Determinants of Primary Pyomyositis in Northern Uganda.

Aim: To describe the determinants of primary pyomyositis in Northern Uganda. Study Design and Setting: A case-control and a cohort study designs were conducted in Hospitals in Northern Uganda. Methods: Primary pyomyositis patients were consecutively recruited and followed to discharge. Controls had minor trauma and were age and sex matched with cases. Patients were admitted, investigated (clinical features, imaging, hematology, clinical chemistry and histology from muscle biopsy); managed surgically and followed up to discharge. Those that did not meet the inclusion criteria for diagnosis histologically were excluded. Ethical approval was obtained from Gulu University IRB. Results: The determinants of primary pyomyositis were: HIV positivity with low CD4 counts (<250 cells/ml) (χ2=11.748; p<0.001; aOR 11.292 at 95% CI (0.698,182.707) (p=0.088)); clinical features of immunosuppression/AIDS (χ2=12.70; p<0.001; aOR 6.50 at 95% CI (0.000,2.500) (p=0.850)); High serum creatinine level (χ2=20.191; p<0.001; aOR 6.070 at 95% CI (0.289,127.545) (p=0.317)) and Low serum albumin (malnutrition) (χ2=103.247; p<0.001; aOR 226.004 at 95% CI (13.449, 3797.786) (p<0.001)). Conclusion: The determinant of primary pyomyositis was low serum albumin (malnutrition) while clinical features of immunosuppression/AIDS, high serum creatinine level and HIV positivity with low CD4 counts were risk factors but not independent predictors of this disease.

High Prevalence of Malnutrition among the Above Thirteen with Primary Pyomyositis in Northern Uganda.

Aim: To determine the prevalence of malnutrition and its association with primary pyomyositis among patients and controls who were age and sex matched. Study Design and Setting: A case-control study was conducted at Gulu Regional, Lacor, Kalongo, Kitgum and St. Joseph’s Hospitals in Northern Uganda. Study Duration: Study was conducted from September 2011 to November 2013. Methods: Primary pyomyositis patients were consecutively recruited to these Hospitals and were age and sex-matched with controls selected during the same period. History, physical examinations, Body Mass Index (BMI), blood samples for haematology, biochemistry, clinical chemistry and muscle biopsy for histology were obtained. Those that did not meet the inclusion criteria were excluded. The study was approved by the Ethics and Review Committee of Gulu University Medical School. Results: During the study period, 63 patients and 63 controls were recruited; 29 females and 34 males. Among primary pyomyositis patients, 59 (93.7%) had malnutrition while there were 2 in the control group, giving a prevalence of 3.2%.The matched analysis produced an aOR of 449.875 with a 95% CI (79.382, 2549.540; p<0.001) for malnutrition. Among the cases, 16 (25.4%) fulfilled the Clinical Case Definition (CCD) for AIDS, compared to 2 (3.2%) among the controls. The adjusted Odds ratio for the difference in fulfilling the CCD for AIDS between cases and controls was statistically significant aOR of 10.383 with a 95% CI (2.275, 47.397; p<0.001). Conclusion: Primary pyomyositis is a common health problem in Northern Uganda. It is evident that malnutrition is the most common risk factor in Primary pyomyositis especially among the above thirteen year olds in Northern Uganda.

Primary Pyomyositis: Its Socioeconomic Effects; A Community Overview. A Qualitative Study Design.

Aims: To assess the community’s views on the socioeconomic effects of primary pyomyositis to patients, family, health facilities and community. Study Design: A cross-sectional study design using qualitative research methods Place and Duration of Study: Gulu Regional and other Hospitals in Northern Uganda from September 2011 to November 2013. Methodology: The study was conducted among patients with primary pyomyositis, next of kin, health workers and opinion leaders on their views on the socioeconomic effects of pyomyositis. Key Informant Interviews, Focus Group Discussions and In-depth Interviews were used to obtain qualitative information. Ethical approval for the study was obtained from Gulu University IRB and the National Council of Science and Technology (UNCS&T). Thematic content analysis was used for analysis of this qualitative data. Results: Primary pyomyositis has several socioeconomic effects to patients, family, health facilities and communities. The effects of the disease ranges from simple disability to inability to earn a living thus deepening the economic status/crisis of individuals, families and communities. It creates series of social problems that make local leaders become less useful to their communities and also sets-in marriage related problems. Education of the school going children are usually affected leading to school dropout. Conclusion: There is a wide range of socioeconomic effects of primary pyomyositis to the population of Northern Uganda and it is presented with a number of socioeconomic effects similar to those chronic diseases such as HIV/AIDS.