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Patterns of postoperative feeding and their association with In-hospital outcomes among emergency laparotomy patients in MNRH: A prospective cohort study
No full textA dissertation submitted to the directorate of research and Graduate Training in partial fulfillment of the requirements for the Award of a Degree in Masters of General Surgery Makerere University.Background: Emergency laparotomy in sub-Saharan Africa is a common place procedure with
relatively poorer outcomes of surgery compared to Elective laparotomy. Mortality following
emergency abdominal surgery in low-income countries has been found to be three times that
of high-income countries (Bhangu et al., 2016) . Perioperative nutrition contributes to the
outcomes of surgery.
Objective: To determine the patterns of oral post-operative feeding among patients following
emergency laparotomy as well as the association between the feeding patterns and the inhospital
outcomes after surgery. Methods: This was a prospective cohort study in Mulago national referral hospital carried out
between May 2023 and September 2023. Patients who underwent emergency laparotomy and
were initiated on oral feeding were recruited and followed for a maximum for 30 days. An
interviewer administered questionnaire was used to collect data on feeding patterns, length of
hospital stay, passage of flatus and gut leakage. Data was cleaned and analysed using STATA
version 16. Mann-whittney U-test was used to compare length of hospital stay between early
and late feeding, modified poisson regression was used to estimate the association of
independent factors with late passage of flatus whereas linear regression was used to estimate
the relationship between length of hospital stay with the independent factors. Results: Of the 125 participants, 91 were male and 34 were female, median age of 28 years. 72.8% of the participants started feeds late. 41% of the participants advanced to solid feeds within 24 hours of initiating feeds. The mean length of hospital stay between early and late
feeding were 5 days and 9 days respectively (p=0.000). Factors associated with increased
length of hospital stay were; Late feeding (b coefficient=0.12(0.04-0.28), p=0.015), positive HIV status (b coefficient =0.17(0.4-0.49), p=0.011) and duration of use of NGT (p=0.001). Early initiation of feeding was associated with reduced risk of delayed passage of flatus (aRR 0.91, 95%CI 0.59-1.42, P-value 0.683. The other factors associated with reduced risk of late passage of flatus were; type of surgery (aRR 0.92, 95% CI 0.72-1.19, p-value 0.558 for laparotomy without bowel surgery and aRR 0.81, 95% CI 0.62-1.06, p-value 0.124 for perforation repair). The delayed timing of ambulation was associated with increased risk of
late passage of flatus (aRR 1.99, 95% CI 1.21-3.25, p-value 0.006, aRR 2.29, 95% CI 1.38-
3.78, p-value 0.001 and aRR 2.86, 95% CI 1.93-3.69, p value 0.002 for 1st, 2nd and 3rd postoperative
days respectively. Conclusion and recommendations: Patients who initiate oral feeding within 24 hours after
emergency laparotomy (early feeding) have a shorter length of hospital stay and early passage of flatus compared to those with late feeding. The other independent factors that predict longer hospital stay were positive HIV status and longer period of nasogastric usage. Delayed ambulation post-operatively predisposes to delayed passage of flatus Early feeding is beneficial
and should be encouraged when indicate
Functional and radiological outcomes of closed ankle fractures managed non-operatively among adults at Mulago National Referral Hospital six months post-injury
No full textIntroduction
Non-operative management is a common approach for treating closed ankle fractures at Mulago National Referral Hospital (MNRH) due to its potential benefits, including shorter hospital stays and the absence of surgical risks. Evaluating functional and radiological outcomes is essential for determining the success of this treatment. This study aimed to evaluate the functional and radiological outcomes of ankle fractures managed non-operatively and to identify the factors associated with these outcomes.
Methods; This study conducted from December 2023 to March 2024 evaluated these outcomes and associated factors in 93 adult ankle fracture patients treated non-operatively at MNRH. Using the American Orthopedic Foot Ankle Society ankle and hind foot score tool for functional scores and examining radiographs for union and parameters like the medial clear space, tibiofibular overlap, tibiofibular clear space, and the talocrural angle, the study aimed to identify the efficacy of non-operative management. Data analysis using STATA was conducted to assess the functional and radiological outcomes.
Results
The mean age and standard deviation were 41+/-12 years. More females n=49(52.7%) had ankle fractures than males. The commonest fracture type was Weber B n=65(69.9%)> Weber C n=16(17.2%)> Weber A n=12 (12.9%). The majority of the patients had an AOFAS-AH score categorized as good (54.8%)>excellent (23.7%)>fair (16.1%)>poor (5.4%). 86(92.5%) of the patients had radiological union with 7(7.5%) having nonunion. 97.7% of the patients had a normal MCS, 80.2% normal TFO, 50% normal TCA, and 13.9% normal TFCS. Significant predictors of poor functional outcomes included being HIV-positive (adjusted odds ratio [95% CI] 0.02 [0.01-0.21], p-value 0.001), Weber B fractures (adjusted odds ratio [95% CI] 0.19 [0.04-0.77], p-value 0.020), and Weber C fractures (adjusted odds ratio [95% CI] 0.16 [0.03-0.87], p-value 0.034). Predictors of good functional outcomes included receiving physiotherapy (adjusted odds ratio [95% CI] 4.45 [1.67-11.90], p-value 0.003) and initiating weight bearing at 4-6 weeks (adjusted odds ratio [95% CI] 5.09 [1.60-1620], p-value 0.006) or after 6 weeks (adjusted odds ratio [95% CI] 4.20 [1.42-1243], p-value 0.009).
Conclusion: The majority of participants achieved radiological union, though all united fractures resulted in malunion. Worse functional outcomes were associated with Weber classifications B and C, as well as HIV-positive status.self-sponsore
Truth trapped: mastering the dark art of witness manipulation a step-by-step guide to cross examination, re-examination, and witness control in civil and criminal cases a Ugandan perspective
No full textA bookIn the intricate world of courtroom battles, cross examination and reexamination become powerful tools that can be used to manipulate witnesses into revealing hidden truths. Mastery over witness manipulation is a skill that requires not only a deep understanding of human psychology but also a firm grasp of the law, especially within the context of Uganda’s legal system. This guide will explore tactics for controlling witnesses, exposing hidden truths, and ensuring that the pursuit of justice is not derailed by manipulative testimony
Stress, perceived social support, and drinking motives among secondary school adolescents in Kampala
No full textA dissertation submitted to the School of Psychology, Department of Mental Health and Community Psychology as a partial fulfillment of the requirements for the award of the Degree of Masters of Art in Counselling Psychology of Makerere UniversityThe purpose of this study was to examine the relationship between Stress, Perceived Social Support, and Drinking Motives among Secondary School Adolescents in Kampala. A government school and a private school were selected. Respondents were students of Senior Five and Senior Six, both male and female. The study employed a quantitative approach and correlational study design. Ethical considerations according to UNCST 2019 were adhered to while collecting data. Random sampling was used to achieve an unbiased sample and the calculated sample size of participants to take part in the study was 144. Data was analysed using Pearson Product Moment Correlation to test hypothesis 1, 2 and 3 and Independent Sample T-test was used for hypothesis 4.
Results revealed that there is no significant relationship between stress and drinking motives. Also, no significant relationship is found between stress and perceived social support. And lastly no significant relationship is found between perceived social support and drinking motives, among secondary school adolescents in Kampala. Although there were no gender differences in drinking motives, through inspecting mean scores the female participants scored higher on drinking motives with slightly higher mean scores except for social motives where males scored slightly higher compared to females. Based on the study findings, Proactive advocacy by various providers of social support like family, schools, and communities, should be done in order to encourage adolescents to seek out support from the various stake holders
Malaria prevalence and associated factors among pregnant women attending their first antenatal care in Nakivale Refugee Settlement
No full textA dissertation submitted to Makerere University School of Public Health in partial fulfillment of requirements for the award of Master of Public Health of Makerere University, KampalaBackground: Malaria is the leading cause of morbidity and mortality in Uganda affecting mostly children under 5 years of age and pregnant mothers. In the post COVID-19 era, malaria incidences have been reportedly rising in the global statistics. Uganda has the third-highest rate of malaria cases worldwide (5.1%) and the seventh-highest rate of malaria deaths (3.2%). Pregnant women in refugee camps are vulnerable to malaria due to a number of factors. There was no available data on malaria infection prevalence and associated factors among pregnant women in a refugee setting such at Nakivale refugee camp in Uganda.
Objective. The aim of this study was to determine the prevalence of malaria infection and the associated factors among pregnant women attending their first antenatal care (ANC) in Nakivale and Rubondo health Centre threes at the refugee settlement.
Methods. A cross-sectional survey was conducted among 374 pregnant women attending their first ANC at Nakivale Health Centre (HC) III and Rubondo HC II
Analysis of women entrepreneurs’ access to financial services: a case of Kigali City
No full textA research report submitted to the School of business in partial fulfilment of the requirements for the award of a degree of Master of Arts in Financial Services of Makerere UniversityThis study examines women entrepreneurs’ access to financial services in Kigali City, Rwanda, with a focus on analysing the nature of women-owned enterprises, the factors affecting access to finance, and the policies and programs that can enhance financial access for these entrepreneurs. The research utilized a cross-sectional survey design, incorporating both quantitative and qualitative approaches. The target population comprised 2,489 registered women-owned/women-managed SMEs in the three districts of Kigali City: Nyarugenge (1,135), Gasabo (912), and Kicukiro (442). A sample size of 345 women entrepreneurs was selected using Kothari’s (2004) stratified simple random sampling formula and Yamane’s (1967) simple random sampling formula, with a response rate of 93.62% (323 respondents). Primary data was collected through a structured questionnaire survey, and descriptive statistics (frequencies and percentages) were used to analyse the data. The findings revealed that women-owned enterprises in Kigali are predominantly in the retail/wholesale sector (53.6%), with a majority being micro-enterprises (62.5%). Most entrepreneurs rely on personal asset sales (42.4%) and peer-to-peer loans (36.5%) for startup capital. Despite high leadership involvement (93.2%) and engagement in social responsibility initiatives (63.5%), significant challenges persist. These include perceived gender inequalities in entrepreneurial opportunities (63.1%) and limited work-life balance (70%). Key factors affecting access to formal financial services include the collateralization of loans (52.3%), gender biases (71.2%), limited resources (47.1%), and cultural barriers (54.2%). Technology, however, plays a crucial role in market access and business management, recognized by 88.9% of respondents. Initiatives such as microfinance programs, government-backed loan schemes, and mentorship programs emphasizing financial literacy were acknowledged by 71.2% of respondents as beneficial. The study contributes significantly to academia by enriching the understanding of the specific challenges faced by women-owned businesses in Kigali and highlighting the roles of technology, mentorship, and financial inclusivity. For policymakers, the findings offer critical insights for designing gender-sensitive financial policies and support mechanisms. Women entrepreneurs can derive practical guidance from the study’s emphasis on financial literacy, innovation, and work-life balance. Recommendations include enhancing financial inclusion through gender-sensitive policies, increasing financial literacy programs, creating flexible financing options, expanding mentorship and networking opportunities, and addressing cultural and gender-related biases through advocacy campaigns. Future research should expand beyond Kigali to encompass the entire country, adopt mixed methods research for a more comprehensive analysis, and investigate the causal relationship between access to finance and entrepreneurial success. In conclusion, this research underscores the multifaceted challenges faced by women-owned businesses in Kigali City and emphasizes the importance of targeted strategies to foster their growth and sustainability. By addressing barriers to financial access and promoting a supportive environment, stakeholders can significantly contribute to the advancement of women entrepreneurs and the broader economic development of the region
Short-term outcomes of non-operatively managed Diaphyseal Clavicle fractures in adults at Mulago National Referral Hospital.
No full textA dissertation submitted to School Of Graduate Studies in partial fulfillment for the award of Master of Medicine in Orthopedic Surgery of Makerere University.Introduction: Clavicular fractures constitute around 4% of all fractures globally, majority (80%) of these occurring in the diaphyseal region (Kihlström, Möller et al., 2017). At Mulago National Referral Hospital (MNRH), clavicle fractures are commonly managed non-operatively with good results. Nonetheless, some patients have reported short-term problems such as reduced shoulder function, persistent pain and discomfort. Despite this, there have been no prior investigations into the outcomes of non-operative treatment of diaphyseal clavicle fractures at MNRH.
Objective: To describe the short-term outcomes of non-operative management of diaphyseal clavicle fractures and their associated factors among adults at MNRH.
Methods: In this cross-sectional study, 54 participants were enrolled and assessed at point between 3 to 6 months following the injury, for outcomes of their treatment. Functional outcomes were assessed using the CMS, while radiologic outcomes were assessed on anteroposterior (AP) and serendipity view radiographs for presence of bridging callus. All collected data was imported into Epidata 4.2 and subsequently imported into STATA version 15 for analysis.
Results: The average age (SD) of participants was 34.5 (12.55) years, range 18 to 70 years. The ratio of males to females was 1.7:1. With regards to fracture pattern, 74.07% of participants had class 2B1 and 44.44% had fracture displacement of more than 100% on initial x-rays. 64.8% of participants reported pain around injury site. Majority (70.37%) had good to excellent outcomes with average (SD) functional score of 78.65 (12.61) and ranging from 59 to 100. 66.67% had achieved union while 33.33% had nonunion. A displacement greater than 100% (p=0.032), duration since injury (p=0.000, 0.009) and the presence of pain were found to be significantly associated with poorer outcomes.
Conclusion: The outcomes were generally good but with significantly large proportions of patients with unfavorable outcomes. A displacement of 100% or more was associated with higher chances of nonunion and poorer functional scores. We therefore conclude that nonoperative management of diaphyseal clavicle fractures in adults yields satisfactory outcomes for displacements than 100% in the short-term, but recommend surgical treatment for fractures with displacement greater than 100% on anteroposterior (AP) radiographs for better short term outcomes
Attrition and associated factors among patients on chronic antihypertensive therapy at Mulago hospital
No full textIntroduction: Attrition among patients on chronic antihypertensive therapy (AHT) is a significant problem that can lead to serious health consequences, including uncontrolled blood pressure, cardiovascular diseases, stroke, sexual dysfunction, loss of kidney functions, and blindness. Multiple factors contribute to this issue, and healthcare providers must be mindful of them to prevent treatment discontinuation and ensure optimal patient outcomes.
Objective: To assess attrition and associated factors among patients on chronic antihypertensive therapy at Mulago Hospital.
Methods: A sequential explanatory mixed-methods design was conducted among 1215 hypertensive patients at Mulago Hospital between January 2020 and December 2022. The quantitative study was a retrospective cohort study design and the qualitative study employed an explanatory descriptive design. An abstraction tool and interview guides were used to gather the data required to accomplish the study goals. Extended Cox model was used to determine the factor associated with time to attrition at <0.05 level of significance. Attrition was characterized as patients who were lost to follow-up, and loss to follow-up was defined as patients who missed ≥2 consecutive appointment visits from the last visit date to the clinic.
Results: Attrition rate was at 56.8% (95%CI 54.0-59.7) with most patients getting lost to follow-up in 2020 (64.9%) and the least in 2021 (54.7%). Age (HR=0.904, 95% CI 0.877-0.932), gender: female (HR=0.713, 95% CI 0.602-0.845), residence: outside Kampala (HR=1.311,95%CI 1.121-1.533), last visit systolic blood pressure (SBP) (HR=1.013,95% CI 1.008-1.017), and last visit diastolic blood pressure (DBP) (HR=0.957,95% CI 0.925-0.990) were associated with time to attrition. Financial constraints, medical rudeness, and COVID-19 restriction measures were among the underlying reasons for attrition.
Conclusion: The hypertensive patient attrition rate at Mulago Hospital is high, making retention rates considerably below the Centers for Disease Control and Prevention's 80% retention target. This calls for innovative retention strategies and targeted support for high-risk groups like young, males and those living far from the health facility
.COVID-19 vaccination uptake and associated factors among employees of sugar corporation of Uganda limited (scoul) in Lugazi, Buikwe District.
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfillment of the requirements for the award of a master of public health degree of Makerere UniversityBackground With over 200 COVID-19 vaccines in development, medical professionals emphasize the critical role of vaccination in combating the pandemic. Despite the proven efficacy of vaccines, hesitancy remains a significant global threat. By examining the interactions between COVID-19 knowledge, attitudes, and vaccine uptake, targeted measures can be developed to increase vaccination rates and achieve herd immunity. This study investigates COVID-19 vaccination uptake and associated factors among employees of Sugar Corporation of Uganda Limited (SCOUL) in Lugazi, Buikwe District Methods A cross-sectional study design using quantitative methods was employed. The dependent variable was, COVID-19 vaccination uptake among employees of Sugar Corporation of Uganda Limited (SCOUL), while the independent variables included socio-demographics, individual factors, and community factors. Data were analysed using STATA-14 software, summarizing continuous and categorical variables. Chi-square tests assessed relationships between predictors and vaccination uptake. A multivariable negative log-binomial regression determined influencing factors. Results Only 38.1% of the 381 participants had received a COVID-19 vaccination. Acceptance reasons included high perceived risk, access to work premises, and personal protection. Males were 40% less likely to get vaccinated [aPR 0.60 (95% CI: 0.24-1.50)]. Married employees and those with post-primary education were 1.46 and 1.84 times more likely to get vaccinated [aPR 1.46 (95% CI: 1.04-2.05)] and [aPR 1.84 (95% CI: 1.23-2.74)]. Those with a monthly household income of 500,001 – 900,000 UGX and a moderately high perceived risk of COVID-19 were 1.13 and 2.65 times more likely to get vaccinated [aPR 1.13 (95% CI:0.79-1.64)] and [aPR 2.65 (95% CI:1.05-6.67)]. Listening to or watching radio and TV at least once a week and exposure to government agencies increased the likelihood of vaccination by 3.08, 3.13, and 2.58 times, respectively [aPR 3.08 (95% CI:1.49-5.67)], [aPR 3.13 (95% CI:1.09-6.18)], and [aPR 2.58 (95% CI:1.02-5.15)]. Conclusion The study identified high perceived risk, access to work premises, and personal protection as key drivers of vaccine uptake. Marital status, gender, education, household income, media exposure, and government agency influence also played significant roles. Future research should explore psychological, sociocultural, and economic factors to further increase COVID-19 vaccination uptake among SCOUL employees
Identification of new sources of resistance to common bean anthracnose (colletotrichum lindemuthianum) among the common bean (phaseolus vulgaris l.) germplasm in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Studies in partial fulfillment of the requirements for the award of the degree of Master of Science in Plant Breeding and Seed Systems of Makerere UniversityBean anthracnose, caused by Colletotrichum lindemuthianum, poses a significant threat to common bean production in Uganda. This study aimed to evaluate the adaptation and resistance levels of common bean genotypes to anthracnose disease and identify new sources of resistance within the local germplasm. Genotype by environment interaction (GEI) plays a crucial role in determining crop performance across diverse environments. To comprehensively understand this phenomenon, multi-environment trials were conducted across four major anthracnose hot-spot regions in Uganda. The study encompassed the evaluation of 260 common bean lines for anthracnose resistance and yield across diverse environments. The analysis of variance (ANOVA) demonstrated significant effects of genotypes, environments, and their interaction on both anthracnose severity and grain yield. The genotype by environment interaction analysis revealed the contributions of these factors to the variability of traits. Furthermore, the Additive Main effects and Multiplicative Interaction (AMMI) model and the Genotype plus Genotype by Environment (GGE) biplot were employed to analyze stability and identify ideal genotypes. Results showed that certain genotypes, such as UNGB 260, UNGB 4964, UNGB 2339, UNGB 1592, and G2333, exhibited high levels of resistance and stability across different environments. The GGE biplot analysis indicated the formation of mega-environments, which provided insights into genotype performance across locations. The identification of stable and resistant genotypes is crucial for developing common bean varieties resilient to anthracnose. The study also investigated the resistance of these common bean genotypes to different races of C. lindemuthianum. The phenotypic data revealed varying levels of resistance to different races, with some genotypes exhibiting moderate resistance to the most virulent race (4041) and higher resistance to other races. In conclusion, this research contributes to the development of common bean varieties with enhanced resistance to anthracnose disease. The findings highlight genotypes that are stable across diverse environments and possess resistance to the prevalent races of C. lindemuthianum. These findings hold significance for improving food security and the livelihoods of smallholder farmers in Uganda. The study emphasizes the importance of considering genotype-environment interaction in breeding efforts and provides valuable insights for future research and breeding strategies to combat bean anthracnose