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Prevalence and factors associated with pre-operative delays among neurotraumatic patients at Mulago National Referral Hospital: a cross-sectional study
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfilment of the requirements for the award of the degree of Master of Medicine in Surgery of Makerere University.Introduction
Neurotraumatic emergencies affect more than 10 million people globally with majority of them from sub-Saharan. Neurotraumatic emergencies present a challenge in emergency surgical care, demanding quick and precise intervention to mitigate potentially life-threatening outcomes. Despite this there are still preoperative delays for these patients. Study Objective; To determine the prevalence and factors associated with pre-operative delays among neurotraumatic patients requiring surgery at Mulago National Referral Hospital. Methods: This was a descriptive cross-sectional study, and the participants were recruited through consecutive sampling. An interviewer administered questionnaire was used to collect data on prevalence and factors associated with preoperative delays. Preoperative delay was defined as the time exceeding six hours (> 6 hours) from the decision to operate to the initiation of surgery and measured as a binary outcome (categorized as either delayed or not delayed). Modified Poisson regression was used to determine independent factors associated with preoperative delays. Results: A total of 184 participants were recruited into the study. The median age of the participants was 33.5 years (IQR, 24-50), 162 (88%) were male. Majority 111(60.3%) of the participants had mild head injury whereas RTA contributed to majority of the injuries at 100 (54.3%). Majority 158 (85.9%) of the participants reported lack of anaesthetic drugs/equipment. The prevalence of pre-operative delays was 90.2% (95%CI,84.9-93.8). The patient related factors associated with pre-operative delays were the GCS score (aRR, 1.02; 95%CI,1.01-1.04; P=0.014) and being unknown patient (aRR, 1.15; 95%CI CI,1.04-1.28; P=0.006). The health system related factors were lack of anaesthetic drugs (aRR, 1.39; 95%CI,1.08-1.81; P=0.011) and lack of theatre space (aRR, 1.09; 95%CI,1.02-1.18; P=0.02). Conclusion: The prevalence of pre-operative delays among neurotraumatic patients at MNRH is high at 90.2%. The patient related factors associated with pre-operative delays were a high GCS score and being an unknown patient whereas the health system related factors associated with pre-operative delays were lack of anaesthetic drugs and lack of theatre spac
Short term outcomes of unstable pelvic fractures in adults treated at Mulago National Referral Hospital
No full textA dissertation submitted to the Directorate of Graduate Studies in partial fulfillment of the requirements for the award of the degree of Master of Medicine in Orthopedic Surgery of Makerere University.Introduction
Pelvic fractures are perhaps the most severe & life-threatening musculoskeletal injuries, constituting about 1.5%–3% of all skeletal injuries. Despite their severity, unstable pelvic fractures can yield favorable outcomes, particularly when timely and appropriate management strategies are implemented. However, some patients who survive may incur temporal or permanent disabilities affecting function. Thus, the study aimed to describe the functional and radiological outcomes of unstable pelvic fractures of adults treated at MNRH.
Methods
We recruited 51 patients consecutively from November 2024 to February 2025. Functional outcomes were assessed using the Majeed Pelvic score, while Radiological outcomes were evaluated for bony union, non-union, and malunion. Data was collected using a structured questionnaire and analyzed using STATA version 15. Continuous variables were summarized using the median and interquartile ranges, while the categorical variables were summarized using frequencies and proportions. Figures and tables were used to present the data.
Results
The median age was 31 (IQR 25,38), and the male sex dominated 56.9% (n=29). Road traffic accidents were the commonest mechanism of injury, 88% (n=45), with Tile B fractures being the most predominant. Operative fracture management dominated by 54.9% (n=28), 21% (n=11) had associated nerve damage, and only 11.8% (n=6) did not adhere to the rehabilitation protocol. A satisfactory functional outcome was observed among 57% (n=29) of the patients, and of these, Tile B fracture dominated with 68.9% (n=20). Radiological union occurred among 78% (n=40) of the patients. The factors associated with the unsatisfactory short-term functional outcome were non-adherence to the rehabilitation protocol [PR 1.22, 95% CI (1.05 – 1.42)], and being managed non-operatively [PR 1.34, 95% CI (1.16 – 1.55)]. Falling from heights as a mechanism of pelvic injury [PR 0.80, 95% CI (0.67 – 0.94)] and having an occupation following injury [PR 0.77, 95% CI (0.66 – 0.91)] were associated with reduced prevalence of unsatisfactory functional outcomes.
Conclusion
In this study, 57% of the patients with unstable pelvic fractures had satisfactory functional outcomes following treatment. Radiological union rates showed better results with 78% attaining union. Being managed operatively and adherence to rehabilitation protocol were associated with satisfactory functional outcomes
Prosthetic fitting and associated factors among lower limb amputees at Mulago Hospital
No full textBackground: Lower limb amputations are a significant global health challenge, with Uganda experiencing a notable burden. Despite the essential role of prosthetic fitting in rehabilitation, disparities in access and prosthetic fitting persist, particularly in low-income countries. Limited research exists on the rate and associated factors of prosthetic fitting among lower limb amputee patients, especially in Uganda. Addressing this gap is crucial for enhancing care and outcomes. This study aimed to investigate the proportion of prosthetic fittings and associated factors among lower limb amputees at Mulago Hospital, providing insights into improving amputee care in Uganda.
Methodology: A cross-sectional study was conducted among 58 lower limb amputees who had completed at least 12 months of prosthetic fitting at Mulago Hospital. Convenience sampling was used to enroll the 58 participants. Prosthetic fitting was assessed using the TAPES scale, with a score of ≥60% considered successful. Data on associated factors were collected using a questionnaire. Data analysis was done using STATA version 15. Bivariate and Multivariate modified Poisson regression was used to identify the associated factors with the level of significance set at 0.05
Results: The study found that the rate of successful prosthetic fitting among lower limb amputees at Mulago Hospital was 34.5%. Factors such as education level and the average number of hours a prosthetic was worn daily were significantly associated with successful prosthetic fitting (p=0.038 and p=0.006, respectively). However, variables such as sex, residual limb pain, phantom limb pain, comorbidities, and time to rehabilitation were not significantly associated with prosthetic fitting.
Conclusion: The study revealed a low rate of successful prosthetic fitting among lower limb amputees at Mulago Hospital, consistent with findings from other settings. Factors such as higher education levels and longer daily prosthetic use were significantly associated with prosthetic fitting, highlighting the importance of addressing clinical and socio demographic factors in prosthetic rehabilitation programs
Prevalence, etiology and computed tomography finding in patients with traumatic brain injury at Mulago National Referral Hospital: A cross sectional study
No full textBackground: Traumatic brain injury (TBI) refers to brain damage following trauma to the head. It is one of the leading causes of morbidity and mortality in the world. The incidence of TBI is a growing burden due to increasing number of high-speed motor vehicle,
more movement of the public and increasing industrial activities. Globally TBI incidence is approximated at 27 million per year, with high prevalence in developing counties. In developing countries, the incidence is approximated to be 3.2 million per year, with a 3.5-fold increase in Sub Saharan Africa, estimated to be 14 million per year by 2050. Uganda as part of sub-Sahara Africa is not excluded in the TBI burden growth.
Objective: This study aimed to determine the prevalence, etiologies and computed tomography findings in patients with traumatic brain injury at MNRH.
Methodology: We conducted a hospital based cross-sectional study on traumatic brain injury patients for one month to determine the prevalence, etiology and Computed tomography findings. Patient’s data collected included demographic data, etiology and CT-findings. Data collected were exported to STATA 18 for analysis.
Results: There were 419 TBI patients out of 822 trauma patients giving a prevalence of 50.97%. Males accounted for 75.3% of the 370 head trauma cases with an approximate male to female ratio of 5.2:1. The mean age of the patients 33.21 years with a standard deviation of 11.88 years. RTA was the most common etiologic factor accounting for 245, (66.67%) of cases. There was 1 case due to
industrial injury in the study population. Abnormal CT findings were present in (90.68%) of cases. Skull fracture was demonstrated in (29.19%) patients and was the most common finding. Extraaxial bleeds were present in (30.46%) and the incidence of contusion was also high (24.64%).
Conclusion: MNRH has a high prevalence traumatic brain injury with young males disproportionately affected. Road traffic accident was the most common cause and skull fracture was the commonest findings on CT followed by contusion
An analysis of revenue sustainability models for online publications in Uganda : a case study of ChimpReports
No full textA thesis submitted to the Directorate of Research and Graduate Training, as part of the requirements for fulfilment of the award of Master of Journalism and Multimedia of Makerere University.This study analyses the revenue sustainability models utilized by online publications in Uganda, using ChimpReports as a case study. It explores the existing revenue models, the influence of technological advancement on revenue models adopted by ChimpReports, as well as investigating challenges faced by ChimpReports as online publication as it struggles to stay in the market. Study findings are grounded on purposive in-depth interviews conducted on 10 personnel, who included the Director, 2 Online Editors, 2 Marketing officers, 2 finance officers, and 3 Reporters. Findings revealed that ChimpReports relies on diversified revenue streams, online presence, brand partnerships, cost efficiency, and high-quality content for financial stability and audience connection. The study also highlights Challenges faced by online media publications, which include managing diverse income streams, balancing free and premium content, optimizing online presence, creating sponsored content, financial management, and adapting to reader preferences. Anchored in the Political Economy theory of the media, this study also highlighted ChimpReports' financial model, thriving through diverse income streams, online presence, brand partnerships, cost efficiency, and quality content. It also found out that technological advancements play a pivotal role in online media operations, refining content, targeting audiences, and exploring non-traditional revenue sources. The study recommended ChimpReports’ adoption of a sustainable model, incorporating diverse revenue streams, strategic technology use, high-quality content, as well as continual exploration of new income streams, enhanced user engagement, strengthened brand partnerships, optimized financial management, and embracing emerging technologies for sustainability
Prevalence and patterns of humeral fractures amongst patients presenting with upper limb fractures to Mulago National Referral Hospital.
No full textIntroduction: Humeral fractures are some of the major orthopaedic injuries presenting to the Accident and Emergency unit among patients with musculoskeletal trauma. However, their true prevalence and patterns is not yet known given the increasing number of patients with musculoskeletal injuries in many health settings. This study aimed to determine the prevalence of humeral fractures and describe their clinical and radiological patterns amongst patients presenting with upper limb fractures to MNRH, a level 1 trauma centre.
Methods: This was a descriptive cross-sectional study conducted among patients with upper limb fractures at MNRH. Participants were recruited from accident and emergency (A&E) unit and the Surgical outpatient department (SOPD) and were interviewed using structured questionnaires to ascertain their demographic characteristics and clinical patterns of the fractures sustained. X-ray and or CT scan images were used to ascertain radiological patterns of the fractures. The updated 2018 AO/OTA fracture classification was used to describe the patterns of humeral fractures in both adult and paediatric population. Data analysis was done using Stata (version MP 13) and the statistical significance level was set at 5%.
Results: Out of a total of 459 participants with upper limb fractures, 62 (13.51%) had humeral fractures. children aged 0-10 years 20 (32.26%) and those adults aged 21-30 years 16 (25.81%) were the most affected. Road traffic accidents (56.45%) and simple falls (29.03%) were the leading causes of humeral fractures. The middle third of the humerus was most affected (56.45%), followed by the distal third (30.65%). Among adults, simple pattern humeral shaft fractures (47.22%) were most common, while paediatric cases mostly had distal metaphyseal fractures (61.54%). All cases were closed fractures, 77.42% isolated while 22.58% of patients had multiple injuries. Only 9.67% fractures involved peripheral nerve injury.
Conclusion: This study reveals that the prevalence of humerus fractures amongst a total of 459 upper limb fractures is 13.51% slightly higher than what is reported globally. The male to female ratio was 5:1. And the paediatric population aged 0-10 constituted the majority of participants presenting with humerus fractures followed by the young adult population aged 21-30 years. Road traffic accidents was the predominant cause of injury in participants. These fractures however have a distinct pattern that vary radiologically and clinically. Proper evaluation for these fractures is crucial for effective diagnosis and management
Intention to use immediate postpartum contraception and associated factors amongst mothers delivering from Kisenyi and Kawaala HC IVs
No full textA research dissertation submitted to the Department of Obstetrics and Gynecology as a requirement for partial fulfillment for the award of Master of Medicine in Obstetrics and Gynecology of Makerere University.Background:. The global prevalence of unintended pregnancies is about 41%, and 40% in low and middle-income countries. A study in Yumbe district indicated the prevalence of short birth intervals of 52.4%, from which 12% had complications, and that in Uganda, up to 4% of infant mortalities are attributed to short birth intervals. Intention to use contraception has an overriding importance to better visualize the women’s future needs and is more likely to translate it to actual behavior. It is likely that perceived control, behavioural beliefs and intention may inform when to use IPPC among women in Uganda. Given the unpredictable time of the return of fertility after childbirth, postnatal women can get pregnant even before the return of their menstruation. The objective: To determine the intention to use immediate postpartum contraception and associated factors amongst mothers delivering from Kisenyi and Kawaala HC IVS. Methods: This was a cross-sectional study. The study was conducted as an exit interview among mothers who had reached their date of discharge from the postnatal wards of Kisenyi and Kawaala HC IVs. The interviews were conducted using a trained research assistant or principal investigator-administered questionnaire that included all variables of interest. Consecutive sampling was used to identify 403 participants.. 229 and 174 interviews were carried out in Kisenyi and Kawaala HC IVs respectively. Data was analyzed using Stata v20. Results: The proportion of intention to use IPPC was 22%. Among those with the intention to use IPPC, 62% actually received the service. Mothers aged 25 years and above were more likely to have intention to use IPPC. Higher education was associated with higher intention to use IPPC. Being married was associated with increased intention to use IPCC. Mothers with a history of contraceptive use were 2.6 times more likely to express intention to use IPPC than those who had never used any contraceptive method. The intention to use IPPC was twice as high among mothers who had received counseling on IPPC compared to those who had not. Mothers who delivered through operative delivery were 2.5 times more likely to intend to use IPPC compared to those who delivered via spontaneous vaginal delivery (SVD). Additionally, the number of ANC visits was positively associated with the intention to use IPPC, with mothers who attended 5–8 ANC visits had a 2.3-fold higher likelihood compared to mothers with 1–4 ANC visits. Conclusion: Less than 1/4 of the women had intention to use IPPC, and less than 2/3 of those with intention actually got the service indicating both a very low attitude towards IPPC among mothers and a big gap in actual utilization of the services by those with the intention. Maternal age, highest level of education, past use of contraception, being counselled about IPPC, mode of delivery, and number of antenatal visits attended are some of the factors that significantly influence intention to use IPPC. Recommendations: To improve the intention to use, and thus improve uptake of Immediate Postpartum Contraception (IPPC), it is crucial to implement a multi-faceted strategy that targets key determinants such as maternal age, education, marital status, and access to antenatal and postnatal care
Short-term side effects of chemoradiation and quality of life among women receiving chemoradiotherapy for locally advanced cervical cancer at Uganda Cancer Institute
No full textA dissertation submitted to the Department of Obstetrics and Gynaecology in partial fulfillment for the award of Master of Medicine in Obstetrics and Gynecology of Makerere University.Background: This study identified the types and prevalence of short-term side effects of chemoradiation and how they affect the quality of life of patients with cervical cancer. Cervical cancer is the leading cause of cancer related deaths among women in Uganda and 80% of diagnoses are made in advanced stages. Primary treatment of locally advanced cervical cancer is chemoradiation. This has been associated with short and long-term side effects. Short-term side effects are usually reversible, occur within the first three months of treatment. The quality of life of patients with cervical cancer receiving chemoradiation has been noted to be negatively affected by side effects of chemoradiation. Objective: The objective of this study was to describe the type and prevalence of short-term side effects of chemoradiation treatment as well as their effect on the quality of life in women undergoing chemoradiotherapy for locally advanced cervical cancer at Uganda Cancer Institute. Methodology: The study was a cross-sectional study and 107 women with locally advanced cervical cancer receiving chemoradiotherapy at Uganda Cancer Institute were enrolled. The short-term side effects of chemoradiation were measured using interviewer administered structured questionnaires and QOL was measured using the WHOQOL BREF questionnaire. The data was collected between December 2024 and March 2025. Data analysis was done using R software and Spearman’s rank correlation was used to assess the relationship between different QOL domains. Results: All patients experienced at least one short-term side effect of chemoradiation. Gastrointestinal side effects and fatigue were the most common. 95.3% reported fatigue, 86.9% diarrhea, 85% nausea and 76.6% had abdominal pain. Quality of life was adversely affected by vomiting (p=0.036) due to chemoradiation, being unmarried (p=0.001), advanced stages (III/IV) of cervical cancer(p=0.026), and incomplete courses of chemoradiation (p=0.010). Attaining education levels of secondary and above improved perception of QOL (p=0.014).Conclusions: Short-term side effects are prevalent in patients receiving chemoradiotherapy for locally advanced cancer of the cervix. The quality of life of patients with locally advanced cervical cancer is negatively affected by the short-term side effects of chemoradiotherapy
Knowledge, attitude and practice towards waste disposal among the residents of Pallisa Town Council - Pallisa District
No full textThe study sought to assess the knowledge, attitude and practice towards waste disposal
among residents of Pallisa Town Council, Pallisa District. The specific objectives were to
determine the knowledge towards waste disposal among residents, to investigate the attitude
towards waste disposal among residents and to establish the practices towards waste disposal
among residents of Pallisa T/C. The descriptive research design was used to obtain
information concerning the status of knowledge, attitudes and practices of the residents and
also describe what exists with respect to the situations on the ground concerning waste
disposal. The study population was 2,120 and the sample size was 336 people, however, 254
participated giving a response rate of 75.6%. Respondents constituted residents, town council
staff, residents and local leaders who were selected through simple random sampling. Data
was collected through questionnaires, interviews, and observations. The findings of the study
indicated that there is a significant positive relationship between knowledge of resident and
waste disposal, (r =.562**, p<.01),attitude towards waste disposal (r = .522**, p<.01),and
practices of residents towards waste disposal (r = .523**, p<01). Multiple regression analysis
indicates that up to r
2
= 0.406 (40.6%), was accounted for by the independent variables
included in the model. The study concluded that enhancing the knowledge level of residents,
and also them having a positive attitude, including the practices thereto significantly
improves waste disposal. The study recommended that The authorities need to sensitize the
residents and business operators on the dangers of not adhering to safety precautions when
handling waste. Secondly, the community should adopt a self-help approach to solve the
problem. Much can be achieved when the various communities mobilize themselves and
organize periodic clean up exercises and by contributing financially to support the exercise,
the residents can also act as watch dogs and make sure that they themselves adhere to proper
waste disposal practices. Finally, the authorities need to help the residents improve the
practices of storage, collection and disposal, including initiating reuse-recycling
Molecular analysis of the MNS, KELL and LEWIS blood group systems in Sickle cell disease patients and blood donors from Kampala, Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of Master of Science in Biochemistry of Makerere University.Introduction: The Sickle cell disease (SCD) is a major red blood cell genetic disorder which is majorly managed by red blood cell transfusion that sometimes culminates into alloimmunisation. In 2016, the rate of alloimmunisation in Ugandan transfused patients was reported to be 6.1%. Objective: This study aimed to determine the genetic diversity of the MNS, KELL and LEWIS blood group systems in sickle cell disease patients and blood donors from Kampala, Uganda. Methods: A total of 250 samples from Mulago Sickle cell clinic and 250 samples from Nakasero blood bank were collected. Genomic DNA from all samples was extracted and this was used to determine the genetic diversity of the MNS, KELL, and LEWIS blood group systems by Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) methods. Results: The study revealed that MNS+s+ blood group of the MNS is the most prevalent with frequencies of 47.2% and 48.4% among sickle cell disease patients and donors respectively. S-s-U- was not detected in sickle cell patients whereas among donors, it was at a frequency of 1.2%. S-s-U+var was at a frequency of 0.4% among sickle cell patients and 0.8% among donors. All individuals in both groups were homozygous for KEL*2 and KEL*4. KEL*6 was only in a heterozygous state with KEL*7 in both groups with a frequency of 25.5% among sickle cell patients and 18.4% among donors. KEL*7 in a homozygous state was the most prevalent with frequencies 74.5% and 81.6% among sickle cell patients and blood donors respectively. The 59T>G SNP in the FUT3 gene of the LEWIS blood groups systems was detected at frequencies of 6.8% and 10.8% among sickle cell disease patients and blood donors respectively whereas 508G>A was at a frequency of 42.1% among sickle cell disease patients and 50.4% among donors. There was no individual in both groups that was detected with 1067T>A SNP. Conclusion: This study revealed that MNS, KELL and Lewis blood groups varied between sickle cell disease patients and blood donor groups and therefore Extended DNA typing of the MNS, KELL and LEWIS blood group systems by PCR and RFLP methods can contribute to management of alloimunisation in multi transfused sickle cell disease patients