Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.

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Incidence of Post Dural Puncture Headache and Associated Factors Following Spinal Anaesthesia for Caesarean Delivery in Mulago National Referral Hospital

10.21203/rs.2.9491/v1 ◽

2019 ◽

Author(s):

Philo Nambooze ◽

Kizito Samuel ◽

John Baptist Kiggundu ◽

Andrew Kintu ◽

Mary T. Nabukenya

Keyword(s):

Caesarean Section ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Associated Factors ◽

Dural Puncture ◽

Cost Effective ◽

Referral Hospital ◽

P Value ◽

Mulago National Referral Hospital ◽

National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

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Incidence Of Post Dural Puncture Headache And Associated Factors Following Spinal Anaesthesia For Caesarean Delivery In Mulago National Referral Hospital

10.21203/rs.2.9491/v2 ◽

2019 ◽

Author(s):

Philo Nambooze ◽

Kizito Samuel ◽

John Baptist Kiggundu ◽

Andrew Kintu ◽

Mary T. Nabukenya

Keyword(s):

Caesarean Section ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Associated Factors ◽

Dural Puncture ◽

Cost Effective ◽

Referral Hospital ◽

P Value ◽

Mulago National Referral Hospital ◽

National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

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Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06326-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Melissa C. MacKinnon ◽

Scott A. McEwen ◽

David L. Pearl ◽

Outi Lyytikäinen ◽

Gunnar Jacobsson ◽

...

Keyword(s):

Escherichia Coli ◽

Mortality Rate ◽

Case Fatality ◽

Population Based ◽

Day Case ◽

Fatality Risk ◽

E Coli ◽

Factors Associated ◽

Case Fatality Risk ◽

Age And Sex

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

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High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda

Endoscopy International Open ◽

10.1055/a-1480-7231 ◽

2021 ◽

Vol 09 (07) ◽

pp. E997-E1000

Author(s):

Ronald Mbiine ◽

Cephas Nakanwagi ◽

Olivia Kituuka

Keyword(s):

Positive Association ◽

Referral Hospital ◽

Outcome Variable ◽

Mulago Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Female Ratio ◽

Mulago National Referral Hospital ◽

Male To Female ◽

Upper Gastrointestinal ◽

National Referral Hospital

Abstract Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant (P = 0.006 and (P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.

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Case fatality risk estimated from routinely collected disease surveillance data: application to COVID–19

Biostatistics & Epidemiology ◽

10.1080/24709360.2021.1913708 ◽

2021 ◽

pp. 1-20

Author(s):

Ian C. Marschner

Keyword(s):

Disease Surveillance ◽

Case Fatality ◽

Surveillance Data ◽

Fatality Risk ◽

Data Application ◽

Case Fatality Risk

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A 24-Hour Walk Through Mulago National Referral Hospital, Uganda: What Kind of In-Patients Do You See?

Brain Degeneration and Dementia in Sub-Saharan Africa ◽

10.1007/978-1-4939-2456-1_3 ◽

2015 ◽

pp. 33-45

Author(s):

Nazarius Mbona Tumwesigye ◽

Jacinto Amandua ◽

David Lubogo ◽

Victoria Masembe

Keyword(s):

Referral Hospital ◽

Mulago National Referral Hospital ◽

National Referral Hospital

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Estimating the Case Fatality Risk of COVID-19 using Cases from Outside China

10.1101/2020.02.15.20023499 ◽

2020 ◽

Cited By ~ 6

Author(s):

Nick Wilson ◽

Amanda Kvalsvig ◽

Lucy Telfar Barnard ◽

Michael G Baker

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Meta Analysis ◽

Case Fatality ◽

Large Uncertainty ◽

Icu Patients ◽

Fatality Risk ◽

Case Fatality Risk ◽

Respiratory Conditions

AbstractThere is large uncertainty around the case fatality risk (CFR) for COVID-19 in China. Therefore, we considered symptomatic cases outside of China (countries/settings with 20+ cases) and the proportion who are in intensive care units (4.0%, 14/349 on 13 February 2020). Given what is known about CFRs for ICU patients with severe respiratory conditions from a meta-analysis, we estimated a CFR of 1.37% (95%CI: 0.57% to 3.22%) for COVID- 19 cases outside of China.

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Pre-injury alcohol use and road traffic injury among patients at Mulago National Referral Hospital, Kampala, Uganda: Cross-sectional study

Journal of the Australasian College of Road Safety ◽

10.33492/jacrs-d-18-00261 ◽

2019 ◽

Vol 30 (4) ◽

pp. 17-25 ◽

Cited By ~ 1

Author(s):

Claire Biribawa ◽

Olive Kobusingye ◽

Possy Mugyenyi ◽

Ezekiel Baguma ◽

Emmanuel Bua ◽

...

Keyword(s):

Emergency Department ◽

Alcohol Use ◽

Road Traffic ◽

Alcohol Intoxication ◽

Referral Hospital ◽

High Rate ◽

Traffic Injury ◽

Mulago National Referral Hospital ◽

Injured Patients ◽

National Referral Hospital

Background: Uganda has a high rate of road traffic injuries (RTI). Alcohol use increases traffic injury risk and severity through impairment of road-use skills and hazard perception. Few studies have examined this problem in Uganda. We therefore assessed the prevalence and determinants of pre-injury alcohol use among road traffic injured patients at Mulago National Referral Hospital, Kampala Uganda. Methods: We enrolled 330 eligible adult RTI patients consecutively in a crosssectional study, at the emergency department in Mulago National Referral Hospital from March-May, 2016. We assessed pre-injury alcohol use using BACtrack professional Breathalyzer, alcohol intoxication assessment tool and alcohol use selfreport covering the period of 6 hours before the injury. We assessed injury severity using Glasgow Coma Scale and Kampala Trauma Score. We estimated prevalence ratios [PR] using modified Poisson regression. Results: Prevalence of pre-injury alcohol use among injured patients was 29.7%. Pedestrians (44%) had the greatest percentage of alcohol use when compared to other road users. Pre-injury alcohol use was associated with mortality at the Emergency Department, PR: 2.33 [1.39 – 3.9]. Conclusion and recommendations: Pre-injury alcohol use is high among pedestrians and yet prevention efforts target mostly motorists. Pre-injury alcohol use also resulted into increased mortality at Emergency Department. We recommend prevention efforts to not only target motorists but also pedestrians.

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