Stakeholders' perceived achievements and challenges after the safe motherhood project in Northern Uganda

The Japanese Red Cross Society (JRCS) and the Uganda Red Cross Society (URCS) implemented the Safe Motherhood project topromote mother-friendly society in northern Uganda from 2010 to 2016. The follow-up study has not been conducted and the information on achievements and challenges after the project were limited. To review the safe motherhood project in northern Uganda, the purpose of the study was to explore the stakeholders' perceived achievements and challenges after the project. Study design was qualitative content analysis using interview guides. After the approval of Institutional Review Board Clearance, the study was started (Approval Number: 2017-034). The subjects were informed about the ethical considerations (informed consent, participation on free will, confidentiality, and anonymity) in participating in the research, and they participated after signing the consent form. Six volunteers, 2 health center staff, and 2 former Uganda Red Cross staff were interviewed. Achievements were the acquisition of knowledge, attitudes changes, behavioural changes, linkage of all stakeholders, and positive influence on Safe Motherhood in community. Challenges of sociocultural barriers, attitudes toward women, accessibility and human resources, incentives and facilities, and sustainability of the project were derived from the interview. The study revealed that the project linked all stakeholders to achieve Safe Motherhood in community and all the developed registration systems were taken over. Long-term support is necessary for Safe Motherhood to take root

Nodding Episodes and High Anion Gap in a 13 Year Old Child with Nodding Syndrome: A Case Report.

Introduction: Nodding syndrome is an unknown neurological disorder affecting children in Northern Uganda, South Sudan and Southern Tanzania. The patient in our case report is, to the best of our knowledge, the first with the syndrome that has been serially followed up for more than three months and the information obtained provides important clue to the possible risk factor to the syndrome. Case Presentation: A 13-year-old boy diagnosed in Atanga Health Centre III using World Health Organization (WHO) surveillance case definition as probable Nodding syndrome was referred to Gulu Regional Referral Hospital with pyomyositis of abdominal wall muscle and head nodding which was not responding to treatment. Serial anthropometry and laboratory investigations including, haematology, clinical chemistry, biochemistry and muscle biopsy were conducted in a period of 3 months and compared to the nodding episodes. Complete blood count showed leucocytosis with immature granulocytes and atypical lymphocytes mainly during the infective phase of the pyomyositis but returned to normal as a result of the surgical procedure, Incision, Drainage and Debridement (I, D & D) of pyomyositis of the anterior abdominal wall muscle combined with administration of antibiotics and analgesics. The liver enzymes were high throughout the period of admission in Gulu Hospital. The renal parameters and serum electrolytes were within normal ranges during the nodding free periods but it was deranged during the nodding episodes. Abdominal ultrasound scan showed a focal mass on the right internal and external oblique muscles of the abdominal wall. Histology of the muscle showed a non-specific inflammation of the abdominal muscles with mass necrosis of the muscle and thrombosed blood vessels. These findings highlight the concurrent existence of pyomyositis in a child with Nodding Syndrome but whose nodding episodes were pronounced during the periods with imbalanced electrolyte pattern and with high anion gap. In conclusion: Nodding syndrome is an unknown neurological disorder affecting children whose nodding episodes are probably related to the high Anion Gap metabolic acidosis.

Incidence of Sigmoid Volvulus in Northern Uganda: A Cross-Sectional Study Design.

Aims: To determine the incidence of sigmoid volvulus in Northern Uganda. Study Design: A cross-sectional (2 years retrospective and one year prospective) study design was conducted on patients’ medical records and those admitted, surgically managed or referred from the 19 hospitals in Northern Uganda. Place and Duration of the Study: This study was conducted in 19 hospitals in Northern Uganda from January 2010 to December 2012. Methodology: A cross sectional study design with a two year retrospective and one year prospective studies were conducted to determine the incidence of sigmoid volvulus in Northern Uganda. All patients’ records with a diagnosis of sigmoid volvulus in 19 hospitals were included in the study. Ethical approval was obtained from the IRB of Gulu University Medical School and Uganda National Council for Science and Technology (UNCS&T). Data analysis was conducted using STATA/IC version 12.1. Results: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 surgical populations in 2 years. Most cases occurred in the dry season particularly from December to April and least observed from May to November. Middle aged and elderly male were the most commonly affected. Conclusion: The incidence of sigmoid volvulus in Northern Uganda was 251.8 per 100,000 surgical populations in 2 years. The proportion of bowel obstructions due to sigmoid volvulus in Northern Uganda was 23.4% and similarly comparable with the proportion found in other African countries and higher than those in developed countries.

Factors influencing Outcome of Management of Sigmoid Volvulus in Northern Uganda: A Prospective Observational Study.

Aims: To determine the factors that influence outcome of management of sigmoid volvulus in Northern Uganda Study Design: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted and surgically managed in 19 hospitals in northern Uganda and followed-up postoperatively for 30 days. Place and Duration of the Study: This study was conducted in 19 hospitals in Northern Uganda from January 2012 to December 2012. Methodology: One hundred and three patients with sigmoid volvulus were consecutively recruited and admitted in 19 of the 20 hospitals in Northern Uganda and were surgically managed by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University Medical School. Data analysis was carried out using STATA/IC version 12.1. The outcome events observed were uneventful recovery morbidity and mortality. Results: Eighteen patients (17.48%) developed complications including wound sepsis 10(9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, thus giving a mortality rate of 7.7%. The factors associated with a high risk of morbidity and mortality were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileosigmoid knotting (RR=4.94; 95% CI: 1.30- 18.78). Resection and primary anastomosis had a better outcome compared to the Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality of sigmoid volvulus management were preoperative hypernatraemia and ilio-sigmoid knotting. Hartmann’s procedure was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.

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.

Misconceptions to Primary Pyomyositis in Postconflict Northern Uganda.

Aims: To assess the perceptions and views of the community to the possible causes and the factors responsible for the high prevalence of primary pyomyositis in the region. Study Design: A cross-sectional study design Place and Duration of Study: Gulu Regional Referral Hospital and 4 other Hospitals in Northern Uganda from September 2011 to September 2013. Methodology: A cross-sectional study was conducted on primary pyomyositis patients, their relatives, health workers and managers of hospitals. Qualitative research methods such as Focus Group Discussions, Key Informant Interviews, and In-Depth Interviews were used to obtain the information on the possible causes, experiences and socio-economic effects of the disease to their family, community, health facility and the patients. The information obtained was triangulated before transcribing to an electronic text. Ethical approval for the study was obtained from the IRB of Gulu University Medical School and Uganda National Council of Science and Technology (UNCS&T). Thematic content analysis was used for data analysis. Results: There was a wide and varying view about pyomyositis, its causes, and its socio-economic effects to the patient, family, health facilities and communities. The knowledge of the community on the disease is completely at variant with that of health workers and this may present with lack of compliant of patients to the western medical treatment in health facilities. The community beliefs that it is caused by witchcraft and that traditional methods by use of red hot arrow was the best method of management of the disease which should take place in the villages and not health facilities. Conclusion: Pyomyositis is a common surgical disease and highly prevalent in Northern Uganda but there are misconceptions about its aetiology and approach to management.

High Anion Gap Metabolic Acidosis among Children with Nodding Syndrome (NS) in Northern Uganda: Case Series.

Aims: To conduct a hormonal and biochemical studies on 10 patients with diagnosis of probable Nodding Syndrome (NS). Study Design: A cross-sectional study Place and Duration of Study: Atanga Health Center III in Pader District in Northern Uganda in September 2012. Methodology: We recruited consecutively 10 children with probable Nodding Syndrome who had been admitted for symptomatic management of seizures, injuries resulting from falls and nutritional rehabilitation. History, physical examinations, biophysical measurements (anthropometry) and blood investigations including serum electrolytes, liver function tests, thyroid hormones and vitamin D assays. Ethical approval was obtained from Gulu University Institutional Review Committee. Results: All children had severely low serum calcium and bicarbonate levels and a high Anion Gap. Thyroid hormones and vitamin D assays were largely normal. Conclusion: Children with Nodding Syndrome undergoing treatment for seizure control and nutritional rehabilitation have high Anion Gap metabolic acidosis.

Nodding Syndrome (NS) in Northern Uganda: A Probable Metabolic Disorder.

Aims: To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10th to 20th June 2012. Methodology: We recruited consecutively 101 children with probable NS in the 2 sub counties in Gulu and Amuru districts. Controls were from the same population but without symptoms of NS and were matched by age, sex and residents. History and physical examinations were conducted; anthropometry, blood samples and skin snips were obtained from cases and controls. Researchers were pediatricians, psychiatrists, nurses, laboratory scientists and epidemiologists. The research proposal was approved by the Ministry of Health and the IRB of Gulu University. Results: There was a statistically significant association between NS with malnutrition (t=0.142; p=0.044), Onchocerciasis (Χ 2 = 152.74, p<0.001; OR 7.025 95% CI 3.891, 12.682) and High Anion Gap (Χ 2=146.752, p<0.001; OR 6.313 95%CI 4.027, 9.895). Conclusion: Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.

HIV/AIDS among youths in Gulu: a post-conflict northern Uganda

HIV/AIDS is one of the commonest reasons for admission of youths in Gulu Hospital. There are no specific studies that have been carried out to determine the prevalence of HIV/AIDS among the youths in this post-conflict region. This study aimed to describe the characteristics of HIV positive youths attending care in Gulu Hospital. A cross-sectional study was conducted among youths aged 13 to 24 years in the specific clinics of Gulu Hospital from January to December 2010 to identify and describe those youths that were HIV positive. A total sample size of 280 HIV positive patients was calculated using the Kish & Leslie formula. Ethical approval was obtained from Gulu Hospital Committee. Majority of respondents 174 (62%) who re-tested for HIV knew their HIV status and most tested between April and June 90 (32%). HIV infection was more prevalent among females 252 (90%), particularly those who were single 118 (47%). HIV infection is more common among female youths in the post-conflict northern Uganda.

Nodding Syndrome in Uganda - A Disease Cluster: An Epidemiological Dilemma

Nodding Syndrome (NS) was recently described in children in Northern Uganda. The affected children were in the age group 5 – 15 years. They were stunted, malnourished, dehydrated, mentally retarded and get recurrent seizures. The objective of this study was to describe the cluster distribution of NS cases in Northern Uganda. We conducted a cross-sectional study using available data on the burden of NS in Northern Uganda and used GPS to map the locations of the most affected areas. The results obtained indicate that Nodding Syndrome in Northern Uganda occurs in clusters in the following locations Odek, Atiak, Angagura, Awere, Laguti, Labongo-Amida, Atanga, Pajimo, Palabek Kal and Palabek Gem sub counties and mainly along Aswa and Pager rivers and their tributaries. Nodding Syndrome in Northern Uganda occurs in clusters predominantly along two rivers; perhaps it is an indication for environmental, dietary and common epidemiological exposures for the syndrome.

A procura da justiça transicional e os valores tradicionais africanos: um choque de civilizações - o caso de Uganda / La búsqueda de justicia transicional y los valores tradicionales africanos: un choque de civilizaciones - el caso de Uganda / The pursuit of transitional justice and African traditional values: a clash of civilizations - the case of Uganda

Este artigo analisa o papel que a anistia e as práticas tradicionais assumem na promoção da justiça e da reconciliação no norte de Uganda.

This article examines the role that amnesty and traditional practices play in fostering justice and reconciliation in northern Uganda.

Este artículo analiza el papel que desempeñan la amnistía y las prácticas tradicionales en la promoción de la justicia y la reconciliación en el norte de Uganda.