Mubende Hospital

Substance use disorders (SUDs) results in stigmatization conditions which end up causing self-stigma in individuals with substance use disorders. It is said that, self-stigma occurs when individuals internalize societal stereotypes and negative attitudes towards oneself which is a significant psychological barrier that individuals with substance use disorders often face. The impact of self-stigma on treatment seeking, recovery and overall wellbeing of individuals with SUDs has been widely recognised. This study aimed to assess self-stigma in individual with SUDs who were being treated at a local psychiatric clinic in Harare. A descriptive simple random sampling of both sexes was done. A structured questionnaire comprising of validated measures was used to assess self-stigma adapted from Substance Abuse Self-Stigma Scale. Consent was sought verbally and in writing before collecting data. The results of this study showed that individuals with SUDs feel as burdens to their families, SUDs defines a person’s worth and limit opportunities were the major factors that led to self-stigma. Self-stigma was impacted by difficult to disclose, isolation and social withdrawal, barrier to accessing support, diminish self-worth and esteem that hindered recovery process. The findings also showed the preferred interventions by this sample population which were implementation of anti-stigma campaigns, access to accurate and non-stigmatizing information and counselling. It is anticipated that, by reducing self-stigma, treatment seeking behaviours, treatment adherence and overall well-being among individuals with SUDs can be improved.

Introduction: The National Community Health Strategy (NCHS), developed by the Ministry of Health in 2022, underpins the ICSDM. Aligned with the 2022 HIV Guidelines, the NCHS aims to strengthen the HIV response, accelerate the 95:95:95 targets, and achieve AIDS elimination by 2030. At baseline in October 2023, 0% of the non-suppressed clients were enrolled in community-based follow-up, and the viral re-suppression rate among this group stood at 89%. Significant gaps existed in HIV/TB service coordination at household and community levels, with only 57% of the workforce effectively reaching communities. These gaps contributed to missed diagnoses, treatment interruptions, and low viral suppression. The ICSDM addresses these challenges by engaging households, supporting clients with unsuppressed viral loads, providing HIV testing, Advanced HIV Disease management and referrals, thereby improving access to comprehensive health service delivery. Methods: A cohort of 225 non-suppressed clients enrolled between October 2023 and September 2024 was monitored to assess viral re-suppression outcomes after ICSDM enrolment. Each Community Health Worker (CHW) was assigned 5 households to conduct Directly Observed Treatment,Short Course (DOTS) daily for 15 days then weekly to complete a month and monthly follow ups till the repeat Viral Load Testing. All household members were also offered TB screening, HIV testing, and appropriate referrals. Results: Of the 225 clients enrolled, 96% (215/225) achieved viral re-suppression following DOTS. This reflects a significant improvement from the baseline 0% enrolment and 89% re-suppression rates respectively. Conclusion: The ICSDM significantly improved community-level service delivery and achieved high viral re-suppression rates among non-suppressed clients demonstrating its potential to strengthen HIV care.

Abstract Background: Healthcare workers (HCWs) mental resilience can be challenged during times of adversity, including outbreaks. On September 20, 2022, the Uganda Ministry of Health declared an Ebola outbreak of the Sudan virus disease (SVD) subtype. We assessed the level and determinants of resilience at the workplace among HCWs working at the epicenter of the SVD outbreak (Mubende and Kassanda districts) in Uganda. Methods: During March 2023, we conducted a cross-sectional survey among all HCWs (clinical and non-clinical) working from September 20, 2022─January 23, 2023 (the outbreak period) in the three health facilities that were directly involved in the SVD response in Mubende and Kassanda districts. Risk perception was assessed using 12 statements with a 4-point Likert-type scale. We assessed resilience using the Connor-Davidson Resilience Scale (CD-RISC-10). Resilience was dichotomized into ‘not resilient’ (score 1-29) and ‘resilient’ (score 30-40). Logistic regression was used to identify factors associated with resilience. Results: Of 429 eligible HCWs, 400 (93%) were interviewed. Mean age was 35 (range: 20-58) years; 222 (56%) were male and median work experience was 8 years (range:1-38). One hundred and ten (28%) were support staff and 72 (18%) were nurses; 344 (86%) worked >40 hours per week. Overall, 93 (23%; 95%CI: 19-25%) were resilient. Three hundred and fifty-six (89%) expressed fear of contracting SVD and 356 (89%) expressed concern about stigma at their workplace if they became infected. Resilience was associated with age >40 years (adjusted odds ratio [AOR]=2.1; CI=1.3-3.5), work experience >10 years (AOR=2.2; CI=1.1-4.7), working >40 hours per week (AOR=6.8; CI=2.1-23), and receiving Ebolavirus-specific counseling (AOR=3.3; CI=1.7-6.5). Conclusion: Most HCWs at the SVD outbreak epicentre in Uganda faced resiliency challenges during the outbreak, related to their infection risk and treatment by others if they became infected. Psychological counselling and mental health support to HCWs and addressing concerns that bring them a high risk of infection could improve on their resilience during future outbreaks.

BackgroundEpidemiology of febrile illness in Uganda is shifting due to increased HIV treatment access, emerging viruses, and increased surveillance. We investigated the aetiology and outcomes of acute febrile illness in adults presenting to hospital using a standardized testing algorithm of available assays in at Arua and Mubende tertiary care hospitals in Uganda.MethodsWe recruited adults with a ≥ 38.0 °C temperature or history of fever within 48 h of presentation from August 2019 to August 2020. Medical history, demographics, and vital signs were recorded. Testing performed included a complete blood count, renal and liver function, malaria smears, blood culture, and human immunodeficiency virus (HIV). When HIV positive, testing included cryptococcal antigen, CD4 count, and urine lateral flow lipoarabinomannan assay for tuberculosis. Participants were followed during hospitalization and at a 1-month visit. A Cox proportional hazard regression was performed to evaluate for baseline clinical features and risk of death.ResultsOf 132 participants, the median age was 33.5 years (IQR 24 to 46) and 58.3% (n = 77) were female. Overall, 73 (55.3%) of 132 had a positive microbiologic result. Among those living with HIV, 31 (68.9%) of 45 had at least one positive assay; 16 (35.6%) had malaria, 14 (31.1%) tuberculosis, and 4 (8.9%) cryptococcal antigenemia. The majority (65.9%) were HIV-negative; 42 (48.3%) of 87 had at least one diagnostic assay positive; 24 (27.6%) had positive malaria smears and 1 was Xpert MTB/RIF Ultra positive. Overall, 16 (12.1%) of 132 died; 9 (56.3%) of 16 were HIV-negative, 6 died after discharge. High respiratory rate (≥ 22 breaths per minute) (hazard ratio [HR] 8.05; 95% CI 1.81 to 35.69) and low (i.e., < 92%) oxygen saturation (HR 4.33; 95% CI 1.38 to 13.61) were identified to be associated with increased risk of death.ConclusionIn those with hospitalized fever, malaria and tuberculosis were common causes of febrile illness, but most deaths were non-malarial, and most HIV-negative participants did not have a positive diagnostic result. Those with respiratory failure had a high risk of death.

Abstract Background: Gastric cancer is the 4th most common cause of cancer death worldwide with an annual global incidence of 985,600; two thirds of them being in the developing countries. Gastric cancer is endemic in the so called stomach cancer region comprising Rwanda, Burundi, South Western Uganda and eastern Kivu province of Democratic Republic of Congo and its incidence in Rwanda is estimated around 13 to 15 per 100,000 population. To date, the outcomes of gastric cancer in the East African region are under investigated, and the survival rate in Rwanda is not known. The aim of this study was to describe the short term outcomes (in-hospital mortality rate, length of hospital stay, 3, 6, 12 and 24 months survival rates) in patients treated for gastric cancer at CHUK.Methods: We retrospectively reviewed the data collected from records of patients who consulted CHUK over a period of 10 years from September 2007 to August 2016. Patients were followed in hospital and after discharge for survival length. Descriptive statistics were used for baseline demographic data, Kaplan-Meier model and univariate cox regression were used for survival analysis.Results: Of the 199 patients enrolled in the study, 92 (46%) were males and 107 (54%) females. The mean age was 55.4 ranging between 24 and 93. The mean symptoms duration was 15 months. Most patients consulted with advanced disease, 62.3% with distant metastases. Treatment with curative intent was offered for only 19.9% of patients. The in-hospital mortality rate was 13.3%. The 3, 6, 12 and 24 months survival rate was 52%, 40.5%, 28% and 23.4% respectively. The Overall survival rate was 7 months.Conclusion: Patients with gastric cancer have delayed consultations and advanced disease at the time of presentation. This cancer is associated with poor outcomes in terms of hospital mortality and post discharge survival rates.

BackgroundPre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease.Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD.MethodsA 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD.ResultsThe team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent.Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making.ConclusionsScreening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

Aims: Uganda still has high fistula burden with 75000-100000 women still living with obstetric fistula and yet new cases are being formed. The ministry of health together with supporting partners established regional treatment centers among which includes Hoima and Mubende regional referral hospitals. This aimed to assess the duration of leaking urine and patient perceived reasons for delay to seek repair among genitourinary fistula mothers who presented in fistula camps at Mubende and Hoima fistula treatment centers.&#x0D; Methods: This was a retrospective study in which qualitative and quantitative data was collected from standardized patient records of patient chats and registers filled by fistula surgeons.&#x0D; Results : We had a total of 125 mothers from 19 districts and of age between 16 to 72 years with genital urinary fistula operated. The majority (47.4%) of the clients were 25 years or less, of low parity with 41 % (para 1+0) and without formal employment. Only 59.5% of the clients presented within one year from the time they developed the fistula. Among the patient perceived bottlenecks are the perception that fistulas are only treated during camps, lack of money, ill health resulting from difficult labour and lack of awareness that the bladder can be repaired.&#x0D; Conclusions: With the low turn up of mothers seeking repair, there is need to reduce leaking time and lessen suffering of obstetric fistula patients by creating more awareness, promoting routine repairs and continued financial support to care for fistula clients.

An incisional hernia develops in the scar of a surgical incision. Rarely, a particularly thin-walled large incisional hernia may actually ulcerate at its fundus so that omentum protrudes or there is even the development of an intestinal fistula. Spontaneous rupture of an abdominal hernia is very rare and usually occurs in incisional or recurrent groin hernia 1 . Von Helwig 2 in 1958 reported 47 cases of spontaneous exteriorization of bowel through abdominal hernia, out of these 17 cases were through incisional hernia while others were through inguinal, femoral, umbilical and epigastric hernias. The site of rupture is different in diverse studies. Hartley 3 and Hamilton 4 reported rupture through thr lower midline incision while Aggarwal 5 found herniation after upper abdominal surgery following perforated duodenal ulcer.