Students' prior knowledge and skills in computer and internet use: An exploration of incoming first year undergraduate health sciences students at Gulu University, Uganda

Internet has provided infrastructure that enables access to a variety of information resources for use by medical students at Gulu University in Northern Uganda. However, little attention has been put to explore prior internet knowledge of undergraduate medical students in Uganda. Cross-sectional research design was used. Fifty-six first year undergraduate health sciences students participated in the study. Self-administered structured questionnaire was used for data collection and analysis was done using SPSS version 16. Results shows that a majority of the participants had prior knowledge of computer 48 (86.0%) and internet 44 (79.0%). 38 (68.0%) participants had access to internet and 34 (61.0%) owned computer before joining the University. Majority owned mobile phones 41 (73.0%) and used it for internet access 43 (84.0%). Use of internet was high in social media 46 (86.8) and searching general information 44 (84.6%). Participants expected easy access to teaching materials 52 (94.5%) and communication 49 (90.7%) via internet. These findings suggest need for healthcare librarians to train incoming medical students on use of ICTs; including social media platforms and mobile phones to improve their ICT literacy skills to enable them access the best academic information resources to enhance medical education.

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.

Tuberculosis (TB) Co-infection with HIV/AIDS: Clinical Presentation at Lacor Hospital, a Post-conflict Northern Uganda.

Aims: To characterize the various clinical presentations of TB diagnosed in HIV/AIDS patients in the post-conflict Northern Uganda. Study Design and Setting: A prospective cohort study was conducted on 320 TB/HIV/AIDS coinfected patients at St. Mary’s Hospital, Lacor which is a specialist hospital in Gulu, Northern Uganda from July 2009 to July 2010. Methodology: Clinical features of confirmed 320 HIV sero-positive patients with confirmed TB coinfection (170 males and 150 females) recruited consecutively were studied and followed up for three months, their clinical presentations analyzed using SPSS version13.0. Ethics and Review Committee approved the study and those who did not meet the inclusion criteria were excluded. All patients gave an informed consent/Assent for the study. Results: The commonest clinical presentations were fever 316(98.8%), productive cough 268(83.7%), evening/night sweats 267(83.4%), general malaise 277(86.6%), wasting 228(71.3%), anaemia 220(68.8%) and lymphadenopathy 100(31.3%). The clinical features which were associated statistically and significantly with TB/HIV/AIDS co-infection were: Low grade fever (p=0.006); haemoptysis (p=0.001); Night sweats and evening fevers (p=0.043); Chest pain (p=0.041); General malaise (p=0.037) and wasting (p=0.047). Most patients 262(81.9%) improved and were discharged on Directly Observed Therapy Short-course (DOTS) while 58(18.1%) died. Conclusion: Clinical assessment is a very important adjuvant in TB/HIV/AIDS co-epidemic diagnosis. Early diagnosis and prompt management of TB co-infection ensured longer life and reduced morbidity and mortality.

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.

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.

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.

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.

Buruli Ulcer in the Proximal Right Thigh and Groin: A Case Report

We report a case of histopathologically proven Buruli ulcer (BU) in a 25-year-old man which was found at the proximal right thigh and groin – an unusual site of occurrence. Laboratory results including Gram and ZN stains were negative while a culture on Lowenstein Jensen media at 33oC from the tissues produced a positive growth of Mycobacterium ulcerans. Histology of the edges of the ulcer showed a granulomatous lesion consistent with BU. This highlights the differentiation of Buruli ulcer from tropical ulcer and, to a lesser extent other forms of skin malignancies and benign skin lesions. The ulcer presented by the young man was Buruli ulcer.