Western International University

Abstract Background Birth asphyxia is a major cause of neonatal morbidity and mortality, particularly in low-resource settings. Hypoxia and metabolic derangements that occur during asphyxia predispose neonates to electrolyte abnormalities, which may worsen the clinical course and contribute to poor outcomes. Early recognition and management of such imbalances can improve survival and prevent long-term neurological damage. This study aimed to determine the incidence, Predictors, and early outcomes of electrolyte imbalance among term neonates admitted with birth asphyxia in Lira Regional Referral Hospital, Uganda. Methods A hospital-based prospective cohort study was conducted among term neonates admitted with birth asphyxia, defined as a 5-minute Apgar score <7. Serum sodium, potassium, and calcium levels were measured at admission, and repeated on days 3, 7, and 14 for those still admitted. Clinical information including maternal and perinatal characteristics was recorded. Modified Poisson regression using SPSS was performed to identify independent predictors of electrolyte imbalance. Early outcomes, including mortality and length of hospital stay, were documented within the first 14 days. Results A total of 152 neonates were enrolled; 52.6% were male. During follow-up, 42 (29.0%) developed hyponatremia, 29 (19.5%) hyperkalemia, and 31 (21.2%) hypocalcemia. Independent predictors of hyponatremia included low Apgar score (0–3), severe hypoxic ischemic encephalopathy (HIE), prolonged intravenous fluid administration (>48 hours), resuscitation at birth, and dehydration. Convulsions, prolonged intravenous fluids, and resuscitation were significantly associated with hypocalcemia, while hyperkalemia was linked to low birth weight and prolonged intravenous fluids (p<0.05 for all). Mortality was highest among neonates with hyperkalemia, whereas hypocalcemia was significantly associated with prolonged hospital stay (p<0.05). Conclusion Electrolyte imbalances are common among term neonates with birth asphyxia, with hyponatremia, hypocalcemia, and hyperkalemia occurring in nearly one-fifth to one-third of cases. Routine electrolyte monitoring is essential in the management of asphyxiated neonates. Protocols for intravenous fluid use and timely correction of electrolyte derangements should be prioritized to reduce mortality and improve outcomes.

Abstract Background Neglected tropical diseases (NTDs) disproportionately affect over one billion people globally, particularly the poorest communities, with Uganda facing a significant burden where over 40 million people are at risk. Despite global efforts by the World Health Organization (WHO) to integrate NTD management into primary health care (PHC) systems, the capacity of health facilities in refugee settings to diagnose and manage these diseases remains largely unknown. This study aimed to assess the capacity of PHC facilities in Nakivale Refugee Settlement, Uganda, with a focus on health workers’ knowledge of NTDs (specifically, soil-transmitted helminths and schistosomiasis) and the perceived facilitators of and barriers to their diagnosis and management. Methods A mixed-methods cross-sectional study employing quantitative and qualitative methods was conducted. We administered a pre-tested questionnaire to health workers in Health Centre III (HCIII) and Health Centre IV (HCIV) facilities within the Nakivale Refugee Settlement. In-depth interviews were conducted with 22 health workers. A thematic analysis approach was employed to code and categorize the qualitative data systematically. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used, while qualitative themes were organized according to the research objectives, focusing on health workers’ knowledge of NTD symptoms and transmission, the availability of diagnostic tools and medications, and the systemic and community-level facilitators and barriers to effective NTD diagnosis and management. Results The study population comprised 150 health workers, predominantly females (60%) with a mean age of 31.5 years, who mostly held diplomas or certificates. Regarding capacity criteria, the findings were striking: 88% of health workers reported no previous training on NTDs, and 84% had not received supportive supervision for NTDs. The process of reporting was also challenging; while 39% found it easy, 38% found it difficult, and 71% reported that the NTD reporting form was difficult to fill out. In terms of knowledge, participants were more aware of the signs of urinary schistosomiasis, with 65% knowing about S. haematobium, compared to 58% for S. mansoni. The qualitative findings identified key barriers, including a lack of knowledge among health workers and communities, and the systemic under-prioritization of NTDs due to funding and a lack of supplies. Facilitators for improved management included health worker and community education programmes, integrated outreaches and Mass Drug Administration (MDA), and strengthening diagnostic capacity. Conclusion The findings reveal a critical gap in NTD-specific training and supportive supervision among health workers in the Nakivale refugee settlement. While basic knowledge of common NTD types, symptoms, and medications exists, the lack of formal training and the perceived complexity of reporting systems pose significant barriers to effective NTD management. Targeted interventions focusing on comprehensive training, structured supervision, and simplification of reporting mechanisms are crucial to enhancing the capacity of PHC facilities and facilitating the integration of NTD programs in refugee settings, thereby accelerating the realization of Sustainable Development Goal 3.

Background: Human immunodeficiency infections have remained one of the major public health threats globally, with much pronounced effects in sub-Saharan Africa and Asia. Globally, over 300 children and adolescents succumb to HIV/AIDS everyday with exp

Abstract Background Single Incision Total Laparoscopic Hysterectomy (SITLH) is a modified version of the Conventional Total Laparoscopic Hysterectomy (CTLH). The newer technique requires advanced skills with special trocars. This may partly explain the rareness of the technique in low-income countries where the special trocars may be lacking due to them being expensive. There is no documented hysterectomy performed using the SITLH technique in Africa. We present two cases of hysterectomies successfully performed using this advanced technique, by a single surgical team led by Dr John Bosco Spire Kiggundu, at Henrob laparoscopy hospital, Kampala, Uganda, using improvised conventional laparoscopic trocars. Case series We present two cases of a 48-year old, Para 2+0, black African with symptomatic uterine fibroids and a 47-year-old para 4+0, black African with endometriosis; Enzian classification P-0 O-0/0 T-2/2 A-1 B-2/0 C-0 FA. These were successfully managed using the SITLH technique by a single surgical team led by Dr John Bosco Spire Kiggundu, at Henrob Laparoscopy Hospital, using improvised conventional laparoscopic trocars. Conclusion Though the single incision total laparoscopic hysterectomy technique requires special trocars, it is still possible to be performed using improvised conventional laparoscopic trocars in low-resource setting. These two cases demonstrate the ability and innovativeness of the surgical team, to use the limited available resources and successfully perform a task that would actually demand advanced special equipment.

Agro-marine waste presents environmental challenges, demanding sustainable solutions. This study explores the potential of ashes from periwinkle shells, plantain stems, and eucalyptus wood for sustainable material use. Physical analyses reveal Periwinkle Shell Powder (PSP) with the highest bulk density (0.52–1.24 g/cm3) and specific gravity (2.05), ideal for load-bearing applications. Plantain Stem Ash (PSA) has a bulk density of 0.98 g/cm3 and fine particle sizes (< 45 µm), enhancing its pozzolanic activity for cementitious uses. Eucalyptus Wood Ash (EWA) shows a lower bulk density (0.2–1.0 g/cm3), suitable for lightweight applications like thermal insulation. Specific gravities are 2.62 (EWA), 2.67 (PSA), and 2.69 (PSP). Chemical analysis via X-ray fluorescence (XRF) identifies calcium oxide (CaO), silica (SiO₂), and potassium oxide (K₂O) as predominant oxides, driving pozzolanic reactivity. Trace amounts of magnesium oxide (MgO), aluminum oxide (Al₂O₃), and iron oxide (Fe₂O₃) enhance structural stability. PSA’s low moisture content (< 5%) ensures superior reactivity, while EWA’s slightly higher moisture (~ 1%) remains viable for low-moisture environments. Microstructural analysis using scanning electron microscopy (SEM) reveals porous, irregular surfaces, improving adsorption and bonding. Energy-dispersive X-ray spectroscopy (EDS) confirms agglomerated particles and fine crystalline phases, supporting industrial use. These findings highlight agro-marine waste ash as a sustainable alternative for applications like supplementary cementitious materials, fillers, and adsorptive agents, offering a pathway for waste valorization and environmental sustainability.

Abstract Background Despite local and national efforts against Khat use, the habit continues to escalate mainly among young people in Uganda; especially those in urban and peri-urban areas. This is compounded by limited understanding of health related effects of Khat use which could have detrimental effects to the users, their families and community as a whole. This study aimed at assessing the health-related effects of Khat (Catha edulis Forsk) consumption among residents of Bushenyi-Ishaka Municipality, South western Uganda. Methodology A community based cross sectional study design was conducted on 384 study participants residing or working in Bushenyi-Ishaka Municipality. Using structured questionnaires and a cluster sampling method, data was obtained on Khat consumption; its patterns, health effects and associated factors. Data was analyzed using SPSS version 27.0 for both descriptive and inferential statistics. Statistical significant association was set at a p-value of ≤ 0.05. Results A 16.9% and 15.1% lifetime and current prevalence of Khat consumption respectively was observed among the participants. The most reported health related effects of Khat use were GUS effects with a mean of 2.0578 ± 0.442, however it was CVS health effects which showed a significant association to Khat use (β = 0.201, P &lt; 0.001). This study also showed that Khat use was positively associated with age 18–43 years (β = 0.189, P = 0.001), age 31–43years (β = 0.205, P = 0.002), primary level of education (β = 0.221, 0.006), being a traditional believer (β = 0.221, P = 0.014), being a driver (β = 0.348, P &lt; 0.001) or a merchant (β = 0.356, P = 0.006) as an occupation and living with people than one’s parents (P &lt; 0.001). On the other hand, Khat use was negatively associated with being a student as occupation (β= -0.934, P &lt; 0.001), and earning a higher monthly income (P &lt; 0.001). Conclusion Lifetime and current prevalence of Khat consumption was 16.9% and 15.1% respectively with CVS health effects as the only positively and significantly associated health effects with Khat chewing. Khat chewing was also significantly associated with age, education level, religion, occupation, income level and type of people someone lives with.

Abstract Background Although treatable, pulmonary tuberculosis (PTB) has a significant morbidity and mortality. Children with malnutrition are immune compromised, which increases the morbidity and mortality of PTB. This study was done to determine the prevalence and factors associated with Tuberculosis among children aged 6 to 59 months admitted with severe acute malnutrition (SAM) at Jinja Regional Referral Hospital (JRRH). Methods This was a cross–sectional study among children aged 6-59 months with SAM at JRRH. History was taken and physical examination done. Gene Xpert was done for all participants, Lipoarabinomannan Antigen Assay for TB (TB-LAM) done for HIV positive children with CD4 below 200 and Chest X-ray for children who presented with cough and difficulty in breathing. Both the investigations and clinical findings were used to make a diagnosis of PTB. Using binary logistic regression in SPSS, the factors associated with Tuberculosis were determined. P value &lt;0.05 was considered significant. Results Of the 137 children enrolled with SAM, majority were in the age groups of 6-11 and 12-23 months. Non-edematous malnutrition was the commonest 73(53.3%). Thirty-two children were diagnosed with TB with a prevalence of 23.4%. Of the 32 diagnosed with Tuberculosis, only 5 had a positive gene expert test, 2 had a positive urine TB LAM and the remaining 25 were diagnosed using the clinical criteria. The commonest symptoms among children diagnosed with TB were cough seen in 25/32 (78.1%) and fever in 24/32 (75%). The most common radiological findings comprised adenopathy (64.3%) and consolidations (49.7%). Coming from rural areas (aOR=1.205, 95%CI=1.067-1.360, P=0.003), being HIV positive (aOR=1.619, CI=1.114-2.354, P=0.012), thrombocytopenia (aOR=1.407, CI=1.069-1.853, P=0.015) and thrombocytosis (aOR=1.202, CI=1.047-1.379, P=0.009) were independently associated with presence of Tuberculosis. Conclusion The prevalence of tuberculosis in Severe Acute Malnutrition was high. Children with SAM should be routinely screened for TB. When resources are constrained, the iinvestigations for TB could be focused on those coming from rural areas, the HIV positive, those with thrombocytopenia and those with thrombocytosis.

Abstract Introduction: Uganda, like other developing countries is experiencing an increasing burden of non communicable diseases. A few studies conducted in sub-Saharan Africa have shown that the incidence of cardiometabolic syndrome is rapidly approaching that of the developed nations. Information regarding key determinants for this anomaly among the Ugandan population in many parts of the country however remains scanty despite the associated morbidity Methods A 3-months cross-sectional study involving 383 adult participants was conducted from November 2022 to January 2023 at Fortportal regional referral hospital medical outpatient clinic. Interviewer administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted using IBM SPSS 20 Results 136(36%) of the 383 participants had CS. Daily physical activity of &gt; 30 minutes (aOR = 0.70; 95%CI: 0.46–0.91, p = 0.003) was protective for CS while BMI &gt; 24 kg/m2 (aOR = 4.25; 95%CI: 1.17–5.59, p = 0.001) was significantly associated with high odds for CS (p &lt; 0.05) Conclusion Daily physical activity and BMI are the key determinants of CS at this facility. Preventive lifestyle interventions should be targeted at lowering BMI and promoting daily physical exercises in this area.

Abstract Introduction: In resource limited settings, the burden of stomas is high due to inadequate elective surgical service. This results in a big number of patients living with stomas for a long time with substandard stoma care, hence, ileostomy complications. This study aimed to determine the incidence, patterns and factors associated with ileostomy complications in two selected hospitals in western Uganda. Methods This was a prospective observational study conducted in the surgical departments of two regional referral hospitals in western Uganda. Patients were enrolled at the time of ileostomy creation and followed up for 6 weeks to assess for occurrence of complications, the time they occurred and the management. Analysis was done using SPSS version 26 with Poisson regression done to determine the factors associated with occurrence of complications. Results Among the 74 patients enrolled, the mean age was 30.2 years (SD = 18.5). Majority of the stomas were cared for by non-medical personnel 54(73.0%), with only 10(13.5%) using stoma bags routinely. The incidence of stoma complications was 68.9% (95%CI = 58.1%-79.7%). The commonest complication was skin excoriation accounting for 43.1% of the complications, followed by prolapse (15.7%), high output stoma (15.7%), and stoma retraction (15.7%). Majority of the complications occurred in the first week (39.2%). Most of the complications were managed non-operatively 30(58.8%). Not using a stoma bag was independently associated with occurrence of complications (aRR = 4.692, CI = 1.131–19.459, P = 0.033). Conclusion More efforts are still needed in reducing ileostomy complications and immediate efforts should be focused on providing standard stoma bags that are affordable to the patients.

Abstract Introduction: Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. However, there is paucity of published data on the patterns of perforated peptic ulcer in the region. The aim of this study was to determine the factors associated with anatomical patterns of peptic ulcer perforation, as well as the clinical, socio-demographic, and anatomical patterns among patients in Uganda. Methods: This was a cross sectional study that enrolled 83 consecutive patients with perforated peptic ulcers. At surgery the patterns of the perforations were determined and using a structured pretested questionnaire the social demographic and clinical characteristics were obtained. Logistic regression was done in SPSS version 22 to determine the factors associated with the anatomical patterns. Results: Perforated peptic ulcer disease was more prevalent amongst male (79.5%) peasants (56.8%) of rural residence (65.4%). Majority of study participants were of blood group O (43.2%). The gastric perforations were more common (74.1%) than duodenal, found anteriorly (81.5%) in most of the cases. Being a casual laborer was independently associated with lower odds of having a gastric perforation compared to being a peasant farmer (P &lt; 0.05). Conclusion Public health campaigns aimed at prevention of peptic ulcer perforations should prioritize the males, peasants and those living in rural areas. When a patient in our setting is suspected to have a peptic ulcer perforation, the anterior part of the stomach should be considered as the most likely site involved more so in peasant farmers.