Naguru General Hospital

<title>Abstract</title> <bold>Background</bold> : Globally, about 26% of women experience maternal near miss (MNM) events during pregnancy or childbirth. MNM events are a crucial indicator for evaluating maternal health services and achieving SDG3 which aims to reduce maternal mortality. The study aimed to determine the predictors of MNM among postnatal mothers at Hoima Regional Referral Hospital. <bold>Methodology:</bold> Study design was cross sectional with a quantitative research approach. Using Cochran’s (1977) formula for sample size computation 289 respondents were assessed and sociodemographic, obstetric and other health related data collected from August to September 2025. Statistical analysis involved chi squares, and logistic regressions through SPSS version 27. P values &lt; 0.05 were considered significant. Ethical approval was obtained from the research ethics committee of Uganda Martyrs University. Other ethical principles like informed consent, anonymity were accordingly upheld. <bold>Results</bold> : Of the assessed mothers, 113/289 (39.1%) were near miss. Underlying causes of maternal near miss were obstetric hemorrhage 54/113 (47.8%), pregnancy‑related infections 30/113 (26.5%), hypertensive disorders 15/113 (13.3%) and other conditions 14/113 (12.3%). Modifiable factors that significantly predicted maternal near miss included having four or fewer ANC visits during pregnancy (AOR = 2.01, [CI: 1.11-3.98], p = 0.047), whereas non modifiable factors that significantly predicted maternal near miss included severe post-partum hemorrhage (AOR = 18.95, [CI: 5.26-68.21], p &lt; 0.001), severe pre-eclampsia (AOR = 4.32, [CI: 3.33-5.57], p &lt; 0.001), sepsis AOR = 5.28, [CI: 7.45-12.22], p = &lt; 0.001) and delivery from the hospital (AOR = 0.23, [CI: 0.08-0.71], p = 0.010). <bold>Conclusion</bold> : The result highlights critical need for targeted intervention to address these leading causes, improve referral system and enhance care for high-risk mothers to eventually reduce the incidence of MNM.

Abstract Background: Hepatitis B virus (HBV) infections are a significant public health concern globally, affecting about 3.2 % of the global population. Few studies have focused on expectant mothers, particularly in urban settings in Uganda. This study assessed the prevalence, knowledge of, and factors associated with HBV infection among expectant mothers attending antenatal care at China-Uganda Friendship Hospital, Naguru, a large urban tertiary hospital in Kampala, Uganda. Methods: We conducted a cross-sectional study among 384 expectant mothers attending antenatal care from July 2024 to August 2024. Data on socio-demographics, HBV knowledge, maternal and behavioural factors were collected using semi-structured questionnaires. HBV status was also determined through serological testing using hepatitis B surface antigen kits. Associations between HBV infection and various factors were analysed using multivariable logistic regression with adjusted odds ratios (AOR) as the measure of association. Results: Among the 384 participants, the median age was 27 years, 336 (87.5%) were married, and their median gravidity was 2. The HBV prevalence was 2.6%, while most respondents (56.3%) had poor knowledge. Factors significantly associated with HBV infection included a positive family history of HBV (AOR 5.63; 95% CI: 1.26-25.06) and a history of body piercing (AOR 5.03; 95% CI: 1.24-20.33). Conclusion: HBV prevalence among expectant mothers at CUFHN was intermediate, and most participants had poor knowledge. Family history and body piercing were significant factors associated with HBV infections. We recommend awareness campaigns, risk-based education, and vaccination for women of reproductive age.

RationaleAcute hypoxaemic respiratory failure (AHRF) is associated with high mortality in sub-Saharan Africa. This is at least in part due to critical care-related resource constraints including limited access to invasive mechanical ventilation and/or highly skilled acute care workers. Continuous positive airway pressure (CPAP) and high-flow oxygen by nasal cannula (HFNC) may prove useful to reduce intubation, and therefore, improve survival outcomes among critically ill patients, particularly in resource-limited settings, but data in such settings are lacking. The aim of this study is to determine whether CPAP or HFNC as compared with standard oxygen therapy, could reduce mortality among adults presenting with AHRF in a resource-limited setting.MethodsThis is a prospective, multicentre, randomised, controlled, stepped wedge trial, in which patients presenting with AHRF in Uganda will be randomly assigned to standard oxygen therapy delivered through a face mask, HFNC oxygen or CPAP. The primary outcome is all-cause mortality at 28 days. Secondary outcomes include the number of patients with criteria for intubation at day 7, the number of patients intubated at day 28, ventilator-free days at day 28 and tolerance of each respiratory support.Ethics and disseminationThe study has obtained ethical approval from the Research and Ethics Committee, School of Biomedical Sciences, College of Health Sciences, Makerere University as well as the Uganda National Council for Science and Technology. Patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04693403.Protocol version8 September 2023; version 5.

BackgroundInfants living with HIV are at high risk of tuberculosis and death. Optimal antituberculosis therapy is essential for favourable clinical outcomes particularly in severely ill children. Using WHO-recommended weight-band dosing, younger children weighing <8kg are at risk of suboptimal exposures. We aimed to evaluate plasma concentration of first line antituberculosis drugs in infants with HIV. MethodsEMPIRICAL trial (#NCT03915366; EDCTP2-funded (RIA2017MC-2013)) is a randomized controlled trial evaluating empirical antituberculosis and cytomegalovirus treatment in infants with HIV hospitalized for severe pneumonia in 5 African countries. Eligible infants aged <1 year, weighing ≥3kg, on antituberculosis treatment had a blood sample taken 2-hours post-dose at days 30, 90 and 180 in a pharmacokinetic sub-study. Antituberculosis drugs were dosed according to WHO weight-bands using fixed-dose-combination dispersible tablets of rifampicin(15mg/kg)/isoniazid(10mg/kg)/pyrazinamide(35mg/kg) 75/50/150mg with ethambutol(20mg/kg) 100mg. Antiretroviral-naïve infants initiated treatment in accordance with national guidelines. We compared C2hr plasma concentrations for rifampicin, isoniazid, pyrazinamide, and ethambutol with published Cmax references. ResultsForty-nine infants of whom 21 were female, median (range) age 6.1(2.5–13.5) months and weighing 5.3(3.4–8.7) kg were included in the analysis of study day 30. The geometric mean (CV%) C2hr for rifampicin, isoniazid, pyrazinamide and ethambutol were 3.66(161) mg/L, 2.80(102) mg/L, 22.27(97) mg/L, and 0.56(101) mg/L, respectively. The C2hr values were substantially below adult reference Cmax for rifampicin [ref in adults (10 mg/kg dose): 8–24 mg/L] and ethambutol [ref: 2–6 mg/L], slightly lower for isoniazid [ref: 3–6 mg/L], and within range for pyrazinamide [ref: 20–60 mg/L].ConclusionPlasma levels of first-line TB drugs in infants with HIV and severe pneumonia were low compared to adults. This is consistent with other studies showing that infants and younger children do not achieve adult references for first-line TB drugs at current recommended doses. Our data support considerations for optimising dosing of first-line TB drugs for infants.

Periportal fibrosis is a late-stage manifestation of chronic infection with Schistosoma mansoni . Praziquantel (PZQ), the only drug available for the treatment of schistosomiasis, has limited effect in treating established morbidity. Preschool-age children (PSAC) are not considered to be an at-risk population for severe morbidity. However, the prevalence of periportal fibrosis in PSAC in S. mansoni endemic settings is unknown. As part of a phase II clinical trial comparing different dosing regimens of PZQ in children age 12-47 months infected with S. mansoni in Uganda ("praziquantel in preschoolers" trial), we present baseline results assessing liver ultrasound (US) findings as per the WHO Niamey Protocol. A total of 7/347 (2%) PSAC had Image Pattern C with pipe stems and echogenic rings suggestive of periportal fibrosis, 29/347 (8%) had Image Pattern B and 58 (17%) had evidence of periportal thickening There were higher adjusted odds of periportal thickening with older age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00-1.07], primary maternal education (OR: 1.04; 95% CI: 1.00-1.07) and being taken to the lake weekly (OR: 3.02; 95% CI: 1.19-7.63). A further 44/347 children (13%) had a rounded caudal liver edge which was associated with high S. mansoni infection intensity (adjusted OR: 3.31; 95% CI: 1.46-7.51). Incipient schistosomiasis-related liver morbidity was detected in young children enrolled in the praziquantel in preschoolers trial. Adequate age-adjusted reference measurements for liver ultrasound findings in very small children are lacking but urgently needed. Schistosomiasis-related fibrosis may be delayed or averted with early and repeated PZQ treatment.

ABSTRACTNot all patients produce sputum, yet most available TB tests use sputum. We investigated the utility of a novel RNA-based quantitative test, the tuberculosis molecular bacterial load assay (TB-MBLA), for the detection and quantification of Mycobacterium tuberculosis in stool. Stools from 100 adult individuals were treated with OMNIgene-sputum reagent and tested using Xpert MTB/RIF ultra (Xpert ultra), auramine O smear microscopy (smear), mycobacterial growth indicator tube (MGIT), and Lowenstein-Jensen (LJ) cultures. The remaining portions were frozen at −20°C and later tested by TB-MBLA. MGIT sputum culture was used as a TB confirmatory test and reference for stool tests. Sixty-one of 100 participants were already confirmed TB positive by MGIT sputum culture, 20 (33%) of whom were HIV coinfected. TB-MBLA detected M. tuberculosis in 57/100 stool samples, including 49 already confirmed for TB. The mean bacterial load measured by stool TB-MBLA was 5.67 ± 1.7 log10 estimated CFU (eCFU) per mL in HIV-coinfected participants, which was higher than the 4.83 ± 1.59 log10 eCFU per mL among the HIV-negative participants (P = 0.04). The sensitivities (95% confidence intervals [CI]) of stool assays were 80% (68 to 89) and 90% (79 to 98) for TB-MBLA and Xpert ultra, which were both higher than the 44% (32 to 58), 64% (51 to 76), and 62% (45 to 77) for smear, MGIT, and Lowenstein-Jensen (LJ) stool cultures, respectively. The specificity (95% CI) of stool assays was highest for smear, at 97% (87 to 100), followed by Xpert ultra at 91% (76 to 98), TB-MBLA at 79% (63 to 90), LJ at 80% (64 to 91), and MGIT at 62% (45 to 77). Twenty-six percent of MGIT and 21% of LJ stool cultures were indeterminate due to contamination. Detection and quantification of viable M. tuberculosis bacilli in stool raises its utility as an alternative to sputum as a sample type for TB diagnosis.IMPORTANCE This paper highlights the value of stool as a sample type for diagnosis of tuberculosis. While other studies have used DNA-based assays like the Xpert MTB/RIF and culture to detect Mycobacterium tuberculosis in stool, this is the first study that has applied TB-MBLA, an RNA-based assay, to quantify TB bacteria in stool. The high microbial density and diversity in stool compromises the specificity and sensitivity of culture-based tests due to overgrowth of non-M. tuberculosis flora. Consequently, TB-MBLA becomes the most sensitive and specific test for the detection and quantification of viable TB bacteria in stool. Most crucially, this study raises the possibility of a nonsputum alternative sample type for diagnosis of TB among people who have difficulty in producing sputum.