Uptake of prostate cancer screening and associated factors among men aged 50 years and above in Lira city, Uganda: a cross-sectional study.

BACKGROUND: Prostate cancer is the most common cancer among men globally, with over 1.2 million cases reported in 2018. About 90% of men with prostate cancer are diagnosed when the disease is in an advanced stage. We assessed the factors associated with the uptake of prostate cancer screening among men aged ≥ 50 years in Lira city. METHODS: This was a cross-sectional study involving 400 men aged ≥ 50 years in Lira city who were sampled using multistage cluster sampling method. Uptake of prostate cancer screening was defined as the proportion of men who received prostate cancer screening in the past one year prior to the interview. Multivariable logistic regression analyses were performed to assess the factors associated with the uptake of prostate cancer screening. Data were analyzed using Stata version 14.0 statistical software. RESULTS: Of the 400 participants, only 18.5% (74/400) had ever been screened for prostate cancer. However, 70.7% (283/400) were willing to screen/rescreen if provided with the opportunity. Majority of the study participants, 70.5% (282/400) had ever heard about prostate cancer, mostly from a health worker (40.8% (115/282)). Less than half of the participants had high knowledge of prostate cancer. The factors that were significantly associated with prostate cancer screening were age ≥ 70 years, Adjusted Odds Ratio (AOR) 3.29: 95% Confidence Interval (CI): 1.20-9.00) and having a family history of prostate cancer, AOR 2.48 (95%CI: 1.32-4.65). CONCLUSION: There was low uptake of prostate cancer screening among men in Lira City, but majority of men were willing to screen. We encourage policymakers in Uganda to ensure prostate cancer screening services are readily available and accessible by men so as to improve on early identification and treatment of the disease.

Specialty career preferences among final year medical students at Makerere University College of health sciences, Uganda: a mixed methods study.

BACKGROUND: Uganda has an imbalanced distribution of the health workforce, which may be influenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors influencing specialty career preferences. We aimed to determine the specialty career preferences and the factors influencing the preferences among fifth year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS). METHODS: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 final year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis. RESULTS: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a first choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Non-established specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a first choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR = 0.37, 95%CI: 0.17-0.84). The focus group discussions highlighted controlled lifestyle, assurance of a good life through better financial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference. CONCLUSION: Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines as a career choice. Therefore, there is a need to implement or establish career guidance and mentorship programs to attract students to the neglected disciplines.

Intra-abdominal hypertension in severe burns: prevalence, incidence and mortality in a sub-Saharan African hospital.

BACKGROUND: Severe burns have been shown to be a risk factor for developing intra-abdominal hypertension (IAH). Fluid resuscitation practices used in burns management further predispose patients to intra-abdominal hypertension. The mortality associated with IAH in severe burns is estimated to be more than 74.5% once organ dysfunction occurs. Despite 95% of all burns occurring in Low and Middle income countries (LMIC), there is paucity of published data on this topic in sub-Saharan Africa. OBJECTIVES: To determine the prevalence, incidence, organ dysfunction and mortality of intra-abdominal hypertension among severe burns patients. METHODS: A prospective cohort study was conducted over a 6 months period in the Burns Unit of Mulago National Referral Hospital. Patients of all age groups with burns ≥25% and 20% in adults and children respectively were recruited and followed up for 7 days or until death occurred. Patients with burns older than 48 hours were excluded. The outcome variables were intra-abdominal pressure, organ dysfunction and seven day mortality. RESULTS: Of all the 335 burns patients admitted, 64 patients met the inclusion criteria. The overall prevalence of IAH was 57.8% while the prevalence in the children and adults was 54.5% and 61.3% respectively. The incidence of IAH was 13.1 cases/100 person days with the incidence in adults being twice that of the children. The one week mortality of patients with IAH was 82.6% with the risk of dying being 3.34 (p=0.0035) and seven day survival being less than 50%. CONCLUSION: One in two patients with severe burns exceeding 20% or 25% in children or adults respectively developed IAH. Adults had a higher prevalence and incidence of IAH. Mortality associated with IAH exceeded 80%.

Quality of life of caregivers of patients diagnosed with severe mental illness at the national referral hospitals in Uganda.

BACKGROUND: Worldwide, 450 million people suffer from mental and behavioral disorders. In Uganda, it is estimated that 35% of the population that is 9,574,915 people suffer from some form of mental illness. Caregivers are increasingly bearing the responsibility of taking care of these patients, which can influence their QoL due to the social and economic costs they incur. The aim of the study was to assess the QoL of caregivers for patients diagnosed with severe mental illness attending the National Referral Hospitals in Uganda. METHOD: This was a cross sectional study. A pretested tool with two parts; a sociodemographic part and a validated WHOQOL-BREF, was used to collect data from 300 consecutive eligible participants. SPSS (Statistical Package for Social Sciences) Version 22 and Stata Version 14 were used in data entry and analysis. RESULTS: Of the 300 participants, 57.3% of the caregivers had a poor QoL. The statistically significant factors associated with QoL were environment (Adjusted coefficient = 0.016, 95% CI = 0.009-0.023), caregiver satisfaction with their health (Adjusted coefficient = 0.405, 95% CI = 0.33-0.487), psychological wellbeing (Adjusted coefficient = 0.007, 95% CI = 0.0002-0.013), and education level (Adjusted coefficient = 0.148, 95% CI = 0.072-0.225). CONCLUSION: QoL of caregivers for patients diagnosed with mental illness is generally poor due to the added responsibilities and occupation of their time, energy and attention. This additional responsibility results in high levels of stress and caregivers may fail to have appropriate coping mechanisms. Interventions like support groups or counseling should be put in place to aid caregivers in their role and therefore improve QoL. This study adds to the international database of QoL literature and calls for more attention to be placed on caregivers in supporting their role and improving their QoL so as to lead to better patient outcomes among those diagnosed with mental illness.

Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study.

BACKGROUND: Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy. METHODOLOGY: Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. EXCLUSION CRITERIA: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart. RESULTS: In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371-560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148-6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017-8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113-12.760) at 24 h postoperatively. CONCLUSION: The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.