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Assessing Neonatal survival and associated factors among extreme preterm deliveries at Mulago specialized women’s and neonatal hospital and Kawempe national referral hospital -a retrospective-study
No full textA dissertation submitted to the directorate of research and graduate training at Makerere University in partial fulfilment for the award of master of medicine in obstetrics and gynecologyBackground: Uganda has high preterm birthrates of 14 per 1000 live births which are responsible for 8/27 neonatal deaths per 1000 live births and therefore remains among the top three leading causes of death during neonatal period. The increasing incidents of preterm follow the lowering of viability gestation age from 28 to 26weeks, hence a need for more research so as to comprehend the contributing elements for this rising trend and therefore provide focused intervention, and develop protocols so as to improve on the survival rates of extreme preterm. Objective: To assess the neonatal survival of extreme preterm births and factors associated with their survival. Methods: This was a retrospective chart review study on a sample of 376 mothers who had extreme preterm delivery and those of extreme preterm babies admitted in NICU. Baseline characteristics were described using descriptive statistics presented in, means and percentages as appropriate Logistic regression was used to assess association between extreme preterm birth and fetal outcomes. Results: The neonatal survival was 16%. Various factors were found to be significantly associated with neonatal survival. Neonatal survival was 4.4 times higher among neonates whose mothers were aged between 25 to 34 years (AOR=4.4; 95% CI: 2.3-11.8, P=0.0001) and 3.7 times higher among neonates whose mothers were aged 35 to 45 years (AOR=3.7; 95% CI: 1.9-8.2, P=0.0020). Survival was 8.9 times higher among neonates whose mothers were formally employed (AOR=8.9, 95% CI: 4.2-24.8, P<0.00001), 12.7 times higher among neonates whose mothers attended ANC (AOR=12.7, 95% CI: 4.3-22.6, P=0.0003), 15.3 times higher among mother who had C-section and 15.6 times among those who received Antenatal corticosteroids (AOR=15.6, 95% CI: 6.8-30.6, P<0.00001). Neonates who had APGAR score at 1 minute of <4 were 95% less likely to survive than those who scored 7-10 respectively (AOR=0.07, 95% CI: 0.02-0.35, P<0.00001). Recommendations: There is need to continuously monitor the pregnancy and better management of the delivery. There is need for sensitization and awareness creation to pregnant mother to always utilize the ANC services to enable early detection of any complications that can affect neonatal survival
Fractured humanity: unraveling the paradoxes of international humanitarian law in Africa’s contemporary conflicts
No full textA bookParadoxes of International Humanitarian Law in Africa’s Contemporary Conflicts, provides an in-depth exploration of the complexities and challenges faced by International Humanitarian Law (IHL) in addressing the realities of modern warfare, with a particular focus on the African continent. Written by Isaac Christopher Lubogo, it critically examines how IHL—intended to mitigate human suffering during armed conflict—often finds itself fractured in the face of Africa's dynamic and multidimensional conflicts. Africa’s contemporary conflicts are characterized by civil wars, ethnic strife, terrorism, guerrilla warfare, and cross-border violence. These conflicts present unique challenges that expose the limitations and paradoxes of IHL. The book begins by dissecting the very foundations of IHL, exploring its principles of humanity, distinction, proportionality, and necessity. It scrutinizes these principles in the context of African conflicts, questioning their adequacy and adaptability to the continent’s complex and evolving conflict landscape. Central to the analysis is the apparent dissonance between the theoretical ideals of IHL and its practical implementation in Africa. The author delves into the causes of warfare in Africa, examining the political, economic, social, cultural, and psychological factors that drive conflicts. These causes include power struggles, competition for natural resources, ideological battles, historical injustices, and the legacies of colonialism. The book underscores how these multifaceted causes create conflicts that donot fit neatly into the conventional frameworks of IHL, leading to significant challenges in its application and enforcement. The book further explores the concepts of jus ad bellum (the right to war) and jus in bello(the law in war), analyzing how African states and nonstate actors navigate the murky waters of legality and morality in their use of force. Lubogo presents detailed case studies from conflicts inregions such as Sudan, the Democratic Republic of Congo, Somalia, and Nigeria, highlighting instances where IHL has been both upheld and violated. He explores how combatants and noncombatants alike become entangled in a web of humanitarian dilemmas, revealing the inadequacy of IHL's protective scope in a symmetric warfare and non-international armed conflicts that dominate the African context. The book also addresses the paradoxes of IHL, such as the clash between sovereignty and the international community's responsibility to protect (R2P), the tensions between state security and human rights, and the practical difficulties of enforcing IHL amidst the blurred lines between combatants and civilians. Lubogo provides a critical analysis of how African conflicts often render the principle of distinction nearly impossible, as seen in conflicts where child soldiers are used, and civilians are forcibly recruited or coerced into participation. In addressing these paradoxes, the book proposes a reevaluation of IHL in the Africancontext. It calls for an adaptive and context specific approach to humanitarian law that acknowledges the continent's unique challenges. Lubogo suggests that while the fundamental principles of IHL remain relevant, their application must evolve to effectively address contemporary realities, including the rise of non-state actors, the changing nature of combat, and the persistent challenges of enforcing accountability. The book concludes by offering recommendations for strengthening the role of IHL in Africa’s conflicts. These include enhancing the capacity of African legal and judicial institutions to prosecute war crimes, Increasing engagement with local communities to foster compliance with humanitarian norms, and promoting a greater balance between sovereignty and international responsibility in addressing gross violations of human rights. Overall, Fractured Humanity is a critical and thought provoking analysis of IHL’s role in Africa’s contemporary conflicts. It exposes the fractures within the humanitarian framework and challenges the international community to rethink its approach to addressing human suffering in warfare. The work provides a vital contribution to the discourse on international law, human rights, and conflict resolution, calling for an evolution in both the understanding and application of IHL to bridge the gap between legal theory and the lived realities of war in Afric
Patterns and factors associated with malignant conjunctival growths among adult patients with conjunctival growths attending eye clinic in Mulago National Referral Hospital
No full textBackground: Conjunctival growths encompass a wide spectrum of lesions that can be benign, pre-malignant, and malignant tumors. Malignant conjunctival growths can cause visual loss, eyeball loss, or even death if not well managed. Conjunctival growth surgeries are the most common surgery in Mulago National Referral Hospital eye department; however, little is known about the patterns and factors associated with malignant conjunctival growths.
General objective: To determine the patterns and factors associated with malignant conjunctival growths among adult patients attending the Eye Clinic at Mulago National Referral Hospital
Methods: This was a quantitative, cross-sectional study conducted at Mulago National Referral Hospital (MNRH) Eye Clinic. Patients with conjunctival swellings were consented and recruited consecutively and Data was collected using a structured, pre-tested questionnaire and entered into EpiData 4.2 which was exported to STATA 17 for analysis. Descriptive statistics were presented as means, standard deviation (SD), frequencies, and proportions. Factors associated were assessed using logistic regression to obtain odds ratios with their corresponding P-values at a 95% confidence interval.
Results: A total of 110 participants were included in this study. Their mean age was 49 (SD=+/-13) years. 29% of the conjunctival growths were malignant and the rest were non-malignant (benign and pre-malignant). Of the malignant growths encountered, the majority had Squamous Cell Carcinoma (SCC) at 90.6%, and 9.4% had conjunctival melanoma. Amongst those with SCC, most participants had carcinoma in situ (38%), followed by well-differentiated growths at 31%. All participants with conjunctival melanoma had pT1a pathological staging. White color (aOR:39.6, 95% CI=2.83-553.51), mixed color (aOR:17.6,95%CI=1.51-205.02), sub-epithelial involvement (aOR:1, 95%CI= 0.000-0.0237), Leucoplakia (aOR:1, 95%CI= 0.001-0.313), Pigmentation(aOR:0.3,95%CI=0.000-0.658) and having a rough texture (aOR:10.8,95% CI =1.23-94.51) were indicators of malignancy.
Conclusion: The commonest malignant conjunctival growth was SCC followed by malignant conjunctival melanoma. Carcinoma in situ was the most common histological pattern while for conjunctival melanoma was the pT1a stage. Leucoplakia, pigmentation, rough texture, and sub-epithelial involvement were found to be highly associated with conjunctival malignancy.The Fogarty International Center of the National Institutes of Health, U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), and President’s Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213
BAGASSE-Based graphene oxide for energy applications.
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfilment of the requirement for the award of the degree of Master of Science in Mechanical Engineering of Makerere UniversityThis study purposed to explore the feasibility of generating and synthesizing graphene oxide
for energy storage applications through sustainable upgrade of bagasse by pyrolysis. The
researcher was cognizant of the fact that sugarcane processing factories produce tons of bagasse
that can be utilized to enhance energy sources and thus, a sustainable method for the preparation
and synthesis of graphene derivatives from a non-graphitic material needed to be explored.
Therefore, this study used bagasse as a biomass precursor to synthesize graphene oxide. The
carbonization was carried out at 550°C and the activation was carried out using both chemical
and physical processes. This was done for comparative purposes. The physical process
involved two steps: carbonization of the bagasse in an inert atmosphere and subsequent
activation of the resulting char in the presence of steam, at furnace temperature of 800°C under
a water stream. The produced materials were tested for energy storage using a three-electrode
system for supercapacitor application with an electrochemical workstation. The activated
carbon exhibited amorphous carbon structures, with 360 to 400 nm peaks. The graphite flakes
and GO were characterized by ultra-violet-visible spectroscopy (UV-Vis), Fourier transform
infrared spectroscopy (FTIR), Scanning Electron microscopy (SEM) with Energy Dispersive
X-ray (EDX), X-Ray Diffraction (XRD) and electrochemical analysis techniques.
This research did appreciate that the expected absorption peak at 283nm in the analysis of the
UV-vis absorption spectrum is an attributive property of the sp2 hybridization π-π* transition.
Also, evidence of graphene oxide in the synthesized sample was underscored by the reflection
peaks 2ϴ = 11o. The incorporation of oxygen into the carbon structure signalled correct
oxidation and profiling by the FTIR spectrum demonstrated a fingerprint region between 1000
cm -1 and 1500 cm-1. The outcome is a superior, locally produced, low cost porous graphene
oxide that will in all likelihood confer good performance in super capacitor applications.
Avowedly, the production of graphene oxide has been replicated to varying degrees world over.
However, herein on offer is the protocol for producing graphene oxide of reliable quality, made
efficiently and sustainably. Consequently, the research offers a seedbed of opportunities to
revolutionise electrochemical and energy storage options in various interdisciplinary and
multifunctional spheres including industrial and biomedical applications in Uganda
Mortality and associated factors among in-patients with multi-drug (antibiotic) resistant bacterial infections at Kiruddu National Referral Hospital, Uganda
No full textA research dissertation submitted in partial fulfillment of the requirements for the award of the Degree of Master of Medicine of Makerere UniversityBackground:
Antimicrobial resistance (AMR) in bacterial infections is an emerging public health threat that caused nearly five million annual deaths as of 2019. Multi-drug resistant (MDR) bacterial infections (resistance to two or more antibiotic classes) are often associated with poor survival outcomes but such data from low-resource settings is generally limited. This study describes the mortality and associated clinical-demographic factors among hospitalized patients diagnosed with MDR bacterial infections at a tertiary-level hospital in Uganda.
Methods:
In this retrospective study, hospital records for patients diagnosed with MDR-bacterial infections at Kiruddu National Referral Hospital between January 2021 and January 2024 were analyzed. Data retrieved from the microbiology register and patient clinical records comprised bacterial pathogen and associated antimicrobial susceptibility patterns, social-demographic data, clinical and treatment data as well as vital status at time of discharge (alive or dead). We estimated the proportion of patients diagnosed with MDR bacterial infections who died and performed logistic regression modeling to determine the predictors of mortality compared to the survivors.
Results:
Of the 4,102 culture and sensitivity tests performed at Kiruddu National Referral Hospital between January 2021 and January 2024; 1,392 (34%) had bacterial growth for which 1,310 (94%) had resistance to two or more antibiotics. The median age was 36, interquartile range (IQR); [21-49] years, with predominance of males (63%, n=124). Mortality among patients with MDR-bacterial infections was 31% (61/198). The factors statistically associated with mortality included; fever (adjusted Odds Ratio[aOR] 4.96, 95% Confidence Interval [C.I.] 1.78 – 13.78, p= 0.002); anemia (aOR 7.24, 95% C.I. 2.10 – 24.99, p=0.002); Proteus mirabilis infection (aOR 5.78, 95% C.I. 1.01 – 32.99, p= 0.048); and bloodstream infections (aOR 3.36, 95% C.I. 1.02 – 11.09, p=0.046).
Conclusion:
Approximately one-third of hospitalized patients diagnosed with MDR-bacterial infections died, and this was associated with documented fever, anemia, bloodstream infections and Proteus mirabilis infectio
Accuracy of the neutrophil-lymphocyte ratio in predicting thirty-day all-cause mortality among patients hospitalized with community-acquired pneumonia in Uganda a nested cross-sectional study
No full textA research dissertation submitted to the Department of Internal Medicine in partial fulfillment of the requirements for the award of the Master of Medicine Degree in Internal Medicine, Makerere University.Background: Community acquired pneumonia (CAP) contributes to approximately 3 million deaths globally. The assessment of severity plays a crucial role in effectively managing CAP and accurately predicting mortality outcomes. The neutrophil-lymphocyte ratio (NLR) has shown promise in assessing the risk of mortality for CAP patients, however, its role in predicting CAP mortality has not been extensively evaluated in Sub-Saharan Africa. This study sought to determine the accuracy of the NLR in predicting 30-day all-cause mortality among adults admitted with CAP to Mulago, Kiruddu, and Naguru Referral hospitals in Uganda.
Methods: A nested cross-sectional study was conducted among consecutively selected adults with CAP admitted at Mulago, Kiruddu, and Naguru Referral Hospitals in Uganda, between April 2022 and January 2024. This study was nested in the LoRTISA study that seeks to determine the etiology and resistance patterns of clinically diagnosed CAP among hospitalized individuals, using a comprehensive microbiological approach. Data concerning the clinical history, physical examination, and laboratory tests were abstracted from the primary study Research Electronic Data Capture (REDCap) dataset, in February and March 2024. Data on the vital status of the participants at day 30 was also abstracted. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimum cut-off point of the NLR for predicting mortality. Sensitivity, Specificity, Positive and Negative predictive values (PPV &NPV) of the optimum cut-off were then determined. Results: A total of 200 participants were enrolled. The median age and NLR were 41 years (IQR: 32-60years) and 4.0 (IQR:2-8) respectively. Majority of the participants were male (54%, 108/200). Mortality at day 30 was 17.5%. The optimum cut-off point of the NLR for predicting 30-day mortality was 4.23, with a corresponding sensitivity and specificity of 63% and 58%, respectively. The PPV was 24.2% and NPV was 88.1%. The area under the ROC curve (AUC) was 0.63. Conclusion: The NLR cut-off of 4.23 has a modest accuracy in predicting 30-day mortality and identifying high-risk CAP patients needing closer monitoring or treatment. Additional studies are needed to validate and refine NLR cut-off points through prospective studies, which will enhance its clinical utility in CAP management and improve patient outcomes.The LoRTISA Project, IDI, EDCT
Experiences and perceptions of misoprostol use for induction of labor among health workers in kampala, uganda; a qualitative study
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfilment of the requirements for the award of master of medicine in obstetrics and gynecology of Makerere UniversityBackground: Induction of labor remains a crucial intervention to reducing the burden of high• risk pregnancies. Misoprostol is one of the relatively cheaper and effective drugs used to induce labor in low resource countries, such as Uganda. In Kampala, health workers play a vital role in maternal and neonatal healthcare, yet there is a paucity of data about their experiences andperceptions regarding the use of Misoprostol for labor induction.Objective: The study explored experiences and perceptions of Misoprostol use for labor induction among Health workers in Kampala, Uganda.Methods: This was a phenomenological study design where five health facilities were selected, and twenty health workers were recruited using purposive sampling. Data was collected by using in-depth interviews with the help of an interview guide. Data was analyzed using an inductive thematic approach. The study was conducted between January 2024 and February 2024. Results: Three main themes emerged from the data: general experiences of using Misoprostol for labor induction, perceived benefits, and perceived risks. Health workers reported both positive and negative experiences with Misoprostol use. The positive experiences included successful vaginal deliveries following induction and shortened induction to delivery time as compared to alternative methods. The negative experiences included poor outcomes following induction such as uterine rupture and fetal distress. Perceived benefits included ease of storage, greater effectiveness compared to alternative methods, reduced workload, and cost effectiveness. However, drug misuse was identified as a perceived risk associated with Misoprostol use for labor induction. Conclusion; This study provides insights into health workers' experiences and perceptions of using Misoprostol for labor induction. Health workers shared varied experiences on the utilization of Misoprostol, indicating a combination of positive and negative experiences. They identified a greater number of benefits compared to risks associated with its use. Recommendations: Healthcare institutions should develop tailored guidelines to address institution-specific challenges related to Misoprostol use for labor. Regular education sessions should be conducted for health workers of all cadres to reinforce proper usage of Misoprostol. Further research is needed in basic emergency obstetric care facilities to understand their perspectives on Misoprostol use
Evaluation of quality of solid synthetic fertilizers along the supply chain in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of a Degree of Master of Science in Soil Science of Makerere University.Increased agricultural productivity, rural households’ food security and income can largely be stimulated through enhanced access to quality inputs especially fertilizers. Fertilizer use in Uganda is the lowest in the region estimated at about 3 kg of nutrient per hectare against 9- 10 kg nutrients per hectare in East Africa. Incidentally, annual nutrient losses through harvest and erosion reported in Uganda are as high as 130kg/ha of nitrogen, 5kg/ha of phosphorus (P2O5) and 25kg/ha of potash (K2O). While fertilizer use remains low, nutrient depletion from the soil continues triggering severe soil degradation. Therefore, a fertilizer quality evaluation was conducted in Uganda in the second season, 2020. A total of 216 samples comprising Calcium Ammonium Nitrate (CAN), Di-ammonium Phosphate (DAP), Nitrogen Phosphorus Potassium (NPK) and Urea fertilizers for three common brands were obtained from Central, Eastern and Western regions were tested. The study examined the quality of fertilizer stores at different levels of the supply chain to determine their effect on the quality of fertilizers in the market. The study also examined the moisture content and declarable primary nutrients. Moisture content was determined using oven method at 105 0C for 24 hours. The total nitrogen and soluble P2O5 were determined calorimetrically using spectrophotometer while K2O was determined using a flame photometer. The results indicated that Urea and DAP met the required moisture standard but CAN and NPK were wet. The nutrient analysis results indicated CAN, DAP, NPK and Urea contained total nitrogen content of 19.2, 16.0, 12.4 and 40.4, % respectively which were below the FAO fertilizer standards. The poor quality fertilizers were partly attributed to import of sub-standard products and the use of poorly ventilated stores at various premises. The report recommended for the intervention of government to strengthen monitoring for compliance to specified standards
Correlation of Alberta stroke program early CT score among ischemic stroke patients and their outcomes at selected centres in Kampala.
No full textA dissertation submitted in partial fulfillment of the requirements for the award of the Degree of Master of Medicine in Radiology of Makerere UniversityIntroduction; Stroke is the second leading cause of death globally and contributes significantly to morbidity. It is important to know the etiology of stroke as secondary stroke prevention management differs. Neuroimaging is very important in confirmation of stroke. The Alberta Stroke Program Early Computed Tomography (ASPECT) Score; a 10-point scoring system with anatomical regions of the brain over the middle cerebral artery (MCA) territory is used to assess early ischemic changes on a head non-contrast CT (NCCT). This study sought to describe the correlation between the ASPECTS among ischemic stroke patients and their outcomes at selected centres in Kampala.
Objectives: This study aimed to determine the correlation between the ASPECTS score and the outcomes of ischemic stroke patients in Kampala, Uganda
Methodology: This was a prospective longitudinal observational study that was carried out in Mulago and Kiruddu National Referral Hospitals and St Francis Hospital Nsambya. All patients diagnosed with ischemic stroke involving the MCA territory as a first time diagnosis and had given informed consent to participate in the study, their head non-contrast head CT scans were evaluated to determine the ASPECT score. Study patients were recruited consecutively until the sample size of 120 patients was obtained, a one month follow up was done.
Data Management and Analysis: STATA version 14.0 was used for data cleaning and analysis. Descriptive analysis was conducted to describe continuous variables. Spearman correlation analysis was carried out to measure the strength and direction of association between ASPECTS and mRS. Pearson chi-square test was used to identify the relationship between patient characteristics and their outcomes at bivariate analysis.
Utility of the study; The ASPECTS on the non-contrast head CT scan is a predictor for functional outcomes in ischemic stroke as well as identifying patients eligible for thrombolysis and thrombectomy. Utilizing it in our Ugandan setting will facilitate timely diagnosis and identification of patients eligible for thrombolysis and thrombectomy. It will inform policy guidelines for immediate rehabilitation services at national level.
Results; 120 patients were enrolled into the study and 118 analyzed for follow up for the functional outcomes. The median age was 60 with 57% being female. The average ASPECTS score was 5.71, SD ± 3.4 with the left hemisphere predominantly affected n=70. There was a significantly high inverse correlation between ASPECTS and mRS scores (r = -0.618, P< 0.001). 31% of patients received rehabilitation services. Poor outcomes among patients were associated with overall lower ASPECTS, no education, low GCS having MCA regions involved as M3, M5 and additional vascular territory PCA involved.
Conclusion: The average ASPECTS from this study was 5.7; over half of the patients n꞊68 (56.8%) had the cut off ASPECTS for thrombectomy and thrombolysis of ≥ 6. The correlation of the ASPECTS and the mRS was -0.618, an inverse correlation as seen with other studies; therefore ASPECTS is a reliable tool to predict the functional outcomes. The majority of patients (83.1%) had poor outcomes. With a 26% mortality, reflects the need to utilize the ASPECTS to ensure appropriate timely interventions and rehabilitation. There is need for individualized stroke protocols in our hospitals to initiate thrombolysis and thrombectomy for these ischemic stroke patients.National Institute of Neurological disorders and Stroke and Stroke of the National Institute of Health under Award number D43NS11856
Comparative study of lung ultrasound patterns of clinically diagnosed severe pneumonia and acute chest syndrome among pediatric sickle cell anemia patients at Mulago Hospital
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfillment of the requirements for the award of the Degree of Master of Medicine in RadiologyBackground: Acute chest syndrome (ACS) and severe pneumonia are both common potentially lethal conditions among sickle cell
anemia (SCA) pediatric patients. However, both conditions are clinically and radiographically indistinguishable which results in
delayed patient diagnosis and management. In this study we compared Lung ultrasound (LUS) patterns among admitted pediatric
SCA patients clinically diagnosed with ACS and severe pneumonia at Mulago Hospital. Methods: This was a comparative cross-sectional study and enrolled 178 admitted SCA pediatric patients below 18 years clinically diagnosed with ACS and severe pneumonia. The study was conducted at ward 16 A Mulago Hospital, Uganda between November 2023 to April 2024. Patient clinical assessment, chest x-ray and LUS were done for all children within 24 hrs of admission. Imaging findings on LUS among the two clinical groups were compared and so were CXR findings. Bivariate and multivariate analysis was done using a modified Poisson model and prevalence ratios at 95% confidence intervals were reported. Results: All the 178 enrolled children had complete data available for analysis. Overall, (71.4%), were clinically diagnosed with ACS while (28.6%), had severe pneumonia. LUS features among children with clinically diagnosed with ACS included; normal findings (3.1%), mild basal bilateral anechoic pleural effusion (1.6%), pleural thickening (39.4%), diffuse B lines (80.3%), pleural irregularity (88.2%), and subcentimeter consolidations (22.0%). LUS features among admitted pediatric SCA patients clinically diagnosed with severe pneumonia included; mixed pattern (70.6%), consolidation (76.5%), pleural thickening (31.4%), mild to moderate echogenic bilateral basal pleural effusion (37.3%), diffuse B lines (90.2), and pleural irregularity (92.0%). Conclusion: Lung ultrasound can be considered an add on tool to physical examination in evaluation of pediatric SCA patients with a normal chest radiograph who are clinically diagnosed with severe pneumonia or ACS