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.

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.