PubMed | Medical Research Council, Mukwaya General Hospital, Nkozi Hospital and Uganda Martyrs University
Type: Journal Article | Journal: BMC pregnancy and childbirth | Year: 2017
The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care.This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit.Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit.The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
Connor D.H.,Georgetown University |
Somers K.,Royal Perth Hospital |
Nelson A.M.,Joint Pathology Center |
D'Arbela P.G.,Uganda Martyrs University |
Lukande R.,Mulago Hospital
Tropical Doctor | Year: 2012
The cause of endomyocardial fibrosis in Uganda remains unknown in spite of studies dating back to 1948. Herbal decoctions have been used by traditional healers for countless generations to treat many complaints, especially fever. We present evidence-ethnic, geographical, tribal, pathological and distribution by age-that the toxic herbal decoctions taken as medicines in Uganda can cause endomyocardial fibrosis.
Kibirige D.,Uganda Martyrs Hospital Lubaga |
Atuhe D.,St Raphael Of St Francis Hospital Nsambya |
Atuhe D.,Uganda Martyrs University |
Sebunya R.,Uganda Martyrs University |
And 2 more authors.
Journal of Diabetes and Metabolic Disorders | Year: 2014
Background: Currently, Sub Saharan Africa is faced with a substantial burden from diabetes mellitus. In most of the African countries, screening for diabetes related complications and control of blood pressure and glycaemic levels is often suboptimal.The study aimed at assessing the extent of optimal glycaemic and blood pressure control and the frequency of screening for diabetic complications in adult ambulatory Ugandan diabetic patients.Methods: This was a retrospective study of 250 medical records of adult diabetic patients attending the outpatient diabetic clinic at St. Raphael of St. Francis hospital Nsambya in Kampala, Uganda.Results: The mean age of the patients was 51.6 ± 9.2 years with the majority being females (155, 62%). Using fasting blood glucose levels assessed in all the patients, optimal glycemic control of <7.2 mmol/l was noted in 42.8% of the patients. Glycated haemoglobin was performed at least once in the last year in 24 (9.6%) patients , of which 5 (20.8%) of these attained optimal control of <7%. Optimal blood pressure (BP) control defined as BP ≤140/80 mmHg was noted in 56% of the patients. Hypertension and diabetic neuropathy were the most screened for diabetic complications in 100% and 47.2% of the patients respectively and were also the most prevalent diabetic complications (76.4% and 31.2% respectively).Conclusions: This study demonstrates that glycemic and blood pressure control and screening for diabetic complications among the adult ambulatory diabetic patients in this urban diabetic clinic is suboptimal. This substantiates development and implementation local guidelines to improve diabetes care. © 2014 Kibirige et al.; licensee BioMed Central Ltd.
Mwine J.,Uganda Martyrs University |
van Damme P.,Ghent University
Scientific Research and Essays | Year: 2011
Euphorbia tirucalli is one of the most important tree Euphorbias known worldwide for its many uses. Endemic to tropical Africa where it often grows wild, it is usually planted for boundary demarcation but also as a live fence around compounds, shrines and kraals due to its ability to withstand extreme aridity and possession of low herbivore pressure. E. tirucalli has white latex which is vesicant and rubifacient but also known to be a remedy against many ailments. However, most of its medicinal features are reported in folk medicine and there appears to be little medical/laboratory analysis to validate them. In this review, we attempt to explore the current knowledge status about E. tirucalli in relation to its classification, chemical content and functions, and the extent to which modern research has gone to validate them. It was found that although a great deal has been done to analyze its chemical composition (bark, roots and latex), and potential for biodiesel production, little is available on validation of its application for medicinal purposes, yet it continues to be used in traditional and alternative medicine on a daily basis. Empirical research is called for to achieve this. © 2011 Academic Journals.
Mwine J.T.,Uganda Martyrs University |
van Damme P.,Ghent University
Journal of Medicinal Plants Research | Year: 2011
Euphorbiaceae is among the large flowering plant families consisting of a wide variety of vegetative forms some of which are plants of great importance. Its classification and chemistry have of late been subjects of interest possibly because of the wide variety of chemical composition of its members, many of which are poisonous but useful. In this review, we have tried to demonstrate why Euphorbiaceae are important medicinal plants. Two important issues have come up. The worldwide distribution of the family exposes its members, to all sorts of habitats to which they must adapt, therefore inducing a large variety of chemicals (secondary substances) that are employed for survival/defense. Succulence and the CAM (crassulacean acid metabolism) pathway that characterize a good number of its members were quoted as some of the adaptations that aid colonization and survival to achieve this induction. We have also found out that medicinal properties of some of its species may be due to stress factors that characterize most habitats of the family. Varying stress factors like temperature, salinity, drought and others were seen to operate in tandem with genetic factors such as gene expression and mutation loads to bring about synthesis of a wide assemblage of secondary substances that may probably be responsible for the family's medicinal nature. It was concluded that the family is a good starting point for the search for plant-based medicines. © 2011 Academic Journals.
Sigei C.,P.O. Box 293 20203 |
Odaga J.,Uganda Martyrs University |
Mvundura M.,PATH |
Madrid Y.,PATH |
Clark A.D.,London School of Hygiene and Tropical Medicine
Vaccine | Year: 2015
Introduction: Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. Methodology: In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. Results: Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). Conclusions: Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national capacity to undertake economic evaluations. © 2015 Elsevier Ltd.
PubMed | Infectious Diseases Research Collaboration, Uganda Martyrs University, Case Western Reserve University and Makerere University
Type: | Journal: BMC research notes | Year: 2016
Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda.In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data.A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5-75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17% were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge.Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.
Kibirige D.,St Raphael Of St Francis Hospital Nsambya |
Mwebaze R.,St Raphael Of St Francis Hospital Nsambya |
Mwebaze R.,Uganda Martyrs University
Journal of Diabetes and Metabolic Disorders | Year: 2013
Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. © 2013 Kibirige and Mwebaze; licensee BioMed Central Ltd.
Odaga J.,Uganda Martyrs University |
Sinclair D.,Uganda Martyrs University |
Lokong J.A.,Uganda Martyrs University |
Donegan S.,Uganda Martyrs University |
And 2 more authors.
The Cochrane database of systematic reviews | Year: 2014
BACKGROUND: In 2010, the World Health Organization recommended that all patients with suspected malaria are tested for malaria before treatment. In rural African settings light microscopy is often unavailable. Diagnosis has relied on detecting fever, and most people were given antimalarial drugs presumptively. Rapid diagnostic tests (RDTs) provide a point-of-care test that may improve management, particularly of people for whom the RDT excludes the diagnosis of malaria.OBJECTIVES: To evaluate whether introducing RDTs into algorithms for diagnosing and treating people with fever improves health outcomes, reduces antimalarial prescribing, and is safe, compared to algorithms using clinical diagnosis.SEARCH METHODS: We searched the Cochrane Infectious Disease Group Specialized Register; CENTRAL (The Cochrane Library); MEDLINE; EMBASE; CINAHL; LILACS; and the metaRegister of Controlled Trials for eligible trials up to 10 January 2014. We contacted researchers in the field and reviewed the reference lists of all included trials to identify any additional trials.SELECTION CRITERIA: Individual or cluster randomized trials (RCTs) comparing RDT-supported algorithms and algorithms using clinical diagnosis alone for diagnosing and treating people with fever living in malaria-endemic settings.DATA COLLECTION AND ANALYSIS: Two authors independently applied the inclusion criteria and extracted data. We combined data from individually and cluster RCTs using the generic inverse variance method. We presented all outcomes as risk ratios (RR) with 95% confidence intervals (CIs), and assessed the quality of evidence using the GRADE approach.MAIN RESULTS: We included seven trials, enrolling 17,505 people with fever or reported history of fever in this review; two individually randomized trials and five cluster randomized trials. All trials were conducted in rural African settings.In most trials the health workers diagnosing and treating malaria were nurses or clinical officers with less than one week of training in RDT supported diagnosis. Health worker prescribing adherence to RDT results was highly variable: the number of participants with a negative RDT result who received antimalarials ranged from 0% to 81%.Overall, RDT supported diagnosis had little or no effect on the number of participants remaining unwell at four to seven days after treatment (6990 participants, five trials, low quality evidence); but using RDTs reduced prescribing of antimalarials by up to three-quarters (17,287 participants, seven trials, moderate quality evidence). As would be expected, the reduction in antimalarial prescriptions was highest where health workers adherence to the RDT result was high, and where the true prevalence of malaria was lower.Using RDTs to support diagnosis did not have a consistent effect on the prescription of antibiotics, with some trials showing higher antibiotic prescribing and some showing lower prescribing in the RDT group (13,573 participants, five trials, very low quality evidence).One trial reported malaria microscopy on all enrolled patients in an area of moderate endemicity, so we could compare the number of patients in the RDT and clinical diagnosis groups that actually had microscopy confirmed malaria infection but did not receive antimalarials. No difference was detected between the two diagnostic strategies (1280 participants, one trial, low quality evidence).AUTHORS' CONCLUSIONS: Algorithms incorporating RDTs can substantially reduce antimalarial prescribing if health workers adhere to the test results. Introducing RDTs has not been shown to improve health outcomes for patients, but adherence to the test result does not seem to result in worse clinical outcomes than presumptive treatment.Concentrating on improving the care of RDT negative patients could improve health outcomes in febrile children.
Nalwoga M.M.,Uganda Martyrs University |
Van Dijk M.P.,Erasmus University Rotterdam
International Journal of Water | Year: 2016
In this contribution, organisational performance measurement models are reviewed to determine to what extent they can also be used as an instrument for poverty alleviation. In this paper, we explore the organisational performance models. We start with a review of general performance measurement in private and public sectors and then we focus on performance measures in the water sector. It is concluded that the performance measurement models reviewed can be applied in the water and sanitation sector as well, but it is a challenge to make them pro-poor. Copyright © 2016 Inderscience Enterprises Ltd.