Soroti Hospital

Background: Monkeypox (Mpox) has resurfaced as a global health concern, extending beyond endemic areas into Southeast Asia, particularly Indonesia. Nurses, constituting the largest frontline workforce, are essential for outbreak identification, infection control, and community engagement. However, research indicates significant deficiencies in understanding, readiness, and vaccine adoption. Purpose: This review consolidates research about nurses' knowledge, attitudes, infection prevention practices, and vaccination preparedness during Mpox epidemics, highlighting their pivotal role in public health readiness. Methods: A systematic narrative review was performed in accordance with PRISMA 2020 guidelines. Five databases (PubMed, Scopus, Web of Science, CINAHL, ScienceDirect) were examined for studies conducted between January 2022 and May 2025. Qualified studies included nurses or healthcare professionals in Mpox settings and examined at least one target domain. Data were thematically synthesized, and quality was evaluated utilizing Joanna Briggs Institute instruments. Results: Five papers fulfilled the criteria: two cross-sectional surveys, one meta-analysis, one qualitative interview, and one narrative review. Knowledge scores varied between 34% and 76.7%, exhibiting prevalent deficiencies in transmission and personal protective equipment utilization. Attitudes were ambivalent, shaped by apprehension, stigma, and workload. IPC compliance varied between 60% and 85%, frequently impeded by insufficient training and institutional backing. Vaccine adoption ranged from 50% to 58.5%, with hesitation associated with safety apprehensions and misinformation. Conclusion: Nurses are inadequately prepared for Mpox outbreaks, particularly in low- and middle-income environments. To address these deficiencies, it is essential to provide specialized training, psychosocial support, and to engage nurses as co-designers of preparedness plans rather than only as executors.

The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive biomarker that potentially predicts acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). We evaluated the association of baseline NLR and respiratory hospitalization risk within one year among chronic obstructive pulmonary disease (COPD) patients in Uganda, a low- and middle-income country. A total of 312 COPD patients were followed for one year. Clinical characteristics and exacerbation rates were collected. Poisson regression with robust variance estimators was used to measure the association between NLR and hospital admissions due to COPD exacerbations. Receiver-operator characteristic (ROC) curves and the area under the curve were used to assess the ability of NLR to predict AECOPDs. The median (Q 1, Q 3) age was 64 years (53, 71). Females comprised 50.96% (n=159) of the cohort, and 71.2% (n=222) of participants had moderate or severe COPD. A total of 9.9% (n=31) of participants experienced a COPD exacerbation during the period of follow-up. At baseline, the median (Q 1, Q 3) NLR ratio among participants who experienced an exacerbation was 1.46 (0.92, 2.33) compared to 1.03 (0.72,1.42) among those who did not experience one during the follow-up period (p=0.002). Using Youden and Liu's methods, the optimal NLR cutoff for predicting COPD exacerbation was 1.17. This cutoff resulted in a ROC curve area of 0.64 (95% confidence interval: 0.56, 0.73). The NLR could be used as a risk predictor, in low- and middle-income countries, for hospital admissions due to COPD exacerbations. A cutoff of 1.17 was an independent predictor of hospitalization due to acute exacerbations of COPD within one year.

Background: Globally, Human Immunodeficiency Virus (HIV) continues to be a major public health burden. Transmission occurs by several means including the transmission from mother to child mostly happening during labor and delivery. The objective of this study was to determine the prevalence and factors associated with HIV infection in women who delivered at Soroti Teaching/Regional Referral Hospital. Methods: A cross-sectional study was conducted from April to June 2023. A total of 422 mothers who delivered in Soroti Regional Referral and Teaching Hospital were sampled by systematic random sampling. A structured data extraction tool was developed and data were collected using the Kobo Collect mobile application. Data was analyzed using STATA 15 and modified Poisson regression model was used for inferential statistics. Statistical significance was accepted for a value of p < 0.05. Results: The average age of the population was 26 years (SD = 0.5). The HIV prevalence was 5.3%. Associated factors were Gravidity ≥ 5 (PR- 95% CI = 1.54 to 1.57, P = 0.007), previous miscarriage ≥ 3 (PR = 0,266 (0.11, 0.642) CI 95%, P = 0.003), Hepatitis B PR-19.429 (2.613, 144.43) CI 95% p = 004 and residing in a rural setting (PR = 2.506 (1.05, 1.593) CI 95% p = 0.038). Conclusion: HIV prevalence among women who delivered at Soroti Teaching Hospital during the study period was 5.3%. Gravidity above 7, Hepatitis B infection, miscarriages more than or equal to 3 and living in a rural setting were significantly associated with HIV infection. Prevention of subsequent pregnancies and sexually transmitted diseases like hepatitis B are key factors in the prevention of HIV.

Dementia is on the rise due to increasing proportion of old people in sub-Saharan Africa (SSA). Although dementia is misattributed to normal ageing or supernatural causes in SSA, it is a brain disease with well-established etiologies. Limited knowledge and understanding of dementia means that many older people are suffering without seeking help and are undiagnosed and untreated. The aim of this study was to determine the prevalence and factors associated with probable dementia and to describe the knowledge of the disease among adults 50 years and over attending a faith-based geriatric center in Uganda. This was a cross-sectional study using quantitative methods. A total of 267 adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda were interviewed between 1 April and 15 May 2022. Interviews were administered using the Early Dementia Questionnaire (EDQ) and Dementia Knowledge Assessment Scale (DKAS). Data on participants’ socio-demographics, economic income, living arrangement, history of smoking, alcohol consumption, exercise and past medical history was collected using an additional questionnaire. Adults 50 years and over were included in the study. Logistic regression analyses were done. Probable dementia was 46.2% in the sample. The most common symptoms of probable dementia in the order of their severity were memory symptoms, (β co-efficient β 0.08, p < .001), physical symptoms (β 0.08, p < .001), sleep disturbances (β 0.81, p < .001) and emotions (β 0.04, p < .027). The final degree of association as determined by adjusted PR in the multivariable model revealed that only older age (aPR = 1.88, p < .001) and occasional/non-believer (aPR = 1.61, p = .001) remained significantly related to probable dementia. The study also found that 8.0% of the participants had optimal knowledge of dementia. There is high burden of probable dementia among adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda. Factors associated with probable dementia are older age and being an occasional/non-believer. Knowledge of dementia among older adults is low. There is need to promote integrated early dementia screening, care and educational program in primary care to reduce the disease burden. Spiritual support would be a rewarding investment in the lives of the ageing population.

IntroductionThe impact of COVID-19 on low-resource surgical systems is concerning but there are limited studies examining the effect in low- and middle-income countries. This study assesses changes in surgical capacity during the COVID-19 pandemic at Soroti Regional Referral Hospital, a tertiary healthcare facility in Soroti, Uganda.MethodsPatients from a prospective general surgery registry at SRRH were divided into cohorts admitted prior to the pandemic (January 2017 to February 2020) and during the pandemic (March 2020 to May 2021). Demographics, pre-hospital characteristics, in-hospital characteristics, provider-reported delays in care, and adverse events were compared between cohorts.ResultsOf the 1547 general surgery patients, 1159 were admitted prior to the pandemic and 388 were admitted during the pandemic. There was no difference in the median number of elective (24.5 vs. 20.0, p value = 0.16) or emergent (6.0 vs. 6.0, p value = 0.36) surgeries per month. Patients were more likely to have a delay in surgical care during the pandemic (22.6% vs. 46.6%, p < 0.01), particularly from lack of operating space (16.9% vs. 46.3%, p < 0.01) and lack of a surgeon (1.6% vs. 4.4%, p < 0.01). Increased proportion of delays in care appear correlated with waves of COVID-19 cases at SRRH. There were no changes in rates of adverse events (5.7% vs. 7.7%, p = 0.18).DiscussionThe COVID-19 pandemic caused significant increases in surgical care delays and emergency surgery at SRRH. Strengthening surgical systems when not in crisis and including provisions for safe, timely surgical delivery during epidemic resource allocation is needed to strengthen the overall healthcare system.

Abstract The COVID-19 pandemic posed a significant threat to healthcare systems worldwide. Efforts to contain the pandemic, including lock-down and cancellation of elective surgery, increased barriers to healthcare. Its impact on the access to surgical care of children in less resourced contexts is not known. This study investigated how paediatric surgical services was affected during the pandemic in the Teso sub-region in Eastern Uganda. Data were collected from theatre logbooks about surgical activity before and during the pandemic (2019–2021). Data about health workers’ and parents’ experience of how access to surgical service for children was affected during the Covid-19 pandemic were collected through interviews. Total surgical procedures for children increased by 24% between 2019 (n = 1407) and 2021 (n = 1751). Procedures performed for pregnancy-related conditions increased most (58.3% increment). 12 parents and 25 health workers participated in the interviews. Using reflexive thematic analysis, two themes emerged. A reduction of surgical service delivery was expected as barriers to surgical care increased in several ways. However, the number of surgical procedures performed increased compared to before the pandemic. Many lessons were learned, and health care system was reinforced. This is an important momentum for building a resilient health care system for future challenges.

&lt;span&gt;The COVID-19 epidemic has spread massively to almost all countries including Indonesia, in just a few months. An important step to overcoming the spread of the COVID-19 is understanding its epidemiology through mathematical modeling intervention. Knowledge of epidemic dynamics patterns is an important part of making timely decisions and preparing hospitals for the outbreak peak. In this study, we developed the susceptible-infected-recovered-dead (SIRD) model, which incorporates the key epidemiological parameters to model and estimate the long-term spread of the COVID-19. The proposed model formulation is data-based analysis using public COVID-19 data from March 2, 2020 to May 15, 2021. Based on numerical analysis, the spread of the pandemic will begin to fade out after November 5, 2021. As a consequence of this virus attack, the cumulative number of infected, recovered, and dead people were estimated at ≈ 3,200,000, ≈ 3,437,000 and ≈ 63,000 people, respectively. Besides, the key epidemiological parameter indicates that the average reproduction number value of COVID-19 in Indonesia is 7.32. The long-term prediction of COVID-19 in Indonesia and its epidemiology can be well described using the SIRD model. The model can be applied in specific regions or cities in understanding the epidemic pattern of COVID-19.&lt;/span&gt;

Background: To prevent poor long-term outcomes (deaths and readmissions) the integrated global action plan for pneumonia and diarrhoea recommends under the 'Treat' element of Protect, Prevent and Treat interventions the importance of continued feeding but gives no specific recommendations for nutritional support. Early nutritional support has been practiced in a wide variety of critically ill patients to provide vital cell substrates, antioxidants, vitamins, and minerals essential for normal cell function and decreasing hypermetabolism. We hypothesise that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery. We suggest that providing additional energy-rich, protein, fat and micronutrient ready-to-use therapeutic feeds (RUTF) to help meet additional nutritional requirements may improve outcome. Methods: COAST-Nutrition is an open, multicentre, Phase II randomised controlled trial in children aged 6 months to 12 years hospitalised with suspected severe pneumonia (and hypoxaemia, SpO 2 <92%) to establish whether supplementary feeds with RUTF given in addition to usual diet for 56-days (experimental) improves outcomes at 90-days compared to usual diet alone (control). Primary endpoint is change in mid-upper arm circumference (MUAC) at 90 days and/or as a composite with 90-day mortality. Secondary outcomes include anthropometric status, mortality, readmission at days 28 and 180. The trial will be conducted in four sites in two countries (Uganda and Kenya) enrolling 840 children followed up to 180 days. Ancillary studies include cost-economic analysis, molecular characterisation of bacterial and viral pathogens, evaluation of putative biomarkers of pneumonia, assessment of muscle and fat mass and host genetic studies. Discussion: This study is the first step in providing an option for nutritional support following severe pneumonia and will help in the design of a large Phase III trial. Registration: ISRCTN10829073 (6 th June 2018) PACTR202106635355751 (2 nd June 2021).

Background:Multidrug-resistant tuberculosis (MDR-TB) is one of the most urgent challenges that Malawi tends to take a firm public health action. A recent increase in multidrug MDR-TB cases, a decrease in treatment success rate, and a double increase of lost-to-follow-up call into question the country’s programmatic management of MDR-TB (PMDT). As such, the study aimed at exploring programmatic challenges in managing MDR-TB in Malawi.Methods:A comprehensive and nonsystematic search was made in PubMed and Google Scholar using mainly the keywords “MDR-TB” “extensively drug-resistant TB,” Malawi. The study reviewed existing guidelines and gray literature and reviewed data obtained from the national TB program (NTP) as well.Results:The study found the following challenges affecting PMDT: decrease in funding, partial access to GeneXpert, delay in diagnosis, long treatment duration, lack of adequate personal protective equipment, the long turnaround time of culture results, failure to initiate all diagnosed patients on treatment, absence of alternative second-line medicines, and lack of transport from health facilities to patient homes.Conclusion:If the Malawi NTP is to achieve a vision of a “TB-free Malawi,” rigorous efforts at all levels must be made, including mobilizing domestic resources for improved MDR-TB program performance. Developing partners should continue providing the much-needed funding to the Malawi government to stand in the wake of the MDR-TB crisis.

SummaryBackgroundSevere anaemia is a leading cause of paediatric admission to hospital in Africa; post-discharge outcomes remain poor, with high 6-month mortality (8%) and re-admission (17%). We aimed to investigate post-discharge interventions that might improve outcomes.MethodsWithin the two-stratum, open-label, multicentre, factorial randomised TRACT trial, children aged 2 months to 12 years with severe anaemia, defined as haemoglobin of less than 6 g/dL, at admission to hospital (three in Uganda, one in Malawi) were randomly assigned, using sequentially numbered envelopes linked to a second non-sequentially numbered set of allocations stratified by centre and severity, to enhanced nutritional supplementation with iron and folate-containing multivitamin multimineral supplements versus iron and folate alone at treatment doses (usual care), and to co-trimoxazole versus no co-trimoxazole. All interventions were administered orally and were given for 3 months after discharge from hospital. Separately reported randomisations investigated transfusion management. The primary outcome was 180-day mortality. All analyses were done in the intention-to-treat population; follow-up was 180 days. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN84086586, and follow-up is complete.FindingsFrom Sept 17, 2014, to May 15, 2017, 3983 eligible children were randomly assigned to treatment, and followed up for 180 days. 164 (4%) were lost to follow-up. 1901 (95%) of 1997 assigned multivitamin multimineral supplement, 1911 (96%) of 1986 assigned iron and folate, and 1922 (96%) of 1994 assigned co-trimoxazole started treatment. By day 180, 166 (8%) children in the multivitamin multimineral supplement group versus 169 (9%) children in the iron and folate group had died (hazard ratio [HR] 0·97, 95% CI 0·79–1·21; p=0·81) and 172 (9%) who received co-trimoxazole versus 163 (8%) who did not receive co-trimoxazole had died (HR 1·07, 95% CI 0·86–1·32; p=0·56). We found no evidence of interactions between these randomisations or with transfusion randomisations (p>0·2). By day 180, 489 (24%) children in the multivitamin multimineral supplement group versus 509 (26%) children in the iron and folate group (HR 0·95, 95% CI 0·84–1·07; p=0·40), and 500 (25%) children in the co-trimoxazole group versus 498 (25%) children in the no co-trimoxazole group (1·01, 0·89–1·15; p=0·85) had had one or more serious adverse events. Most serious adverse events were re-admissions, occurring in 692 (17%) children (175 [4%] with at least two re-admissions).InterpretationNeither enhanced supplementation with multivitamin multimineral supplement versus iron and folate treatment or co-trimoxazole prophylaxis improved 6-month survival. High rates of hospital re-admission suggest that novel interventions are urgently required for severe anaemia, given the burden it places on overstretched health services in Africa.FundingMedical Research Council and Department for International Development.