scholarly journals Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda

2021 ◽  
Vol 6 ◽  
pp. 302
Author(s):  
Olivie C. Namuju ◽  
Richard Kwizera ◽  
Robert Lukande ◽  
Katelyn A. Pastick ◽  
Jonee M. Taylor ◽  
...  
Keyword(s):  
Family Satisfaction ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Next Of Kin ◽  
Perceived Benefit ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Acceptance Rates ◽  
National Referral Hospital

Background: Human immunodeficiency virus (HIV)-related mortality remains high in sub-Saharan Africa. Clinical autopsies can provide invaluable information to help ascertain the cause of death. We aimed to determine the rate and reasons for autopsy refusal amongst families of HIV-positive decedents in Uganda. Methods: We consented the next-of-kin for post-mortem examinations among Ugandan decedents with HIV from 2017-2020 at Kiruddu National Referral Hospital. For those who refused autopsies, reasons were recorded. Results: In this analysis, 165 decedents with HIV were included from three selected wards at Kiruddu National Referral Hospital.  Autopsy was not performed in 45% of the deceased patients; the rate of autopsy refusal was 36%. The most common reasons for autopsy refusal were time constraints (30%), family satisfaction with clinical diagnosis (15%), fear of disfigurement of the remains (15%), and lack of perceived benefit (15%). By seeking consent from multiple family members and clearly explaining to them the purpose of performing the autopsy, we found a reduction in the rate of autopsy refusal among relatives of the deceased patients at this hospital compared to previous studies at the same site (36% vs. 60%). Conclusions: We found lower rates of autopsy refusal compared to previous studies at the same site. This underscores the importance of clearly explaining the purpose of autopsies as they increase active sensitization about their relevance and dispel myths related to autopsies among the general population. Good, culturally sensitive, and timely explanations to the family of the benefits of autopsy increase the rate of obtaining permission. Building capacity for performing autopsies by training more pathologists and increasing laboratory resources to decrease the turn-around-time for autopsy reports and extending these services to peripheral health facilities could improve autopsy acceptance rates.

scholarly journals Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi

2008 ◽  
Vol 38 (1) ◽  
pp. 5-7 ◽  
Author(s):  
Simon D Makombe ◽  
Anthony D Harries ◽  
Joseph Kwong-Leung Yu ◽  
Mindy Hochgesang ◽  
Eustice Mhango ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Unfavourable Prognosis ◽  
Sub Saharan

AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.

Blood utilization at a national referral hospital in sub-Saharan Africa

Transfusion ◽  
2015 ◽  
Vol 55 (5) ◽  
pp. 1058-1066 ◽  
Author(s):  
Elissa K. Butler ◽  
Heather Hume ◽  
Isaac Birungi ◽  
Brenda Ainomugisha ◽  
Ruth Namazzi ◽  
...  
Keyword(s):  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Blood Utilization ◽  
Sub Saharan ◽  
National Referral Hospital

scholarly journals Medical complications in pregnancy at Mulago Hospital, Uganda’s national referral hospital

2018 ◽  
Vol 12 (4) ◽  
pp. 168-174 ◽  
Author(s):  
JM Milln ◽  
A Nakimuli
Keyword(s):  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Medical Complications ◽  
High Dependency Unit ◽  
Medical Conditions ◽  
High Dependency ◽  
Obstetric Medicine ◽  
Sub Saharan ◽  
National Referral Hospital ◽  
In Pregnancy

Introduction Medical complications in pregnancy contribute significantly to maternal morbidity in sub-Saharan Africa. Anecdotally, obstetricians in Uganda do not feel equipped to treat complex medical cases, and receive little support from physicians. Methods The aim of the study was to quantify the burden of complex medical conditions on the obstetric high dependency unit at Mulago National Referral Hospital, and potential deficiencies in the referral of cases and training in obstetric medicine. A prospective audit was taken on the obstetric high dependency unit from April to May 2014. In addition, 50 trainees in obstetrics and gynaecology filled a nine-point questionnaire regarding their experiences. Results Complex medical disorders of pregnancy accounted for 22/106 (21%) admissions to the high dependency unit, and these cases were responsible for 51% of total bed occupancy, and had a case fatality rate of 6/22 (27.2%). Only 6/14 (43%) of referrals to medical specialties were fulfilled within 48 h. Of the six women who died due to medical conditions, three specialty referrals were made, none of which were fulfilled. Trainees reported deficiencies in obstetric medicine training and in referral of complex conditions. They were least confident addressing non-communicable conditions in pregnancy. Discussion Deficiencies exist in the care of women with complex medical conditions in pregnancy in Uganda. Frameworks of obstetric medicine training and referral of complex cases should be explored and adapted to the sub-Saharan African setting.

scholarly journals Narrating the Transition to Adulthood for Youth in Uganda: Leaving School, Mobility, Risky Occupations, and HIV

2019 ◽  
Vol 46 (4) ◽  
pp. 550-558 ◽  
Author(s):  
Philip Kreniske ◽  
Stephanie Grilo ◽  
Neema Nakyanjo ◽  
Fred Nalugoda ◽  
Jason Wolfe ◽  
...  
Keyword(s):  
Transition To Adulthood ◽  
Life Histories ◽  
School Enrollment ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
School Mobility ◽  
Immunodeficiency Virus ◽  
Home Village ◽  
Sub Saharan ◽  
Hiv Negative

School enrollment, mobility, and occupation are each important factors to consider when examining HIV (human immunodeficiency virus) infection risk among youth in sub-Saharan Africa. Through an analysis of narrative life histories from 30 HIV-positive and 30 HIV-negative youth (aged 15-24 years), matched on gender, age, and village and purposively selected and interviewed from the Rakai Community Cohort Study, this article shows the complex connection between leaving school, mobility, and occupation with implications for HIV risk. We identified a pattern of risk factors that was present in many more HIV-positive than HIV-negative youth life stories. These HIV-positive youth shared a similar pathway during their transition to adulthood: After leaving school, they moved in search of occupations; they then engaged in risky occupations before eventually returning to their home village. Linking the lines of inquiry on school enrollment, mobility, and risky occupations, our findings have important implications for adolescent health research, practice, and policy in Uganda and across sub-Saharan Africa and the developing world.

scholarly journals Methylome-wide analysis reveals epigenetic marks associated with resistance to tuberculosis in HIV-infected individuals from East Africa

2020 ◽  
Author(s):  
Catherine Stein ◽  
Penelope Bencheck ◽  
Jacquelaine Bartlett ◽  
Robert P Igo ◽  
Rafal S Sobota ◽  
...  
Keyword(s):  
Genome Wide Association Study ◽  
Sub Saharan Africa ◽  
Chromosome 1 ◽  
Chromosome 2 ◽  
Chromosome 5 ◽  
Epigenetic Marks ◽  
Genome Wide ◽  
A Genome ◽  
Immunodeficiency Virus ◽  
Sub Saharan

Background: Tuberculosis (TB) is the most deadly infectious disease globally and highly prevalent in the developing world, especially sub-Saharan Africa. Even though a third of humans are exposed to Myocbacterium tuberculosis (Mtb), most infected immunocompetent individuals do not develop active TB. In contrast, for individuals infected with both TB and the human immunodeficiency virus (HIV), the risk of active disease is 10% or more per year. Previously, we identified in a genome-wide association study a region on chromosome 5 that was associated with resistance to TB. This region included epigenetic marks that could influence gene regulation so we hypothesized that HIV-infected individuals exposed to Mtb, who remain disease free, carry epigenetic changes that strongly protect them from active TB. To test this hypothesis, we conducted a methylome-wide study in HIV-infected, TB-exposed cohorts from Uganda and Tanzania. Results: In 221 HIV-infected adults from Uganda and Tanzania, we identified 3 regions of interest that included markers that were differentially methylated between TB cases and LTBI controls, that also included methylation QTLs and associated SNPs: chromosome 1 (RNF220, p=4x10-5), chromosome 2 (between COPS8 and COL6A3 genes, p=2.7x10-5), and chromosome 5 (CEP72, p=1.3x10-5). These methylation results colocalized with associated SNPs, methylation QTLs, and methylation x SNP interaction effects. These markers were in regions with regulatory markers for cells involved in TB immunity and/or lung. Conclusion: Epigenetic regulation is a potential biologic factor underlying resistance to TB in immunocompromised individuals that can act in conjunction with genetic variants.

scholarly journals Vaccine Hesitancy: In the Age of the COVID-19 Pandemic

2021 ◽  
pp. 9-16
Author(s):  
Mohammad Jahidur Rahman Khan ◽  
Samshad Jahan Shumu ◽  
Farzana Mim ◽  
Md. Selim Reza
Keyword(s):  
Modern Science ◽  
Sub Saharan Africa ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Common Causes ◽  
Vaccination Acceptance ◽  
Worldwide Phenomenon ◽  
Sub Saharan ◽  
The Government ◽  
Acceptance Rates

Vaccines are one of the most significant innovations of modern science. Worldwide, millions of lives are saved each year by the vaccine. Vaccine hesitancy, which represents the refusal to receive vaccines when vaccination services are available and reachable, is a major obstacle to global health. While vaccine hesitancy has been present for many years, its damaging effects are likely to be more evident during the COVID-19 pandemic than ever before. This study aimed to find out common causes of vaccine hesitancy, assess COVID-19 vaccination acceptance rates worldwide, and present the approaches by which vaccine hesitancy rate can be reduced. This study revealed though vaccine hesitancy is a worldwide phenomenon, the causes differ from country to country or reign. More studies are needed to address COVID-19 vaccine hesitancy, especially in the Middle and South America, the Middle East and North Africa, Central Asia, Sub-Saharan Africa, Eastern Europe. The leading causes of COVID-19 vaccine hesitancy are found lack of confidence towards the government or pharmaceutical companies, less concern about the outcome of SARS-CoV-2 infection, and shortage of supply of different types of COVID-19 vaccines. Healthcare personnel and social media play an essential role in addressing vaccine hesitancy. Convincing the general population about the safety and effectiveness of COVID-19 vaccines, the consequence of being unvaccinated, and the delivery of free vaccines in an easily accessible way can reduce vaccine hesitancy rate.

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