Mulago 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.

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.

Down syndrome (DS) is the leading chromosomal abnormality globally and contributes to 10% of all congenital heart diseases. Approximately half of the children with DS present with congenital heart diseases (CHD) and are prone to the early development of pulmonary hypertension, leading to increased morbidity and mortality. This study aimed to evaluate cardiac screening practices and experiences for children with DS at Mulago National Referral Hospital (MNRH), Uganda. A cross-sectional multimethod study was conducted among children below 3 years with DS and their caretakers at four pediatric wards and outpatient clinics at MNRH. A research assistant-administered questionnaire was used to document participants’ demographics, history of cardiac screening, and outcomes of echocardiography and chest radiography. Key-informant and in-depth Interviews were conducted with healthcare providers and caretakers of children with DS, respectively, to explore their knowledge, practices, and barriers related to cardiac screening. Quantitative data were analyzed in STATA 15, while qualitative data were thematically analyzed using Atlas ti. A total of 61 children were recruited over 22 months, of which 31 (50.5%) were female. The mean age was 5.9 months (SD: 2.2), however, only 47 (77.1%) had undergone echocardiography, suggesting delays in early cardiac screening. The prevalence of CHD was 97.9%. The most common defects were patent-ductus arteriosus (PDA) (59.6%) and atrioventricular septal defect (36.2%). Only 12 (19.7%) children had undergone chest radiography, most frequently showing cardiomegaly (26.7%) and heterogeneous opacities (20%). Financial constraints were the main barrier to echocardiography (71.4%), while lack of healthcare worker requests limited chest radiography (77.1%). Parents and healthcare providers emphasized the importance of cardiac screening for early detection and management of cardiac defects. They recommended subsidizing or waiving screening fees and providing counselling to caretakers prior to screening to improve access. Nearly eight in ten children with DS at MNRH underwent echocardiography, revealing CHD in 97.9%, with PDA being the most common. Although the importance of cardiac screening was recognized, financial barriers and lack of imaging requests limited access. Strengthening access to routine early cardiac screening is essential to improve quality of care for children with Down syndrome in this setting.

Background:Uganda, an East African country with a population of approximately 46 million, has 72.62% of its people living in rural areas. Plastic and reconstructive surgery was historically delivered by visiting surgical teams, which, although impactful, faced limitations in follow-up and patient reach. Uganda has only 22 trained local plastic surgeons, mostly in urban private practice. Few work in public hospitals, limiting access to reconstructive care for the country’s largely rural population.Methods:A cross-sectional survey of 35 participants (plastic surgeons and trainees) was conducted using self-administered questionnaires across teaching and nonteaching hospitals in Uganda. The study examines the current gaps in reconstructive surgical care and possible solutions specific to Uganda.Results:Among 17 practicing surgeons, most were men (76.5%) and based in urban areas (94.1%). Nearly half (41.2%) had 6–10 years of posttraining experience, and all (100%) reported a mixed reconstructive and aesthetic practice. There is a high reconstructive burden due to acute burn and burn complications, congenital anomalies, road traffic accidents, commonly from commercial motorcycles known as boda bodas, and an increasing rate of cancer. Despite the small number of surgeons and their desire to train more, a whole 53% are working in nonteaching hospitals. Of the 18 senior plastic surgery residents, 72.2% were men, with the majority in their fourth year of training.Conclusions:Establishing training hubs and implementing retention strategies for plastic surgeons, while strengthening regional hospital infrastructure, is essential for improving equitable access to quality plastic surgical care in Uganda.

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with a reduction in left ventricular systolic function towards the end of pregnancy or in the months after delivery. It is a life-threatening condition with a substantial mortality rate ranging from six to 25%, commonly due to heart failure or sudden cardiac death. Pregnancy is a prothrombotic state. Due to poor systolic function, women with PPCM are prone to intracardiac thrombi and a high risk of thromboembolic events. Early diagnosis with echocardiography and treatment plays a critical role. We describe a case of a woman with PPCM and biventricular thrombi, with the aim of creating awareness for early echocardiographic screening for thrombi and appropriate implementation of care.

ABSTRACT Several systematic reviews have been published on psychosocial care interventions (PCIs) in cancer care. However, there are limited systematic reviews and meta-analyses (SRMA) on the effectiveness of PCIs in cancer care for adults patients in low- and-middle income countries (LMICs). This study aimed at synthesizing the available evidence on the effectiveness of PCI in improving the quality of life (QoL) of adult cancer patients in LMICs. We registered the protocol with PROSPERO (ID: CRD4202342156) before conducting this SRMA. Studies published between 2002 and 2023 were searched from MEDLINE, Web of Science, EmBASE and APA PsycINFO. We followed the standard guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results of the pooled studies were analysed using MedCalc version 10.10 statistical software. Twenty-six intervention studies were included in this SRMA. The Eastern Mediterranean WHO region had the highest number of studies and Africa region had the least. Most studies utilised Cognitive Behavioural therapy-related interventions (38%, n = 10 studies), while Family systems therapy 4% (n = 1) was the least utilised. From the subgroup analyses of the means and standard deviations of domains of QoL in the pooled primary studies, the respective standardized mean differences indicated that the PCIs had a significant positive effect on the physical (0.972: p = 0.002), social (0.884: p = 0.005) and psychological (0.590: p = 0.03) domains of QoL of adult cancer patients. However, some PCIs did not improve the QoL of study participants. Generally, PCIs effectively improved most domains of the QoL of adult cancer patients. However, more research is needed for PCIs that had a negative effect on some domains of the QoL of cancer patients. Lastly, there is need for LMICs to prioritise resources to strengthen the integration of psychosocial care interventions in cancer care to meet the different QoL sub-domains of patients with cancer.

Lung ultrasound (LUS) vertical artifacts are critical sonographic markers commonly used in evaluating pulmonary conditions such as pulmonary edema, interstitial lung disease, pneumonia, and COVID-19. Accurate detection and localization of these artifacts are vital for informed clinical decision-making. However, interpreting LUS images remains highly operator-dependent, leading to variability in diagnosis. While deep learning (DL) models offer promising potential to automate LUS interpretation, their development is limited by the scarcity of annotated datasets specifically focused on vertical artifacts. This study introduces a curated dataset of 401 high-resolution LUS images, each annotated with polygonal bounding boxes to indicate vertical artifact locations. The images were collected from 152 patients with pulmonary conditions at Mulago and Kiruddu National Referral Hospitals in Uganda. This dataset serves as a valuable resource for training and evaluating DL models designed to accurately detect and localize LUS vertical artifacts, contributing to the advancement of AI-driven diagnostic tools for early detection and monitoring of respiratory diseases.

PurposeTo determine the prevalence and causes of blindness and vision impairment (VI) among adults aged ≥50 years in Western Uganda.MethodsA population-based cross-sectional survey was conducted in Western Uganda (July-August 2023) using RAAB7. Adults aged ≥50 years who had resided in the study districts for at least six months in the past year were eligible. Participants were identified through door-to-door household visits using a two-stage cluster sampling approach. Primary outcomes include prevalence of blindness and VI and its causes. Secondary outcomes include cataract surgical coverage (CSC), effective CSC (eCSC), refractive error coverage (REC), and effective REC (eREC).ResultsA total of 3,125 participants were examined (54.1% female). The adjusted prevalence of blindness (presenting visual acuity (PVA) <3/60) was 0.9% (95% CI: 0.5–1.3%). Severe, moderate, and mild VI were found in 0.9% (95% CI: 0.4–1.3%), 4.5% (95% CI: 3.3–5.8%), and 3.8% (95% CI: 3.0–4.6%), respectively. Untreated cataract was the leading cause of bilateral blindness (49.4%). The CSC and eCSC at the < 6/12 threshold were 19.7% and 7.3%, respectively. Only 19.4% of 108 operated eyes achieved good outcomes (PVA ≥ 6/12). The main barriers to cataract surgery included lack of awareness (32.8%), cost (23.9%), and perceived lack of need (20.9%). The adjusted prevalence of uncorrected refractive error as a cause of moderate VI was 1.6% (95% CI: 1.1–2.0%), and mild VI was 2.8% (95% CI: 2.2–3.5%). REC was 1.0%, while eREC was 0.6% (95% CI: 0.0–1.4%).ConclusionBlindness and vision impairment remain major public health issues in Western Uganda, primarily due to untreated cataract and uncorrected refractive error. Poor post-operative outcomes highlight the urgent need to improve surgical quality. These findings may guide targeted interventions and policy to strengthen eye care services.

Cesarean birth (CB) rates are increasing globally, with a current prevalence of 21.1% and a projected prevalence of 28.5% by 2030. Conversely, assisted vaginal birth (AVB) rates are declining, with reported rates of less than 10% in low- and middle-income countries (LMICs) and 10%-15% in high-income countries (HICs). In some African countries, AVB rates are as low as <1%. Declining AVB rates are attributable to lack of appropriate skills, equipment, and trained personnel, especially in LMICs, fear of litigation, and misconceptions that CB is safer, paucity of local guidelines and policies encouraging AVB, and increasingly accessible, acceptable, and safer CB techniques, amongst others. Optimizing appropriate care and decision making around CB and mode of birth is now a public health priority, especially given the significantly higher morbidity and mortality associated with CB compared to vaginal birth. Increasing AVB rates can potentially reduce CB rates, therefore improving maternity safety. This paper reviews the current best evidence on AVB and makes recommendations for good practice, including indications and prerequisites for AVB, who to determine who is suitable for AVB, choice of instrument, sequential application of instrument, when to abandon AVB, analgesia, antibiotic prophylaxis and episiotomy for AVB, special situations such as fetal macrosomia, maternal viral infections, previous CB, and risks and benefits of AVB versus second stage CB. An AVB safety checklist is included to reduce the risk of complications. We conclude by recommending that all maternity care providers and skilled birth attendants, including obstetricians, obstetric trainees/residents, interns, and midwives, should be trained and competent to perform AVB, to potentially reduce the current CB epidemic and its associated higher mortality and morbidity.