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Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross‑sectional study
No full textGlycemic control is of paramount importance in care and management for patients with type 2 diabetes mellitus (T2DM). Poor glycemic control is a major health problem that greatly contributes to the development of diabetes related complications. This study aims to assess the prevalence of
poor glycemic control and associated factors among outpatients with T2DM attending diabetes clinic at Amana Regional Referral Hospital in Dar-es-salaam, Tanzania from December 2021 to September 2022.
A face to face interviewer semi-structured questionnaire was administered during data collection. Binary logistic regression under multivariable analysis was used to determine the independent predictors of poor glycemic control. A total of 248 patients with T2DM were included in
the analysis with mean age of 59.8 ± 12.1 years. The mean fasting blood glucose was 166.9 ± 60.8 mg/dL. The prevalence of poor glycemic control was 66.1% (fasting blood glucose > 130 mg/dL or < 70 mg/dL).
Failure to adhere to regular follow-up (AOR = 7.53, 95% CI = 2.34–19.73, p < 0.001) and alcoholism (AOR = 4.71, 95% CI = 1.08–20.59, p = 0.040) were the independent predictors of poor glycemic control.
The prevalence of poor glycemic control observed in this study was significantly high. Emphasis should be placed on ensuring that patients have regular follow-up for their diabetes clinics and they should also continue modifying some of lifestyle behaviors including refraining from alcoholism, this can help them to have good glycemic control
Levels of total aflatoxins in maize and groundnuts across food value chains, gender and Agro-ecological zones of Uganda
No full textAbstract
Maize and groundnuts are traditional nutrient-rich and high economic value foods grown in Uganda. However, these crops are susceptible to aflatoxin contamination which may result into aflatoxicosis related illnesses. Occurrence of flatoxins in the foods varies across food value chains, gender and agro-ecological zones of Uganda. Therefore, we conducted a cross-sectional study in 80 maize and groundnut foodstuff from Masindi and Soroti agro-ecological districts respectively. We determined levels of total aflatoxins in maize and groundnut samples across food value chains, gender and agro-ecological zones. This was aimed at assessing safety and quality status of the foods in Uganda. Questionnaires were administered to obtain information on food handling practices. 500g of each food sample were obtained and analyzed for total aflatoxin levels using ELISA assay. Data was analyzed using descriptive and analytical statistics. In overall, 45% of maize and 30% of groundnut foods were contaminated with aflatoxins. Mean aflatoxin levels in foods from Eastern and Western agro-ecological zones were 0.052±0.036ppb and 0.045±0.033ppb respectively (p=0.124). Mean aflatoxin levels in groundnuts from both male and female respondents were coincidentally 0.052ppb. Whereas, the mean aflatoxin levels in maize from male and female respondents were 0.056±0.037ppb and 0.039±0.029ppb respectively. Across the food value chain, wholesaler groundnut foods contained the highest mean aflatoxin levels of 0.088ppb (p= 0.27). Growing high polyamine containing crops, routine testing of aflatoxin prone foods and sensitizing food value chain players are important aflatoxin control strategies.Government of Uganda for funding support through Ministry of Science, Technology and Innovation under Grant Number –MoSTI/NRIP/2020-2021/35
RUFORUM Working Document Series: Research Application Summary
No full textNAAbstract
Elders from Teso sub region in Eastern Uganda nursed a dream that one day, they would have a University in
their area. This dream came true on 11th December 2011 when Uganda Government decided to set up a Public
University known as Soroti University, located in Teso sub-region. The University was established by Statutory
Instrument No. 34 of July 2015 as the 9th Public University under the Universities and Other Tertiary Institu
tions Act of 2001 as amended. Soroti University is governed by the University Council and Council Committees
plus Senate and its Committees as stated the act. Based on its Vision of being an institution of Professionals and
Innovators, the Niche of Soroti University is to provide knowledge, skills and innovations in applied sciences.
The University’s thematic areas are: - Health Sciences; Engineering and Technology; Renewable Energy; Ap
plied Science and Science Education; Value addition courses and Food Science and Technology and currently
has a population of 474 students.N
Immunohistochemical expression of P53 protein in nephroblastoma: a predictor of unfavorable prognosis
No full textObjective Immunohistochemical expression of P53 protein is so closely related to status of mutation of P53 gene which is tightly linked with pathogenesis of nephroblastoma or Wilms tumor. This study aims to determine the immunohistochemical expression of P53 protein and its predictors in formalin-fixed paraffin-embedded tissue blocks of patients with nephroblastoma.
Materials and methods A series of 83 histologically diagnosed cases of nephroblastoma from formalin-fixed paraffin-embedded tissue blocks archived at the Department of Pathology, Makerere University, in Kampala, Uganda, were analyzed. Monoclonal anti-p53 antibody (DO-7, DAKO) was used to assess the expression of P53 protein expression. Multivariable logistic regression analysis was performed to determine the predictors of P53 protein immunohistochemical expression, and statistical significance was considered when p-value was less than 0.05.
Results: Most (42.2%, n = 35) of the cases were in advanced tumor stages (III–V), and almost one-quarter (21.7%, n = 18) of the cases were in high-risk group. The immunohistochemical expression of P53 protein was (8.4%, n = 7), and there were more (83.3%, n = 5) positive anaplastic cases for P53 protein compared with (2.6%, n = 2) of P53 expression for non-anaplastic cases. High risk (AOR = 3.42, 95% CI = 7.91–12.55, p = 0.037) and anaplasia (AOR = 1.41, 95% CI = 13.85–4.46, p = 0.001) were potential predictors of immunohistochemical expression of P53 protein.
Conclusion: Most of patients with nephroblastoma in resources-limited settings are diagnosed with advanced clinical stages. Association of P53 protein with anaplasia found in this study indicates the possibility of having novel target therapy for treatment of patients with anaplastic form of nephroblastoma with a focus of identifying molecules that lead to its suppression in such subpopulations of patients with nephroblastoma
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’ files. 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.Abstract
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 chemoradiotherapy.
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
Factors associated with retention of mother baby pairs in the elimination of mother-to child transmission of HIV program in Kaberamaido district: A longitudinal analysis
No full textThe authors would like to extend their appreciation to all the lecturers of Busitema University,
Faculty of Health Sciences for the guidance offered during proposal development and conduct
of this research. We would also like to acknowledge Mr. Ogwang Bernard, the Chief Adminis
trative Officer Kaberamaido District Local Government, for allowing us to conduct this study
in his district. Finally, we acknowledge the contribution of our HIV/AIDS service delivery
partner in the district, The AIDS Support Organization, Soroti regional project for supporting
high quality HIV services in the district.Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in
Ugandaremains poor asonly 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
eMTCTcascade(12and18months)andassociated factors.
Methods
This was alongitudinal analysis of 368 mother-baby pairs who were enrolled into the
eMTCTprograminKaberamaido district from January 2013 to December 2018. Data was
extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Micro
soft Excel and then exported to Stata statistical software package version 14.0 for manage
ment andanalysis. 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 vari
able, while Cox proportional hazard regression model was built at multivariate level to deter
mine the factors independently associated with retention of mother-baby pairs in the
eMTCTprogram.
Results
Of the 368mothers 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
eMTCTprogramwhile45(12.2%, 95CI=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 ARTinitiation 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
whoinitiated 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
LTFUascomparedtothoseenrolled 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
hadnosignificant association with lost to follow up and cascade completion at multivariate
level.
Conclusion
There washigh level of retention of mother-baby pairs in the eMTCT program in Kabera
maido at 12months, but it was suboptimal at 18months. ART initiation during the antenatal
and/or post-natal period was significantly associated with suboptimal retention of mother
baby pairs along the eMTCT cascade.Funding: The authors received no specific funding for this work
A case report about a uterine Tumor’s case
No full textAbstract:
Introduction: Malignant mixed Mullerian tumor (MMMT) is an exceedingly rare and aggressive tumor which
occurs predominantly in postmenopausal women though it has been reported rarely in premenopausal women.
Case presentation: A 54-year old nulliparous postmenopausal female presented with a 3-month history of vaginal
bleeding, mild lower abdominal pain and weight loss. Ultrasound revealed markedly enlarged uterus with a
hyper-echoic solid and cystic mass and a right adnexal complex mass. Total abdominal hysterectomy and
bilateral salpingioopherectomy were done. Histopathological features were consistent with MMMT. The patient
is currently stable after 6 cycles of adjuvant chemotherapy which consisted of paclitaxel and carboplatin.
Clinical discussion: MMMT of the uterus is rare, high-grade neoplasms comprising only 1–2% of uterine cancers
and 3–5% of all uterine malignancies. This tumor may arise in the ovaries, fallopian tubes and vagina. Histologically,
MMMT is a biphasic tumor composed of both epithelial (carcinoma) elements and mesenchymal
(sarcoma) elements; though, which component is responsible for the tumor’s aggressive biological behavior
remains undetermined.
Conclusion: MMMT is a rare and aggressive tumor which is commonly seen in postmenopausal women with high
rate of recurrence therefore, Radical surgery and close follow-up is mandatory since the role of chemoradiotherapy
remains unclear in the management of patients with this tumor. Both stage of the tumor and
myometrial invasion are considered as potential prognostic factors.No Fundin
Infant and Young Child Feeding in the Developed and Developing Countries
No full textAbstract
Infant feeding challenges continue to manifest in developed and developing
countries. Worldwide, more than 80% of babies are breastfed in the first few weeks
of birth. However, about 37%, 25%, and less than 1% are exclusively breastfed at
6 months of age in Africa, the United States of America, and the United Kingdom,
respectively. These statistics are far below the World Health Organization targets
of 50% and 70% by 2025 and 2030, respectively. Complementary feeding practices
are varied as well due to nonadherence to Infant and Young Child Feeding (IYCF)
guidelines among parents. This accounts for the current trends in malnutrition in
children under−5 years of age, adolescents, and the youth, and leads to intergenera tion malnutrition. In this chapter we have included sections on appropriate infant
feeding; including how to initiate breastfeeding in the first hour of birth, how to
exclusively breastfeed infants until 6 months of age, how to complement breastfeed ing after 6 months of infant’s age as well as continuing to breastfeed until 24 months
of age and even beyond. Furthermore, we have included a description of how mothers
who are unable to breastfeed can feed their infants on expressed breastmilk or replace
breastmilk with appropriate homemade or commercial formula. This chapter as well
covers infant feeding in prematurit
A rare case report
No full textCavernous hemangioma (CH) of urinary bladder occurs relatively infrequently,
accounting for 0.6% of all bladder tumors. This tumor may occur sporadically
or coexist with other benign and malignant vascular lesions. In this report, we
present a rare case of CH in a 3-year-old Ugandan girl. A 3-year-old girl was re ferred to Mbarara Regional Referral Hospital (MRRH) for urological evaluation
following a 3-year history of intravaginal swelling, dysuria, and heavy hematuria
resulting in anemia. Imaging was consistent with polypoid bladder mass arising
from the bladdertrigone. Embryonalrhabdomyosarcoma wassuspected based on
clinical eyeballing. She was worked up for chemotherapy and received 26 cycles
of vincristine sulfate, actinomycin-d, and cyclophosphamide (VAC). Biopsy and
fulguration were performed after optimizing the patient. Histopathology con firmed CH. The surgery was uneventful and resulted in complete cure. CH should
be considered in the differential diagnosis of childhood genitourinary masses. It
is a rare entity in the real-life clinical practice and therefore can be overlooked.
Excision biopsy and histology should be performed before initiating the patients
to chemotherapy. CH is very insensitive to chemotherapy and therefore surgery
maybe adequate in resource-limited settings.Non
Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda
No full textBackground: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource
settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of
this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at
Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.
Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at
MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files.
Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied.
Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal
cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis
10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic
pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal
pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were
the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pan creatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which
malignancy carried the highest mortality 20 (95.24%).
Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early
recognition and appropriate referral are key in this population to improve outcomes.Non