High Mortality During the Second Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic in Uganda: Experience From a National Referral COVID-19 Treatment Unit

Background We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n=91) or critical (66%, n=315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P=.011), oxygen saturation at admission of ≥92% (aOR, 0.97; 95% CI, 0.91–0.95; P<.001), and admission pulse rate of ≥100 beats per minute (aOR, 1.01; 95% CI, 1.00–1.02; P=.042). The risk of death was 1.4-fold higher in female participants compared with their male counterparts (hazards ratio, 1.4; 95% CI, 1.0–2.0; P=.025). Conclusions In this cohort, where the majority of the patients presented with severe or critical illness, more than one third of the patients hospitalized with COVID-19 at a national CTU died of the illness.

Outcome of infants with 10 min Apgar scores of 0–1 in a low-resource setting

BackgroundIn high-resource settings, postponing the interruption of cardiopulmonary resuscitation from 10 to 20 min after birth has been recently suggested, but data from low-resource settings are lacking. We investigated the outcome of newborns with Apgar scores of 0–1 at 10 min of resuscitative efforts in a low-resource setting.MethodsThis observational substudy from the NeoSupra trial included all 49 late preterm/full-term newborns with Apgar scores of 0–1 at 10 min of resuscitation. The study was carried out at Mulago National Referral Hospital (Kampala, Uganda) between May 2018 and August 2019. Outcome measures were mortality and hypoxic-ischaemic encephalopathy in the first week of life. All resuscitations were video recorded and daily reviewed by trial researchers.ResultsMedian duration of resuscitation was 32 min (IQR 17–37). Advanced resuscitation was provided to 21/49 neonates (43%). Overall, 48 neonates (98%) died within 2 days of life (44 in the delivery room, three on the first day and one on the second day) and one survived at 1 week with severe hypoxic-ischaemic encephalopathy.ConclusionOur study adds information from a low-resource setting to the recent evidence from high-resource settings about prolonging the resuscitation in infants with Apgar scores of 0–1 at 10 min. The vast majority died in the delivery room despite prolonged resuscitative efforts. We confirm that duration of resuscitation should be tailored to the setting, while the focus in low-resource settings should be improving the quality of antenatal and immediately after birth care.

Factors associated with delayed uptake of cataract surgery among adult patients at Mulago National Referral Hospital, Uganda

Background: Cataract is the leading cause of blindness globally. Many patients with cataract in developing countries delay to come for cataract surgery. Objectives: This study aimed to determine the factors associated with delayed uptake of cataract surgery among adult pa- tients seen at Mulago National Referral Hospital eye clinic in Uganda. Methods: Employing a hospital based cross-sectional study, adult patients with cataract and having moderate visual impair- ment or blindness were recruited. Patient-related factors for delayed surgery were assessed using a predetermined question- naire. Data was analyzed using stata version 14.2. Logistic regressions were used to determine the factors associated with delayed uptake of cataract surgery among these patients. Results: Eighty two participants with operable cataract were evaluated. Females were 44 (54%) and the mean age of partic- ipants was 67 years. Fifty three (65%) had delayed uptake of cataract surgery. The factors associated with delayed uptake of cataract surgery among patients with cataract were financial constraint, felt no need for surgery and good unilateral vision. Conclusions: Financial constraints, no felt need for cataract surgery and having good unilateral vision are the factors asso- ciated with delayed uptake of cataract surgery among cataract patients. We recommend cataract surgical outreach to remote areas and health education. Keywords: Risk factors; operable cataract; cataract; surgery; Uganda; sub-Saharan Africa.

Chest X-Ray Findings in Drug Sensitive and Drug Resistant Pulmonary Tuberculosis Patients in Uganda

Background: Tuberculosis (TB) is one of the leading causes of death worldwide. Radiology has an important role in the diagnosis of both drug-sensitive (DS) and drug-resistant (DR) pulmonary TB (PTB). This study aimed at comparing the chest x-ray (CXR) patterns of microbiologically confirmed cases of DS and DR PTB in Uganda.Methods: We conducted a hospital based retrospective study at the Mulago National Referral Hospital (MNRH) TB wards. All participants had microbiologically confirmed diagnosis of PTB. CXR findings extracted included infiltrate, consolidation, cavity, fibrosis, bronchiectasis, atelectasis and other non-lung parenchymal findings. All films were independently examined by two experienced radiologists blinded to clinical diagnosis.Results: We analyzed CXR findings of 165 participants: 139 DS- and 26 DR-TB cases. Majority (n=118, 71.7%) of the participants were seronegative for HIV. Overall, 5/165 (3%) participants had normal CXR. There was no statistically significant difference in the proportion of participants with consolidations (74.8% versus 88.5%; p – 0.203), bronchopneumonic opacities (56.1% versus 42.3%, p=0.207) and cavities (38.1% versus 46.2%, p=0.514), across drug susceptibility status (DS versus DR TB). Among HIV infected participants, consolidations were predominantly in the middle lung zone in the DS TB group and in the lower lung zone in the DR TB group (42.5% versus 12.8%, p – 0.66). HIV infected participants with DR TB had statistically significantly larger cavity sizes compared to their HIV uninfected counterparts with DR TB (7.7 ± 6.8cm versus 4.2 ± 1.3cm, p – 0.004). Conclusion- We observed that a vast majority of participants had similar CXR changes, irrespective of drug susceptibility status. However, HIV infected DR PTB had larger cavities. The diagnostic utility of cavity sizes for the differentiation of DR from DS TB could be investigated further.

Prevalence of Leptospirosis Among Patients Attending Renal and General Outpatient Clinics in Mulago Hospital, Kampala, Uganda

In this study we sought to establish the prevalence and associated factors of Leptospirosis among renal patients and general outpatients attending Mulago National Referral Hospital, Uganda. This cross-sectional study recruited and collected blood samples from a total of 254 patients attending Mulago hospital from July to October 2018. Additionally, the semi-structured questionnaires were administered to enrolled patients to collect data on socio-demographics and occupational practices that may be risks of getting infected with Leptospirosis. The blood samples were analyzed using the standard Microscopic Agglutination Test (MAT) with a panel of 14 Leptospira-serovars belonging to 10 serogroups. We identified 12 seropositivity of Hebdomadis, Hebdomadis (L.borgapetersenii serovar Nona), Icterohaemorrhagiae (L.interrogans Serovar Icterohaemorrhagiae, Canicola (L. interrogans serovarCanicola), Djasiman (L. interrogansserovarDjasiman), Pomona (L. interrogans serovar Pomona) and Ballum (L. borgpetersenii serovar Kenya). The overall prevalence of leptospirosis in examined samples was 4.7% (CI = 2.6-8.3, P<0.05) among patients attending Renal and General Outpatient clinics in Mulago hospital. The participants who reported with fever were 15.4 times more likely to be diagnosed with leptospirosis. The study reveals that leptospirosis may be among the causative agents among renal patients and should be included among the differential diagnostic list to consider for further testing and diagnosis.

Umbilical artery lactate levels and associated maternal and newborn characteristics at Mulago National Referral Hospital: a cross-sectional observational study

ObjectiveTo determine the maternal and newborn characteristics associated with high umbilical artery lactate levels at Mulago National Referral Hospital.DesignCross-sectional observational study.SettingDepartment of Obstetrics and Gynecology at a national referral hospital located in the capital of Uganda, Kampala.ParticipantsWe randomly selected 720 pregnant mothers at term who presented in labour and their newborn babies.Primary outcomeUmbilical artery lactate level.ResultsDuring the study, there were 579 vaginal deliveries (18 instrumental) and 141 caesarean sections which met the inclusion criteria. One hundred and eighty-seven neonates (187) had high arterial lactate levels. The following factors were associated with an increased likelihood of high lactate concentration: male sex (adjusted OR (aOR)=1.71; 95% CI 1.16 to 2.54; p<0.05), primigravidity (aOR=2.78; 95% CI 1.89 to 4.08; p<0.001), meconium-stained liquor (aOR=5.85; 95% CI 4.08 to 8.47; p<0.001) and administration of oxytocin (aOR=1.97; 95% CI 1.00 to 3.77; p<0.05).ConclusionAbout a fifth of the babies born in Mulago National Referral Hospital during the study period had high umbilical artery lactate. The maternal-fetal factors significantly associated with high umbilical artery lactate levels included: baby’s sex, mother’s gravidity, meconium-stained amniotic fluid and oxytocin administration during labour.

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

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.

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

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.

The Prevalence of Disseminated Tuberculosis Among Tuberculosis Patients in Uganda

Background: The incidence of disseminated tuberculosis (DTB) is increasing worldwide yet its epidemiological characteristics in Uganda are not known. The purpose of this study was to determine the prevalence, associated factors, and treatment outcomes of DTB among patients at a national tuberculosis (TB) treatment center in Uganda.Methodology: The study took place at the TB unit of Mulago National Referral Hospital in Kampala, Uganda. We conducted a retrospective chart review of TB patients who were enrolled in care between January 2015 and December 2019. Eligible charts were for patients with pulmonary bacteriologically confirmed TB enrolled into care in the period under study. DTB was defined as TB at two or more non-contiguous sites.Results: Overall, 400 patient charts were eligible, of whom 240(60.0%) were aged 15 – 34 years and 205 (51.3%) were female. The prevalence of DTB was 8.5% (34/400) (95% CI: 6.0% – 11.7%). Patients with DTB were more likely to be casual laborers (44.1% vs 21.3%, p = 0.023), from Bantu ethnic group (67.7% vs. 40.5%, p = 0.0021), and had at least one comorbidity (82.4% vs 37.2%, p <0.001), of which HIV was the most frequent. Further, patients with DTB (n = 20) were more likely to have empyema (15% vs 2.6%, p = 028) but less likely to have bronchopneumonic opacification (0.0% vs 15.3%, p = 0.043) on chest x-ray imaging. Patients with DTB had higher mortality (26.5% vs 6.37%) and a lower cure rate (41.2% vs 64.8%), p = 0.002.Conclusion: Our findings highlight the need for early detection of TB before dissemination and greater use of TB preventive therapies in HIV-infected individuals to counter the observed high mortality of DTB.

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

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.