St. Mary's Hospital Lacor

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.

Referral is critical in the chain of managing women receiving post-abortion care (PAC). We assessed factors influencing referral among women receiving PAC at two tertiary hospitals in Northern Uganda. An embedded, mixed-methods study design was conducted from July to December 2023. Quantitative data were collected from 152 women of reproductive age (15–49 years) using structured questionnaires, while qualitative data were gathered through 20 in-depth interviews with women and healthcare providers. Logistic regression was applied for quantitative analysis, and thematic content analysis was used for qualitative data. Median age of all participants was 26 years (IQR: 21–32). Referrals accounted for 46 (30.3%). The odds of being referred was significantly higher among rural residence (adjusted Odds Ratio (aOR): 15.5; 95% Confidence Interval (CI) 4.44–53.83; p < 0.001) and those under 20 years of age (aOR: 2.8; 95% CI 1.02–7.56; p = 0.046). Qualitatively, limited PAC services at lower-level facilities, financial barriers to private care, and transport challenges were key drivers for referral. Therefore, strengthening PAC services at lower-level facilities could reduce referrals and improve care access. Major economic reforms are essential to achieving universal health coverage, including PAC services in northern Uganda.

PURPOSEHepatocellular carcinoma (HCC) is common and deadly in sub-Saharan Africa, where advanced imaging techniques, such as computerized tomography and magnetic resonance imaging, are scarce. The purpose of this study was to develop a pragmatic HCC diagnostic strategy for such settings.METHODSWe evaluated standardized protocol-collected data on clinical, ultrasonographic, biochemical, and pathological criteria in a multisite study of 649 suspected HCC cases in Uganda. Participants underwent standardized interviews, clinical assessments, and ultrasound examinations by trained staff with alpha-fetoprotein (AFP) testing at a central laboratory, and pathology was obtained for selected participants. Concordance analysis and percentage-confirmed yield using different HCC case definitions were performed, with survival follow-up as a validation measure.RESULTSThe median age was 45 years, 68% were male, and 45% had chronic hepatitis B infection. Ultrasonographic, biochemical (AFP), and pathological definitions confirmed 91%, 57%, and 17% of clinically defined HCC cases, respectively. The median survival after diagnosis was 46 days. An integrated HCC case definition that combined clinical criteria with one confirmatory test increased the percentage-confirmed yield by 3.7% (ultrasonographic), 37.7% (biochemical), and 77.7% (pathologic) over the clinical definition alone. Yield from AFP or pathology beyond ultrasound was minimal. Survival did not differ appreciably by HCC case definition. This integrated HCC case definition maintained diagnostic rigor while maximizing yield.CONCLUSIONWe propose an integrated HCC case definition as a pragmatic, resource-adaptable approach for clinical diagnosis and research in sub-Saharan Africa. This definition can be readily implemented and can support regional collaborative efforts to develop novel diagnostics and improved treatments to ameliorate the heavy HCC burden.

Key Clinical MessageNeonatal cutaneous myiasis is a rare disease in newborns. Although it is unlikely, the level of suspicion for this condition should be high, especially in tropical regions. Treatment may deviate from the standard approach when necessary, and chemical debridement can be considered, particularly for smaller lesions. Ultimately, clinical judgment plays a key role in decision‐making.Myiasis is the infestation of the skin of a mammal by larvae or maggots. The skin is the most affected organ. However, it can also affect other organs of the body. Gasterophilus and Hypoderma are two flies that produce creeping myiasis, a type of cutaneous myiasis our patient had. The infestation is common in Sub‐Saharan Africa and most especially among rural dwellers. We report on a case of a 7‐day‐old term neonate who reported to St. Mary's Hospital Lacor, a Private‐not‐for‐Profit hospital situated in the Northern region of Uganda, who was admitted as a case of neonatal sepsis with a focus on the skin initially, however, while on the ward was eventually diagnosed with Cutaneous Myiasis. The management plan included chemical debridement with Hydrogen peroxide, IV antibiotics, and other supportive therapies, and the neonate was ultimately discharged home after 9 days in the NICU. This case report aims to inform healthcare workers of the importance of heightening the index of suspicion of myiasis for neonates who present with sudden‐onset rash that can resemble pustules and be mistaken for a pustular rash. Additionally, chemical debridement, in this case, underscores the importance of an innovative approach to managing cutaneous myiasis in resource‐limited settings. Mass education and awareness programs focusing on proper hygiene practices, safe handling of newborns, and early recognition of symptoms can help mitigate the risk of myiasis.

Electricity accessibility in Global South remains a challenge necessitating innovative solutions for reliable power supply. Grid-connected microgrids present a viable solution, especially for critical infrastructure requiring increased supply security. However, persistent issues such as renewable curtailment and grid instability necessitate advanced approaches. This paper, having the St. Mary's Hospital Lacor as a case study, demonstrates the effectiveness of a limited size battery in mitigating renewable curtailment and improving security of the supply in the transition to off-grid operations. Owing to collection of on-field data, a procedure was developed to reconstruct the potential RES generation from the curtailed profile. Subsequently, a rule based control strategy was developed to govern the power dispatch over a year in presence of a multi-parameter empirical model of the battery to optimally supply the load with the available generation portfolio of a diesel generator, PV and battery. Optimal sizing was conducted by means of a NPV analysis over a multiyear horizon calculating the operation savings and reliability improvements deriving from the initial capital investment in the storage system. Significant improvements in renewable production exploitation and off-grid resource adequacy are obtained with a limited size battery.

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.

Odontogenic bone tumor (OT) is a rare pathology in the world, but it is very common in developing countries; its etiology is still unknown, and it causes serious deformities of the mandible and maxilla if it is not operated upon soon. Lassa virus (LASV) belongs to the Arenaviridae family, and its reservoir is a rodent of the genus Mastomys. The transmission of the LASV to humans can occur through ingestion or inhalation by contact with dirty objects, the consumption of contaminated food, or exposure to wounds, as rodents shed the virus in their urine and excrement. In this observational study, we aim to evaluate the presence of LASV in OT patient tissues collected in the Democratic Republic of the Congo. For this purpose, a group of nine patients affected by OT were enrolled, and the tissues derived from the surgery were collected. In total, 81.5% of the tissues were positive for LASV presence. Interestingly, we found that not only was the tumor LASV-positive, but in some cases, the bone was close to the tumor and the oral mucosa lining. These preliminary data could suggest the hypothesis that LASV may be involved with the onset of OT.

BackgroundHepatitis B virus (HBV) infection is a global public health problem against which vaccination is recommended for all high-risk adults. HBV is highly endemic in Northern Uganda, however, there is a paucity of literature regarding HBV vaccine uptake and associated factors within the community in the region. In this study, we aimed to determine the level of HBV vaccine uptake and associated factors among adults in Gulu city, Uganda.MethodsWe conducted a community-based, cross-sectional study in Gulu city among eligible adults between March and May 2022. Data on HBV vaccination status and sociodemographic characteristics were collected using an interviewer-administered questionnaire. Full uptake of HBV vaccine was defined as receipt of all 3 recommended doses, and partial uptake for 1 or 2 doses. Multivariable logistic regression analysis was performed using STATA 16.0 to determine factors independently associated with HBV vaccine uptake. P<0.05 was considered statistically significant.ResultsIn total, 360 participants were enrolled, of whom 212 (58.9%) were female, 183 (50.8%) were aged 30 years or younger, and 143 (39.7%) had attained tertiary education. Overall, 96 (26.7%) participants had full uptake of HBV vaccine and 73 (20.3%) had partial uptake. Factors that were statistically significantly associated with full uptake of HBV vaccine were good knowledge regarding HBV transmission (aOR = 1.9, 95% Confidence Interval (CI) = 1.03–3.46, p = 0.040) and receiving health education on HBV vaccination (aOR = 4.4, 95% CI = 2.3–8.4, p<0.001).ConclusionsThere is a low uptake of HBV vaccine in Gulu city, Uganda. The Uganda Ministry of Health should correct misconceptions, create awareness of the severity of HBV infection through health education regarding HBV infection within the community in Gulu City; and set mechanisms to follow-up clients due for next HBV vaccination.

Acute poisonings, including envenomation as well as toxicological emergencies stemming from accidental or intentional ingestion of poisonous substances or drug overdose, are significant worldwide causes of morbidity and mortality. The study aimed to characterise acute poisoning emergencies admitted to two major hospitals in Northern Uganda. We conducted a retrospective review of charts of all patients admitted with acute poisoning emergencies between January and December 2021, as well as a structured interview of hospital staff working in these hospitals on challenges faced while managing these emergencies. Of the total 40,653 patient admissions, 416 (1%) were due to acute poisonings. The majority were admitted to SMHL (71.4%), 43.3% were between 20 and 40 years of age, and 59.9% were males. The average length of hospital stay was 1 (0-3). The most frequent diagnoses were acute alcohol intoxications (27.2%, n=113), snake bites (26.0%, n=108), and organophosphate poisonings (21.2%, n=88). Only 29.6% (n=123) of patients received antidotes. Peak admissions were observed in February, May, and July. The majority of poisonings were intentional (61.3%), resulting in a Case Fatality Rate of 6.3%. In the qualitative findings, participants highlighted key challenges in managing these conditions, including the lack of antidotes, patients presenting late at the hospital, economic barriers, staff shortages, and limited community awareness. Acute poisoning, especially acute alcoholic intoxication, snake bites and organophosphate poisoning, are common in northern Uganda, with significant numbers dying from it. The lack of antidotes remains a problem in these hospitals. Restriction of alcohol consumption use of agricultural organophosphates, and training of healthcare workers in managing these emergencies are recommended