Masaka Hospital

Blended oxygen has been shown to reduce severe retinopathy of prematurity (ROP) incidence worldwide, and more recently in Uganda. Although it has been established that ROP-driven visual impairment has a substantial societal burden and that screening and treatment programs are cost-effective in low- and middle-income countries, there is limited evidence for the economic impact of prevention with appropriate oxygen management equipment (OME) in these regions. We performed a cost-utility analysis of OME implementation comparing variations ranging between most and least favorable values. Disability-adjusted life years (DALYs) were calculated with a 3% discount rate. Calculations assumed a 62.1% incidence of visual impairment in untreated severe ROP and a disability weight of 0.184 for severe visual impairment due to ROP. One set of OME costs between $677.50-$1,844.11 USD in Uganda. We found that the cost to prevent one case of ROP-driven severe visual impairment in Uganda ranges from $25.55-$543.99, with a base case (best estimate) of $168.92 per case averted. This reflects 5.18 DALYs averted over the 58-year average Ugandan lifespan and a cost of $4.97-$104.98 to avert one DALY, with a base case of $32.60 per DALY averted. In comparison, prevention of malaria via mosquito net distribution was estimated in a 2020 meta-analysis to cost $50 for every DALY averted. The high-end estimate is roughly 10% of the annual gross domestic product per capita ($1,002.30). Therefore, OME is a cost-effective means to prevent severe visual impairment among infants in Uganda. Implementation of OME in Uganda would also reflect a clear ethical and humanitarian success.

Neonatal units can be stressful for pre-term infants at a time of rapid brain growth and plasticity, which may contribute to poorer developmental outcomes. Environmental modification to protect against negative sensory experiences and provide positive caregiver stimuli is the standard of care, but little is known about practices in low-income settings. We aimed to determine knowledge and practice relating to developmentally-supportive-care in Uganda. A quantitative survey on knowledge and practice of developmentally-supportive-care was conducted with 135 health workers in four neonatal units. In addition, observations of practices and sound measurements were conducted. Only 36% of respondents reported that stress, and 21% that parental interaction can affect brain development, and knowledge of stress reduction was limited. 84% of respondents reported actions to protect infants from excessive light in their unit, 33% from excessive sound, and 69% from sleep disruption. The main perceived benefit of family involvement in care was to reduce parental stress levels (67%), with infection risk perceived as the main negative (71%). Workers at the largest volume facility had the lowest knowledge and practice, with wide variations across facilities. All units had sound readings over recommended levels. Knowledge and practice of DSC in this setting were low and needs to be improved to ensure that pre-terms in this setting both survive and thrive.

Abstract Introduction Post-discharge mortality among children following an acute illness in low-resource settings is high and demands urgent attention. We aimed to assess the impact of Smart Discharges, a mortality prevention risk-differentiated approach to peri-discharge care among children under five years admitted with suspected sepsis. Methods We conducted a before-after two-phase study with staggered implementation at six hospitals in Uganda. During a baseline period (Phase-1), clinical prediction algorithms for post-discharge mortality were developed based on clinical and socio-demographic data collected at hospital admission. Outcomes, primarily mortality within six months of discharge, were compared against an interventional period (Phase-2). In the Smart Discharges intervention each family was given soap, a mosquito net, their risk category (low/medium/high/very high), counselling, and educational materials regardless of risk stratification, after which the intensity of recommended follow-up care was determined by age (0-6, 6-60 months) and predicted post-discharge mortality risk. Results Overall, 13,051 children were enrolled: Phase-1, n=6,955; Phase-2, n=6,096. Characteristics were similar between groups, including mean predicted post-discharge mortality risk (6.3% Phase-1 vs. 5.9% Phase-2). With Smart Discharges, 2,331/3,891 (59.9%) medium/high/very high-risk families attending all their scheduled visits. The observed post-discharge mortality rate was 439 (6.3%) in Phase-1 vs. 296 (4.9%) in Phase-2; adjusted hazard ratio 0.77 (95%CI 0.67 to 0.90) favouring the intervention. In Phase-1, 1,313 (18.9%) children were re-admitted to hospital vs. 1,024 (16.8%) in Phase-2. Conclusion A simple approach of risk assessment paired with education and engagement through scheduled follow-up after discharge is an appropriate strategy to improve child survival in low-resource settings.

Background:Despite widespread access to antiretroviral therapy (ART) in the “Treat All” era, HIV-associated Kaposi sarcoma (KS) remains among the most common malignancies in sub-Saharan Africa. Survival after KS diagnosis has historically been poor in Africa, but knowledge whether survival has changed at the population level in the contemporary era has been limited by lack of community-representative surveillance and monitoring systems.Methods:We identified all adult persons living with HIV (PLWH) with a new diagnosis of KS made between 2016 and 2019 during outpatient or inpatient care at prototypical primary care-providing medical facilities in Kenya and Uganda using rapid case ascertainment. Participants were subsequently followed for vital status, including community tracking for those who became lost to follow-up.Findings:Among 411 participants with newly diagnosed KS, 71% were men, median age was 34 (IQR: 30 to 41) years, and 91% had ACTG T1 tumor extent. Over a median follow-up of 7.8 (IQR: 2.4 to 17.9) months, cumulative incidence of death (95% CI) at months 6, 12 and 18 were 34% (30% to 39%), 41% (36% to 46%) and 45% (40% to 51%), respectively. Having the highest number of anatomic sites (11 to 16) harboring KS lesions (hazard ratio 2.2 (95% CI: 1.3–3.8) compared to 1 to 3 sites) and presence of oral KS lesions (hazard ratio 2.2 (95% CI: 1.4–3.3)) were independently associated with higher mortality. Lower hemoglobin and CD4 count as well as higher plasma HIV RNA were also associated with higher mortality.Interpretation:Among PLWH with newly diagnosed KS in East Africa in the “Treat All” era, survival was poor and related to mucocutaneous extent of KS. The findings emphasize the need for better control of KS in Africa, including novel approaches for earlier detection, better linkage to oncologic care, and more potent therapy.

Introduction and HypothesisWe aimed to determine the incidence and risk factors for post-operative urinary retention (POUR) following surgery for perineal tears, and to determine the time to normal voiding after POUR.MethodsThis was a prospective cohort study of women who underwent surgery for old (≥ 3 months) obstetric perineal tears from January 2022 to December 2023. The diagnosis of POUR was made in a woman who completely failed to void despite a full bladder or, one who had post-void residual (PVR) > 150 ml within 10 min of voiding. Return to normal voiding was considered if a patient with POUR had two consecutive PVRs of ≤ 150 ml. Descriptive analyses and multivariable logistic regression were performed to determine risk factors for POUR.ResultsA total of 153 participants were enrolled in this study with a mean age of 35.9 (SD ± 10.8) years. The incidence of POUR was 19.6% (30/153, 95% CI 14.02–26.7), and the median time to normal voiding for these patients was 42.4 h (range 24–72). Risk factors for POUR included repeat perineal tear surgery (RR = 4.24; 95% CI 1.16–15.52; p = 0.029) and early urinary catheter removal (RR = 2.89; 95% CI 1.09–7.67; p = 0.033).ConclusionPost-operative urinary retention following surgery for perineal tears is common. The time to return to normal voiding in patients with POUR is short. Women having repeat perineal tear surgery and those in whom the urinary catheter is removed early were more likely to experience POUR. Delayed urinary catheter removal could be considered, especially in patients undergoing repeat perineal tear surgery.

This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa. APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce. Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN-specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost-effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce. Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce. The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes. APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care. The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long-term impact and establish best practices for its implementation in emergency care across Africa.

The goal of this article is to describe surgical ethics and to outline the principal moral dilemmas that surgeons must resolve. Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others.Surgeons must have a moral compass in their armamentarium which guide their decisions and actions. Surgery is an ethical practice and therefore surgeons should display surgical competence and diligence in their academic and medical activities. Surgeons should be trustworthy from a moral and ethical standpoint and should be skilled in the science and art of surgery. Surgeons must act as ethical models for society, surgeons in training, and fellow colleagues in the place he/she works. A guide used for discussion in surgical ethics should be based on the four-box approach and principalism to clinical ethics. Proximity, surgery-rescue, aftermath, ordeal and presence are five categories of relationships and experience that are important.

BackgroundHand hygiene (HH) has proven to be the leading measure to prevent the cross-transmission of microorganisms. However, HH compliance among healthcare workers has been very low in Rwanda, with average compliance of<40%. There was no nationwide data related to HH compliance in Rwanda except for a few studies in different institutions on quality improvement. The research aimed to assess the hand hygiene knowledge level and compliance among the health care providers at Kirehe District Hospital. MethodsA cross-sectional study was conducted among 29 healthcare workers (20 nurses/midwives and 9 doctors) working at the maternity unit at Kirehe District Hospital in Rwanda. Knowledge was assessed using the WHO HH questionnaire. ResultsThe overall knowledge score was 77.5%, and 44% of participants had moderate HH knowledge. Gloves were 98% available and accessible to health professionals. The hand rub was available in 52%, mostly used by doctors who carried it in their pockets (40.6). The availability of soap and water was 45% and 29%, respectively. A binomial test was done to see if there was any factor that was associated with HH knowledge; it was found that there was no statistically significant association between knowledge and demographics. ConclusionThe findings of this study showed that most healthcare workers had good knowledge of HH. Healthcare workers were observed putting on gloves without washing their hands between patients during rounds. The HH infrastructure was poorly located, with limited supplies, and there were no hand-washing facilities in some rooms.