Patient Delay in Accessing Breast Cancer Care in a Sub Saharan African Country: Uganda.

Aims: To assess patient delay differences between early and late stage breast cancer among women in Uganda. Study Design: A retrospective analytical study. Place and Duration of the Study: A study conducted at a tertiary teaching hospital. Selected patients’ data available for the period between 2008 and 2011 were included in this study. Methodology: We included 201 women with histologically confirmed breast cancer. The variables analysed included age, residence, histological subtype, stage at presentation and time delays. Ethical approval was obtained. Results: The mean age for the early and late presenters was 49 and 46 years respectively (p=0.065). Rural women were more likely to present late. Triple negative breast cancer (TNBC) and HER2+ were the majority cancer subtypes for the late presenters. On average women waited for 29 months before they presented for specialized cancer treatment (median 12 months; range 1-120 months). The duration of symptoms didn’t differ between the two groups (p=0.295) and 75% of early stage presenters, reported at least 6 months after noticing symptoms. Only 9% of the TNBC patients presented under 3 months in comparison to 14 % for HER2+, 33% for Luminal B and 36% for luminal A. Overall 23% (39/168) presented with early stage disease. Conclusion: Delay in seeking appropriate breast cancer care in Uganda was excessive, a sign of a neglected disease. Tumor biology factors seem to play a role in late stage presentation. Research in factors that lead to prolonged delay in accessing care in a resource poor context are needed urgently.

Malaria Burden in Pregnancy at Mulago National Referral Hospital in Kampala; Uganda

Pregnancy-associated malaria is a major global health concern. To assess the Plasmodium falciparum burden in pregnancy we conducted a cross-sectional study at Mulago Hospital in Kampala; Uganda. Malaria prevalence by each of three measures-peripheral smear; placental smear; and placental histology was 9(35/391); 11.3(44/389); and 13.9(53/382) respectively. Together; smear and histology data yielded an infection rate of 15.5(59/380) of active infections and 4.5(17/380) of past infections; hence 20had been or were infected when giving birth. A crude parity dependency was observed with main burden being concentrated in gravidae 1 through gravidae 3. Twenty-two percent were afflicted by anaemia and 12.2delivered low birthweight babies. Active placental infection and anaemia showed strong association (OR=2.8) whereas parity and placental infection had an interactive effect on mean birthweight (P=.036). Primigravidae with active infection and multigravidae with past infection delivered on average lighter babies. Use of bednet protected significantly against infection (OR=0.56) whilst increased haemoglobin level protected against low birthweight (OR=0.83) irrespective of infection status. Albeit a high attendance at antenatal clinics (96.8); there was a poor coverage of insecticide-treated nets (32) and intermittent preventive antimalarial treatment (41.5)

Unintended Pregnancy And Induced Abortion In Uganda: Causes and Consequences

Because abortion is banned in Uganda (except to save a woman's life) and because strong social stigma surrounds the issue; many women try to conceal their unplanned pregnancies and abortions.The clandestine nature of abortion makes it difficult to measure its incidence in Uganda and allows policymakers to avoid dealing with the problem. Yet the serious health consequences of abortions carried out in unsafe conditions by untrained or poorly trained practitioners impose a heavy burden on women; families and Uganda's already overburdened health care system. Studies of womenhospitalized for the treatment of complications from unsafe abortion have documented the tragic burden of morbidity and death borne by many Ugandan women. New research findings now make it possible to fill in the many gaps in our understanding of the prevalence; causes and consequences of induced abortion in Uganda