 and Ang-2 among 294 uninfected Ugandan infants born to women with HIV (WWH). The median Ang-2/Ang-1 ratio was 0.051 [interquartile range (IQR) 0.023-0.19] among infants with LBW and 0.018 (IQR 0.010-0.037) among controls (P = 0.00011). Endothelial dysregulation may contribute to LBW among infants born to WWH.

<title>Abstract</title> Introduction: Bacterial vaginosis (BV) and antisperm antibodies (ASA) are recognised contributors to infertility, yet their combined involvement in unexplained infertility remains insufficiently documented. Their combined influence on unexplained infertility (UI) remains inadequately documented. This study aimed to examine the relationship between BV, its associated pathogens, and ASA in women with UI in Kisangani, Democratic Republic of Congo. Methods A cross-sectional analytical study was conducted from August to November 2023 among 523 infertile couples who had completed the standard investigations. One hundred and forty-four women met the criteria for UI. ASA were detected using a rapid diagnostic test, followed by an indirect mixed antiglobulin reaction test when positive. BV was diagnosed using Nugent scoring. Vaginal pathogens were identified with the VITEK 2 Compact system. Associations were evaluated using the chi-square test, Phi coefficient, and logistic regression models. Results In the full infertile cohort, bacterial vaginosis was significantly linked to ASA positivity (p &lt; 0.001, Phi = 0.383). This association was stronger among women with UI (p &lt; 0.001, Phi = 0.879). In multivariable analysis, ASA were independently associated with <italic>Atopobium vaginae</italic> (aOR 15.08 [3.30-68.89]), <italic>Gardnerella vaginalis</italic> (aOR 6.31 [2.09–19.08]), <italic>Mobiluncus species</italic> (aOR 3.24 [1.07–9.82]), <italic>Mycoplasma hominis</italic> (aOR 3.60 [1.11–11.68]), and <italic>Prevotella timonensis</italic> (aOR 3.88 [1.28–11.74]). Conclusion BV and several of its core pathogens show strong associations with ASA in women with UI. These findings support an infection-immune pathway that may contribute to infertility and emphasise the importance of combining microbiological and immunological tests in infertility assessments, highlighting the need for longitudinal studies to clarify temporal relationships.

Soluble urokinase-type plasminogen activator receptor (suPAR) is an emerging critical illness biomarker. Circulating suPAR levels are elevated in severe malaria and are associated with mortality risk. The present study evaluated clinical predictors of elevated plasma suPAR (≥15 ng/mL). Elevated suPAR occurred in 22.1% of 1226 Ugandan children with severe malaria and was independently associated with severe acute kidney injury, hyperlactatemia, and coma, as well as biomarkers of immune and endothelial activation. An optimized clinical decision algorithm that prioritizes suPAR testing for children with clinical danger signs, including coma and kidney injury, could improve the identification of children at highest risk of death.

Mortality among adults admitted to hospital with community acquired pneumonia in resource-limited settings is high. Recent studies conducted in high-income settings have demonstrated beneficial effects of low-dose corticosteroids in reducing mortality in patients with severe community acquired pneumonia. It is unknown whether these findings apply to low-income settings such as sub-Saharan Africa.This pragmatic randomized-controlled open-label trial will determine the effect of adjunctive low-dose corticosteroids in the management of adults admitted to hospital with community acquired pneumonia on mortality 30-days post-randomization. We will enroll and randomize 2180 patients admitted with a diagnosis of community acquired pneumonia into two arms: the control and intervention arm. Those in the control arm will receive standard care for the treatment of community acquired pneumonia i.e., combination therapy with a beta-lactam and macrolide antibiotic. Those in the intervention arm will receive up to 10-days treatment with low-dose oral corticosteroids in addition to standard care. All participants will be followed up to 30- days post randomization and their final status recorded (alive or dead). If adjunctive low-dose oral corticosteroids are found to be beneficial, this easily scalable intervention would significantly reduce the currently high mortality associated with community acquired pneumonia.Pan-African Clinical Trials Registry: PACTR202111481740832; ISRCTRN registry: ISRCTN36138594.

Abstract Background Caesarean section delivery has played a key role in reducing maternal and perinatal mortality when offered where it is medically indicated. Caesarean section delivery rates have risen over the last 3 decades across the globe making this a public health concern. Reasons for these high rates are not known especially for South-western Uganda. We therefore aimed to determine the prevalence and predictors of caesarean section delivery among women delivering at a tertiary Hospital in South-western Uganda. Methods This cross sectional study was done between 1st September and 30th November 2023. We reviewed and abstracted secondary data from the from the Uganda health management information system including the Integrated Maternity Register coded as HMIS 072 in the maternity ward at Kabale Regional Referral Hospital, in south-western Uganda. We abstracted data on maternal-related factors including socio-demographic – and pregnancy-related characteristics as well as foetal-related characteristics Data were analysed using Stata version 14.0 (StataCorp, College Station, Texas, USA.). We estimated adjusted prevalence ratios using modified Poisson regression models. Results The prevalence of caesarean section delivery in this study is 47.9% (n=457/955) (95%CI: 44.6% - 51.1%). The indications for a caesarean section were previous uterine scar, prolonged labour, foetal distress, premature rupture of membranes, and inadequate pelvis among others. Predictors for caesarean section delivery include: 1) maternal-related characteristics included: having attained a tertiary level of education (APR=0.74, 95%CI: 0.55 – 0.96), having a careered profession (APR=1.37, 95%CI: 1.05 – 1.77), belonging to other ethnic groups that are not predominant in the study setting (APR=1.33, 95%CI: 1.09 – 1.64). 2) foetal-related factors included: multiple pregnancy (APR=1.89, 95%CI: 1.43 – 2.48) and foetus in a position other than the left or right occipital anterior (APR=1.81, 95%CI: 1.18 – 2.78) Conclusions and recommendations. The prevalence of caesarean section remains alarmingly high. We recommend that keen attention should be given to pregnant women during health education especially those that do not understand the predominantly used language during the sessions. We also recommend caesarean section audits done for all women that have been referred from lower health facilities to deliver at this tertiary hospital especially for women with a previous uterine scar

Current prognostic tools do not reliably and objectively identify children with pneumonia at risk of a severe or life-threatening episode. Heparin-binding protein (HBP) is a host immune protein that is released in response to infection. We hypothesized that measuring HBP concentrations at hospital admission could help risk-stratify children with pneumonia and identify those at higher risk of an adverse prognosis. We evaluated the prognostic accuracy of HBP for predicting in-hospital mortality among children with respiratory distress, and whether HBP could improve the accuracy of validated composite clinical severity scores. Of 778 Ugandan children under 5 years of age and presenting with clinically defined pneumonia, 60 (7.7%) died during hospital admission. HBP concentrations at presentation were significantly higher in children with fatal outcomes (median, 76 ng/mL [interquartile range {IQR}, 41-150]) compared to children who survived (median, 31 ng/mL [IQR, 18-57]) (P < .001). Children with HBP >41 ng/mL on admission had an elevated risk of death (hazard ratio, 5.3 [95% confidence interval {CI}, 2.9-9.5]; P < .0001). In receiver operating characteristic (ROC) curve analysis, HBP concentrations distinguished between fatal and nonfatal outcomes (area under the ROC curve, 0.75 [95% CI, .66-.84]) and significantly improved the prediction provided by the Respiratory Index of Severity in Children, a composite clinical severity score (P = .0026). Measuring HBP at presentation could help identify children at risk of severe and fatal pneumonia. Adding HBP to clinical scores could improve the recognition and triage of children with pneumonia at risk of death.

BackgroundThe efficiency of the patient care process of short-term medical service trips is often not assessed. The Gregory School of Pharmacy has organized annual medical camps in rural Uganda, however, the paper health records used for documentation and communication between stations have shown several limitations that hinder an optimal patient care process. Therefore, our objective was to implement an electronic health record system in these medical camps to improve the workflow and optimize the patient care process.MethodsAn electronic health record system that functioned over a battery-operated local area network was developed and implemented. Patient health information was entered and reviewed at the different stations using mobile devices. The impact of electronic health records (used in 2019) on the patient care process was assessed using the number of patients served per physician per hour and the number of prescriptions filled per hour and comparing these to paper records (used in 2017).ResultsElectronic health records were successfully implemented and communication across stations was fluid, thus improving transitions. Importantly, 45% more patients were served per physician per hour and 38% more prescriptions were dispensed per hour when using electronic (2019) compared to paper records (2017), despite having a smaller team in 2019.ConclusionImplementation of electronic health records in rural Uganda improved the patient care process and the efficiency of the medical camp.