scholarly journals Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

2021 ◽  
Vol 6 (2) ◽  
pp. 82
Author(s):  
Gerald Mboowa ◽  
Dickson Aruhomukama ◽  
Ivan Sserwadda ◽  
Freddy Eric Kitutu ◽  
Hayk Davtyan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Laboratory Data ◽  
Referral Hospital ◽  
Infection Prevention And Control ◽  
Antibiotic Prescribing ◽  
Global Public Health ◽  
Sensitivity Testing ◽  
Mulago National Referral Hospital ◽  
Public Health Challenges ◽  
National Referral Hospital

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.

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

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.

scholarly journals Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sirijan Santajit ◽  
Nitaya Indrawattana
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Global Public Health ◽  
Drug Usage ◽  
Inappropriate Use ◽  
Public Health Challenges ◽  
Eskape Pathogens

The ESKAPE pathogens (Enterococcus faecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa, andEnterobacterspecies) are the leading cause of nosocomial infections throughout the world. Most of them are multidrug resistant isolates, which is one of the greatest challenges in clinical practice. Multidrug resistance is amongst the top three threats to global public health and is usually caused by excessive drug usage or prescription, inappropriate use of antimicrobials, and substandard pharmaceuticals. Understanding the resistance mechanisms of these bacteria is crucial for the development of novel antimicrobial agents or other alternative tools to combat these public health challenges. Greater mechanistic understanding would also aid in the prediction of underlying or even unknown mechanisms of resistance, which could be applied to other emerging multidrug resistant pathogens. In this review, we summarize the known antimicrobial resistance mechanisms of ESKAPE pathogens.

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

2019 ◽  
Vol 30 (4) ◽  
pp. 17-25 ◽  
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.

scholarly journals User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala

2021 ◽  
Vol 21 (1) ◽  
pp. 248-53
Author(s):  
Jane Namakula Katende ◽  
Kizito Omona
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Service Integration ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Hiv Services ◽  
Provider Perspectives ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. Objectives: To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital. Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services. Keywords: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.

scholarly journals Factors associated with undernutrition among children with sickle cell disease attending the sickle cell clinic in Mulago National Referral Hospital, Uganda

2019 ◽  
Author(s):  
Rosta Asiimwe ◽  
Rornald Muhumuza Kananura ◽  
Richard Kajjura ◽  
Adoke Yeka
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Older Age ◽  
Referral Hospital ◽  
Childhood Mortality ◽  
Mulago Hospital ◽  
Cell Disease ◽  
Factors Associated ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Abstract Background Sickle cell disease (SCD) is among the neglected non-communicable diseases, which significantly contributes to early childhood mortality. In Uganda, over 20,000 children are estimated to be sicklers. Undernutrition is common among children with SCD and contributes to increased morbidity and mortality. There is paucity of data on prevalence of undernutrition and associated factors in Uganda. Objective To assess the extent of undernutrition and related factors among children aged 5-12 years with SCD attending the sickle cell clinic at Mulago hospital, Uganda. Methods A total of 263 children with SCD attending the sickle cell clinic at Mulago National Referral hospital were recruited consecutively between May and June 2017. The nutritional status of the children was assessed by weight-for-age, BMI-for-age, and height-for-age z-scores calculated using STATA in accordance with WHO 2007 growth standards. Binomial regression was conducted to assess the predictors of undernutrition. Results About 20.2%, 11.4%, and 13.7% of the children were underweight, wasted and stunted respectively. Wasting was significantly associated with older age (10-12 years) (AOR=4.20, CI=2.18-8.10) and living in a female headed household (AOR=0.43, CI=0.19-0.99). Stunting was significantly associated with older age (10-12 years) (AOR=2.90, CI=1.39-6.06). Underweight was significantly associated with older age (10-12 years) (AOR=2.23, CI=1.05-5.16). Conclusion Underweight, wasting and stunting were prevalent among children with SCD attending Mulago hospital. The factors associated with undernutrition were older age and living in a female headed household.

scholarly journals Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 497
Author(s):  
Massimo Sartelli ◽  
Timothy C. Hardcastle ◽  
Fausto Catena ◽  
Alain Chichom-Mefire ◽  
Federico Coccolini ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Control ◽  
Low And Middle Income

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda

2016 ◽  
Vol 95 ◽  
pp. 309-314 ◽  
Author(s):  
Anthony T. Fuller ◽  
Michael M. Haglund ◽  
Stephanie Lim ◽  
John Mukasa ◽  
Michael Muhumuza ◽  
...  
Keyword(s):  
Health System ◽  
Referral Hospital ◽  
System Intervention ◽  
Mulago National Referral Hospital ◽  
Health System Intervention ◽  
National Referral Hospital
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