Rubaga 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.

ABSTRACTObjective To identify modifiable intensive care unit factors associated with outcomes among patients receiving invasive mechanical ventilation in a low-income setting.Methods This prospective, multicenter, registry-embedded observational study has two components: a prospective registry-based cohort assessing patient- and care-process-related factors and a cross-sectional intensive care unit survey evaluating organizational structure. Functional intensive care units in Uganda will be included. Patients aged ≥ 15 years old requiring invasive mechanical ventilation will be enrolled. Patients extubated within 48 hours, transferred after > 24 hours, and imminent early death will be excluded. Primary outcomes will include 28-day intensive care unit mortality, intensive care unit length of stay, and mechanical ventilation duration. Tracheostomy-related outcomes will be explored in a pre-planned sub-study. Factors potentially associated with outcomes will be categorized into non-modifiable and potentially modifiable factors. Non-modifiable factors will include patient-related factors like age, comorbidities, and illness severity; potentially modifiable factors include processes of care (e.g., sedation levels) and intensive care unit organizational structure (e.g., staffing patterns). Multilevel multivariable logistic regression models will assess association outcomes. Survival analysis (Kaplan-Meier curves) will explore mortality trends. Confounders will be identified using directed acyclic graphs.Results (anticipated findings) This study will generate high-quality data on modifiable intensive care unit factors associated with ventilated patient outcomes in low-resource settings.Conclusion This is Uganda’s first registry-embedded, multicenter intensive care unit study to systematically potentially modifiable factors associated with ventilated patient outcomes. This study will provide evidence-based insights to optimize critical care management in low- and middle-income countries by leveraging real-time intensive care unit registry data.

<title>Abstract</title> Background Maternal tuberculosis (TB) remains a significant risk factor for compromising infant immune development in high-burden TB disease settings. The integrity of B-cells in early life is important for the development of immediate and long-term immunity in infants. This study assessed circulating B-cell subset frequencies in babies born to mothers with and without active TB in Uganda. Methods A cohort of 46 mother-infant pairs (24 cases, 22 controls) was recruited between September 2021 and July 2022 from three health facilities in Kampala. Infant cases were born to mothers with active TB, whereas infant controls were born to mothers without active TB. Peripheral blood mononuclear cells (PBMCs) were collected and processed from infants at baseline (≤ 1 month of age), and at three months and six months. PBMCs were stained with a 15-marker B-cell panel for spectral flow cytometry. Data were analysed using FlowJo and R v4.4.3. Mixed-effects modelling was applied for statistical testing, with time point as a fixed effect and participant as a random effect. Post-hoc comparisons used estimated marginal means. Results At baseline, infant cases were associated with decreased mean circulating frequencies of total B cells (18.5 versus 30.2; p = 0.02), naïve B cells (55.1 versus 68.9; p = 0.01), and mature B cells (43.6 versus 66.5; p = 0.03) compared to infant controls. Additionally, the infant cases were associated with increased baseline immature (56.4 versus 33.4; p = 0.03) and antibody-secreting B cells (15.6 versus 10.5; p = 0.04) compared to infant controls. No differences were observed at three or six months, except for IgG-only memory B cells, which were increased among infant cases at six months (14.4 versus 8.3; p = 0.04). Conclusions Exposure to <italic>Mycobacterium tuberculosis</italic> in utero may decrease the preimmune B-cell repertoire in early life, potentially increasing the risk of neonatal infections and altered responses to routine infant vaccines. Prompt diagnosis and treatment of TB during pregnancy are therefore crucial to prevent poor neonatal morbidity and mortality in our setting.

Diabetes mellitus (DM) is a significant contributor to tuberculosis (TB) incidence and poor treatment outcomes. This study explored the impact of isoniazid preventive therapy (IPT) on Mycobacterium tuberculosis (Mtb)-specific T-cell memory phenotypes and function among participants with latent TB infection and DM (LTBI-DM) at baseline and after 6 months of IPT; and compared the responses to healthy controls (HC). Peripheral blood mononuclear cells were stimulated with ESAT-6 and CFP-10 peptide pools to analyse CD4+ and CD8+ T-cell responses using flow cytometry. In LTBI-DM participants, effector memory CD4+ and CD8+ T cells were decreased post-IPT, suggesting a shift towards a less-activated state or differentiation into other subsets. CXCR5 expression on both CD4+ and CD8+ T cells was upregulated, while PD-1 expression was downregulated post-IPT, indicating reduced T-cell exhaustion and improved homing capabilities. Lastly, IL-17 A and IL-13 production in CD4+ and CD8+ T cells was increased post-IPT, respectively, which play a role in enhanced Mtb infection control. The post-IPT T-cell alterations were similar to normal HC levels. These findings suggest that IPT modulates and normalises specific T-cell memory phenotypes and functional responses in LTBI-DM participants, potentially contributing to improved long-term immunity and protection against TB. This study highlights the importance of preventive therapy in high-risk populations, and larger studies with more extended follow-up are needed to assess long-lasting IPT effects.

Background Malaria remains a significant public health concern globally, with Sub-Saharan Africa bearing the largest burden. Insecticide-Treated Nets (ITNs) are a cornerstone in malaria prevention, as a cost-effective and efficient strategy. Despite the widespread distribution and promotion of ITNs, their utilization remains suboptimal in many endemic regions. This study aimed to assess the knowledge of ITN utilization in malaria prevention among residents of Mutungo Zone IV, Kampala district. &nbsp;Methodology The study was a cross-sectional study design that involved a quantitative data collection method. 30 participants were selected using a simple random sampling method. Data was collected using semi-structured questionnaires consisting of open and closed-ended questions, data was analyzed and presented in tables, graphs, and pie-charts where frequencies and percentages were used. &nbsp;Results Majority 21(70%) were female, and the minority 9(30%) were male. Most 12(40%) were between 31-40years and the minority 4(13.3%) were between 10-30 years. The majority of the respondents (57%) reported the use of ITNs as the best way of preventing malaria and (6.7%) reported draining of water-logged areas. 28(93.3%) wanted to know more information concerning with ITNs. 22(73.3%) said that ITNs are used to protect against malaria. 17(57%) said that the use of ITNs is the most effective malaria preventive measure. &nbsp;Conclusion The study found relatively good knowledge about ITN use because respondents knew the purpose of insecticide-treated bed nets and also knew that the use of ITNs is the most effective. Malaria preventive measure. &nbsp;Recommendation The Government/ Ministry of Health should conduct door-to-door education talks on the utilization of ITNs in the prevention of malaria.

Background Folic acid supplementation is essential for preventing neural tube defects in developing fetuses. Understanding attitudes and perceptions at Kagote Health Centre III is crucial for developing effective health interventions and improving maternal and child health outcomes. Therefore, this study seeks to assess the attitude and the perceptions of pregnant mothers towards folic acid supplementation at Kagote Health Centre III, Kabarole District. Methodology The study employed a descriptive cross sectional study design and questionnaires comprising of both structured and unstructured questions were used. Data collected was entered into Microsoft excel, 2013 and analyzed. Results Findings also revealed that 2(7%) of the respondents had bad pregnancy outcome while the majority 28 (93%) had no bad pregnancy outcome. Among those who had bad pregnancy, one had a miscarriage while the other had a newborn with neural tube defect. In addition, majority 28(93%) of the respondents will continue using folic acid supplements throughout the pregnancy since they had better perceptions for folic acid. Furthermore, findings revealed that that 2(7%) of the respondents had bad pregnancy outcome while the majority 28 (93%) had no bad pregnancy outcome. Among those who had bad pregnancy, one had a miscarriage while the other had a newborn with neural tube defect and so cannot continue using folic acid supplements throughout the pregnancy. Conclusion Most respondents had positive pregnancy outcomes and plan to continue using folic acid supplements. However, a few experienced adverse outcomes, influencing their decision against continued supplementation. Recommendation The researcher recommends nurses make another study on factors that promote adherence to folic acid supplementation so that neural birth defects and miscarriages are prevented.

Background: Wound management is a critical component of post-operative care particularly for mothers recovering from caesarean sections. Proper wound care can significantly impact recovery times, reduce infection risk, and improve maternal health outcomes. However, the effectiveness of wound management is influenced by many factors including health workers, health facilities, and health-related variables. Therefore, this study seeks to determine the health worker, health facility, and health-related factors affecting proper wound management by health workers attending cesarean section mothers seeking health services in Mukono General Hospital Mukono District. Methodology: A descriptive cross-sectional study was used with a purposive sampling method to select 30 study participants. Structured questionnaires were used to collect data being analyzed using Microsoft Excel and presented using tables, figures, graphs, and charts. Results: The study findings on health worker-related factors were that 17(56.7%) were certificate holders, 20(66.7%) rarely washed their hands during cesarean section incision site care and 24(80%) reported a shortage of time. Health facility-related factors included; 16(53.3%) reporting the absence of policies about wound care at the unit, 24(80%) never received supervision during wound care, and 28(93.3%) reporting the absence of guidelines on wound management. Patient-related factors; 21(70%) reported patients weighing above 75 kilograms, 17(56.7%) reported diabetes and 16(69.6%) reported alcohol intake was challenging with wound healing. Conclusion: Factors that affected proper wound management health workers, health facilities, and health-related factors consisted of low academic qualification, inconsistent hand washing, shortage of time, absence of policies, supervision, guidelines, and training, high body weight, alcohol intake, comorbidities especially diabetes, herb medicine use and absence of support from family members. Recommendation: Stakeholders should improve the quality of health facility management systems and sensitize mothers about appropriate cesarean wound care.

Background Globally, mental illness affects over 970 people, with 1 in every 8 people, and is among the leading causes of the global burden of disease. The purpose of the study was to assess the challenges faced by nurses in the provision of mental health in Masaka Regional Referral Hospital, Masaka City. Methodology A descriptive cross-sectional study design that utilized quantitative methods of data collection was conducted at Masaka Regional Referral Hospital, in 3 days, 30 nurses were selected using the purposive sampling method. Results The majority 16(53%) of the respondents agreed that it is hard to develop a health worker-patient relationship with mentally ill patients due to the aggressive behavior of patients, 22(73%) of the respondents said that patient’s economic status affected their services, 16(53%) of the respondents said that drug stock outs affected the wellness pattern of mentally ill patients, 17(57%) said they were affected psychologically while taking care of mentally ill patients since other people would say that they were behaving like mentally ill patients, 23(77%) mentioned that they had ever been aggressively harassed by mentally ill patients, and 18(60%) said that the facility administration rarely held training for the management of mental illnesses. Conclusion Challenges faced by nurses in the provision of mental health services included; difficulty in developing a nurse-patient relationship due to aggressive behavior, drug stock-outs which affected the wellness pattern of patients, and lack of training on management of mental illnesses. Recommendation The Ministry of Health and the Management of Masaka Regional Referral Hospital should encourage nurses to practice self-care and prioritize their well-being, resources and workshops on stress management techniques, and provide enough drugs to use during the provision of mental health services.