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Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study
No full textAcknowledgements
The authors are grateful to the study participants for accepting to provide the
necessary data, and the research assistants who diligently interviewed the
participants and collected data. The authors are also grateful to the nursing officer at the CI who coordinated the study and helped identified patients’
f iles. We also appreciate the CI director and administrators from allowing
use access the patients. JLL is profoundly grateful to the African Breast and
Cervical Cancer Awareness research collaborations for supporting her in this
research project.Background Majority of patients with cervical cancer in the low- and middle-income countries experience long
diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and
pre-treatment intervals among patients with cervical cancer.
Methods This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to
January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data
were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals,
defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed
diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from
histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late.
Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to
determine socio-demographic and clinical factors associated with the intervals.
Results The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals
were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403)
were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo
radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5)
(aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more
likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI:
(0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68;
95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60
years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR =
0.52;95%CI: 0.29 - 0.95).
Conclusion Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target
primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate
diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of
chemo-radiation therapy.
Keywords Cervical cancer, Diagnostic intervals, Pre-treatment intervals, Advanced stageThis work was funded through a student support to JLL by a multinational
research collaboration between Makerere University, University of Cape Town,
and University of Cambridge which was jointly supported by the Cancer
Association of South Africa (CANSA), GlaxoSmithKline (GSK) Africa Non
Communicable Disease Open Lab (via a supporting grant Project Number:
023), the United Kingdom Medical Research Council via the Newton Fund
(Award/Grant number not applicable). The funders had no role in study
design, data collection and analysis, preparation of the manuscript, decision to
publish and where to publish
Factors associated with retention of motherbaby pairs in the elimination of mother-tochild transmission of HIV program in Kaberamaido district: A longitudinal analysis
No full textAbstract
Background
Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in
Uganda remains poor as only 62.7%-69.5% are followed up to 18months. The objective of
this study was to determine the rates of retention of mother-baby pairs at two levels of the
eMTCT cascade (12 and 18 months) and associated factors.
Methods
This was a longitudinal analysis of 368 mother-baby pairs who were enrolled into the
eMTCT program in Kaberamaido district from January 2013 to December 2018. Data was
extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Microsoft
Excel and then exported to Stata statistical software package version 14.0 for management
and analysis. Descriptive statistics such as mean and frequencies were computed at
univariate level. At the bivariate level, Cox proportional hazard regression was performed to
assess the level of association between the primary outcome and each independent variable,
while Cox proportional hazard regression model was built at multivariate level to determine
the factors independently associated with retention of mother-baby pairs in the
eMTCT program.
Results
Of the 368 mothers enrolled into the study, their average age was 29.7years (SD = 6.6).
Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother
baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%,
95%CI = 92.0–96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3–8.0) were lost
to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0–90.8) were active in
eMTCT program while 45(12.2%, 95 CI = 9.2–16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers’ ART treatment supporter, and
mothers’ ART enrolment time were significantly associated with survival/lost to follow up
(LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers’
time of ART initiation was significantly associated with survival/lost to follow up (LTFU) of
mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated
during the antenatal/post-natal periods having higher hazards of LTFU compared to those
who initiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62–
11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the
implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of
LTFU as compared to those enrolled before the implementation of test and treat policy in
Uganda (year 2013–2016), aHR = 2.22(95% CI, 1.15–4.30, P = 0.017). All the other factors
had no significant association with lost to follow up and cascade completion at multivariate
level.
Conclusion
There was high level of retention of mother-baby pairs in the eMTCT program in Kaberamaido
at 12 months, but it was suboptimal at 18months. ART initiation during the antenatal
and/or post-natal period was significantly associated with suboptimal retention of motherbaby
pairs along the eMTCT cascade.Non
Disseminated peritoneal leiomyomatosis as an incidental finding: A case report
No full textWe present the case of a 23-year-old female with multiple diffuse and nodular masses of different sizes involving predominantly the posterior wall of the uterus, omentum, and peritoneum which were histopathologically confirmed to be dis seminated peritoneal leiomyomatosis. Meticulous investigation and accurate di agnosis are of utmost importance for the establishment of the correct diagnosis.
Additionally, proper management of the patient while considering choice of the patients including close follow-up of the patients is mandatory for the reason of ensuring early detection of recurrence.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector
Predictors of recurrence and disease‑free survival for salivary gland tumors among children and young adults in Kampala, Uganda: a retrospective follow‑up study
No full textBackground: Salivary gland tumors are a group of tumors which are highly heterogeneous, and they are uncommon among children and young adults. We aimed to investigate the predictors of recurrence and disease-free survival for salivary gland tumors among children and young adults.
Methods: We retrospectively extracted clinical, pathologic, and follow-up data of patients who were diagnosed histologically with salivary gland tumors from January 2013 to December 2018 at the department of pathology, Makerere University in Kampala, Uganda. Then, we applied Cox regression analysis to determine the predictors of disease-free survival using hazard ratio as the measure of probability of the survival with 95% confidence interval. We also used Kaplan–Meier curves to analyze the disease-free survival. P ˂ 0.05 was considered significant.
Results: A total of 144 patients with salivary gland tumors were included in the present study who were aged not more than 20 years with mean age of 13.9 ± 4.5 years. Over one quarter (26.4%, n = 38) of the salivary gland tumors that were analyzed in the present study were malignant. The prevalence of recurrence was (27.1%, n = 39), and the mean disease-free survival was 58.7 ± 1.9 months. Category of the salivary gland (AHR = 1.36, 95% CI = 0.137–0.942, p = 0.037) and behavior of the tumors (AHR = 1.82, 95% CI = 0.729–0.990, p = 0.023) were the potential predictors of
disease-free survival.
Conclusion: Over one quarter of the patients had malignant salivary tumors, and also, one-third of the patients developed recurrence at the end of the follow-up period of 6 years. Involvement of minor salivary glands and having a malignant salivary gland tumor both have shown increased risk of recurrence as well as short disease-free survival. Therefore, patients with minor salivary gland involvement and those with malignant variants require optimal surgical resection of the tumors for possible prevention of early recurrence and increasing the survival of the patients without
relapse of such tumors after initial resection of the primary lesions
a retrospective study of routine health facility based data
No full textAbstract
Background Most data describing severe malaria (SM) in sub‑Saharan Africa (SSA) are from research settings out
side disease endemic areas. Using routinely collected data from Apac District Hospital, this study aimed at determin
ing the burden and clinical spectrum of severe malaria.
Methods This was a retrospective study that reviewed all paediatric admission records for malaria in the 24 months
period from Jan 2019 to Dec 2020 at Apac District Hospital. Data on children aged 60 days to 12 years who at admis
sion tested positive for malaria and fulfilled the World Health Organization clinical criteria for surveillance of severe
malaria were abstracted using a customized proforma designed to capture variables on social demographic, clinical
presentation, treatment, and outcomes. In addition, the tool included laboratory variables for complete blood counts,
haemoglobin, and glucose levels. Data were analysed using STATA V15.0. The study had ethical approval from Mbale
Regional Referral Hospital REC, Approval No. MRRH‑REC 053/2019.
Results A total of 5631 admission records were retrieved for this study period. Of these, 3649 (64.8%) were malaria
admissions and 3422/3649 were children below 12years, with only 1864 (54.5%) of children having complete data.
Of the 1864 children, 745 (40.0%) fulfilled the severe malaria inclusion criteria. Of the 745 children, 51.4% (n = 381)
were males. The median age at admission was 31 months (IQR = 17–60). The most common clinical presentations
among children with severe malaria were fever 722 (97.3%), cough 478 (64.2%), and difficulty in breathing 122 (17.9%).
The median length of hospital stay was 2 (IQR; 2–4) days and 133 (17.9%) had prolonged hospital stay (> 4 days).
Factors independently associated with prolonged hospital stay were, presenting with difficulty in breathing, aOR 1.83
(95% CI 1.02–3.27, P = 0.042) and prostration aOR 8.47 (95% CI 1.94–36.99, P = 0.004). A majority of admitted children,
735 (98.7%) survived, while 10 (1.3%) died of SM.
Conclusion A high proportion (40.0%) of malaria admissions were due to SM. Prolonged Hospital stay was associ
ated with prostration and difficulty in breathing. Overall mortality was low, 1.3% compared to mortality in the previ
ously reported series. This study was able to use routinely collected data to describe the burden and clinical spectrum
of SM. Improvement in the quality of data from such settings would improve disease descriptions for policy, monitor
ing of epidemics, response to interventions and to inform researchThis publication was supported through MEPIE Study, part of the EDCTP2
programme supported by the European Union (Grant Number: TMA2016SF
1514‑MEPIE Study). The views and opinions of the authors expressed herein
do not necessarily state or reflect those of EDCTP
Duodenal Strongyloides stercoralis infection in a 56-year old male: A case report
No full textIntroduction and importance: The infection caused by Strongyloides stercoralis (S stercoralis) is usually an asymptomatic condition particularly in immunocompetent individuals and the condition may remain unnoticed even for decades, however, strongyloidiasis is more severe in patients who are immunocompromised.
Case presentation: The patient is a 56-year old male who presented with nine months history of episodes of abdominal pain, nausea loss of appetite, and chronic diarrhea. His diarrhea had mucus and trace blood. His oesophagogastroduodenoscopy (OGD) revealed erythematous, hypertrophied, and ulcerating lining mucosa of the duodenum. The specimen sampled showed sections of the duodenum with numerous Strongyloides stercoralis larvae, some inside the crypts with associated active duodenitis.
Clinical discussion: Despite the asymptomatic nature of Strongyloides stercoralis infectious condition especially for immunocompetent patients, the infection may sometimes result into serious complications including exudative enteropathy and paralytic ileus. The clinical outcome of patients with strongyloidiasis is usually better despite severe infection may develop and it is associated with slightly increased morbidity and even mortality.
Conclusion: Diagnosis of Strongyloides stercoralis infection in individuals residing in tropical or subtropical countries who present with chronic diarrhea, abdominal pain should always be considered so as to avoid delay of diagnosis. This may help in preventing unnecessary complication such as severe anaemia, intestinal perforation or even death
Invasive ductal carcinoma of breast in a 73-year old male: A rare case report and literature review
No full textIntroduction and importance: Male breast cancers despite being similar to female breast cancers in various aspects; however, they have important distinctive characteristics such as molecular biology, increased tendency for axillary lymph node metastasis and late age at presentation.
Presentation of case: We present the case of a 73-year old indigenous African male who had a 3-year history of right breast swelling which was associated with episodes of pain and tenderness. The assigned clinical stage for the patient was T2aNoMo. The mass was histologically confirmed to be invasive ductal carcinoma, not specified type (NST) without axillary lymph node involvement or distant metastasis. Immunohistochemistry also showed positive results for ER and PR hormonal receptors but negative for HER2.
Clinical discussion: Considering the rarity nature of male breast cancers, this contributes to lack of evidence of the specific treatment approaches despite the noticeable difference in clinical presentation and even biological characteristics of male breast cancers, which are more likely to contribute to poor prognosis.
Conclusion: The prevalence of male breast cancers has been reported to be less than 1 % of all male cancers. This contributes to the lack of analytical large studies that address the comprehensive data regarding the clinical outcomes of breast cancer among men and their predictors. Therefore, having prospective multicenter studies in future would help in providing high level of evidence on prognosis
A cross-sectional study
No full textThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.Abstract
Background: Most breast cancer (BC) patients in Uganda are diagnosed with
advanced-stage
disease and experience poor outcomes. This study examined the
diagnostic and pre-treatment
intervals and factors associated with these intervals
among BC patients attending care at the Uganda Cancer Institute (UCI).
Methods: This was a cross-sectional,
facility-based
study. Data were collected
using structured questionnaire administered by trained research assistants and
analyzed using STATA version 14.0. Modified Poisson regressions models were
used to determine the strength of associations between independent variables
and diagnostic and pre-treatment
intervals.
Results: The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four
in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140)
stage IV cancers. The median interval from first consultation to diagnosis diagnostic
interval (DI) was 5.6 months (IQR: 1.5–17.0),
while the median interval
from histological diagnosis to start of chemotherapy pre-treatment
interval (PTI)
was 1.7 months (IQR: 0.7–4.5).
Majority (85%, n = 341) of participants were diagnosed
at ≥3 months from first consultation with clinicians. Participants with
tertiary education and those who lived within 100–199
km from the UCI were
about four times and twice more likely to be diagnosed early (DI <3 months from
first consultation) ([aPR = 3.88; 95% CI: 1.15–13.0]
and [aPR = 2.19; 95% CI: 1.06–4.55]),
respectively. About half (48.3%; n = 176) of participants started chemotherapy
within 1 month of cancer diagnosis. Patients who lived more than 300 km
from the UCI were less likely to start chemotherapy within 1 month of histology
diagnosis of cancer.
Conclusion: Majority of breast cancer patients are diagnosed late and in advanced
stages. There is need to promote all efforts toward timely diagnosis when
cancers are still in early stages by identifying factors responsible for prolonged
diagnostic intervals among breast cancer patients.This work was funded through a student support to JA by a multinational research collaboration between Makerere University, University of Cape Town and University of Cambridge which was jointly supported by the Cancer Association of South Africa (CANSA), the University of Cape Town and the South African Medical Research Council with funds received from the South
African National Department of Health, GlaxoSmith- Kline (GSK) Africa Non-Communicable Disease Open Lab (via a supporting grant Project Number: 023), the United Kingdom Medical Research Council, MRC (via the Newton Fund). GSK provided in-kind
scientific and statistical support as part of capacity strengthening. Award/Grant number is not applicable. The funders
had no role in study design, data collection and analysis, preparation of the manuscript, decision to publish, and where to publish
Endometriosis of the umbilicus in a 36-year-old woman: a case report and literature review
No full textIntroduction and importance: Extrapelvic endometriosis is quite rare, with a reported prevalence ranging between 0.5 and 1%, and the condition is more likely to pose diagnostic challenges. This condition is more likely to pose clinical diagnostic challenges as it may mimic metastasis such as Sister Mary Joseph’s nodule.
Case presentation: Herein is reported the case of a 36-year-old woman who presented with a hard nodular dark-bluish umbilicus mass that had a tendency to increase in size and was accompanied by severe pain during menstruation for ∼2 years is reported. Laparotomy revealed a normal uterus without involvement of any other pelvic organ by the endometrial tissue except the umbilicus
part. Histological evaluation revealed endometriosis of the umbilicus.
Clinical discussion: By far, primary endometriosis of the umbilicus is extremely rare, and most of the time, extrapelvic endometriosis involving the umbilicus would be secondary to surgical procedures involving the abdominal cavity as it was for the presented patient. Although endometriosis is rare, it should always be considered among women of reproductive age presenting with cyclic pains.
Conclusions: Meticulous investigation of patients suspected to have umbilical endometriosis helps to confirm the diagnosis and hence expedites proper management of the patients; this also prevents chances of malignant transformation of the condition despite such possibilities being extremely rare
Prevalence of Aflatoxin Contamination Across the Food Value Chain for Maize and Groundnuts in Uganda
No full textoai:ir.sun.ac.ug:123456789/75Abstract
Background: Maize and groundnuts are some of the most highly contaminated foods on the Ugandan market. Since 2006 there have
been some scattered studies on the prevalence of aflatoxin contamination among these grains. However, there were no recent studies
of 2022 to highlight the status of aflatoxin contamination.
Methods: Grain samples were collected from two highest producing districts that is Masindi and Soroti districts; and across the value
chain, from farmers to wholesalers, retailers, processors and restaurants/homes. The samples were tested using ELISA method and
the prevalence calculated.
Results: Aflatoxins were detected in 45% and 30% of maize and groundnuts, respectively. Contamination increases over the value
chain from 31% at farm level, to 42% at table level. In general, contamination was highest among processors at 43%, followed by
restaurants (42%), wholesalers (40%), farmers (31%) and retailers at 29%.
Keywords: Aflatoxins; Prevalence; Maize; Corn; Groundnuts; Gnuts; Uganda; Value ChainGovernment of Uganda for funding support through the Ministry of Science, Technology and Innovation under Grant Number –MoSTI/NRIP/2020-2021/35