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1.
Afr Health Sci ; 22(Spec Issue): 68-70, 2022 Aug.
Article in English | MEDLINE | ID: mdl-36321124

ABSTRACT

Background: Makerere University College of Health Sciences has been collaborating with the Uganda Heart Institute to build capacity for research, training and clinical care in cardiovascular medicine for the last 34 years to appropriately respond to rising societal needs for advanced cardiovascular care which was lacking before this period. Aim: To describe the major milestones in the MakCHS-UHI cardiovascular training collaboration and chart way for future collaborations. Method: This short communication highlights some of the salient features and important milestones in the collaboration journey of the two institutions. Conclusion: Clinical centres of excellence in specialised fields of health care, such as the Uganda Heart Institute for Cardiology, provide a conducive academic environment for MakCHS clinical scientists to provide high quality evidence-based care to meet societal needs.


Subject(s)
Cardiovascular Diseases , Medicine , Humans , Universities , Uganda , Delivery of Health Care
2.
Crit Care Res Pract ; 2019: 6081954, 2019.
Article in English | MEDLINE | ID: mdl-31687206

ABSTRACT

BACKGROUND: Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). Following the identification of Gram-negative organisms (GNOs) in all cases of HAIs in the cardiac intensive care unit (ICU), we sought to determine the burden of hand colonization with GNOs among healthcare workers who access the cardiac ICU. METHODS: We retrospectively reviewed results from surveillance cultures of fingertip imprints of HCWs who access the cardiac ICU at the Uganda Heart Institute. We collected data on staff category, isolates, and susceptibility to antibiotics. We analyzed the data using Microsoft Excel, and the results are summarized in proportions and percentages and presented in charts and tables. RESULTS: Fifty-six healthcare workers participated in the surveillance. 21 were ICU clinicians, 21 non-ICU clinicians, and 14 nonclinicians. GNOs were cultured in 19 (33.9%) HCWs, in which 8/19 (42.1%) were non-ICU clinicians, 6/19 (31.2%) ICU clinicians, and 5/19 (26.3%) nonclinicians. 32 isolates were identified, of which 47%, 28%, and 25% were cultured from non-ICU clinicians, nonclinicians, and ICU clinicians, respectively. Predominant isolates were Acinetobacter (34%), Citrobacter (21.9%), and Pseudomonas (21.9%). Antimicrobial resistance ranged from 4% to 90%. 9/28 (32.1%) isolates, predominantly Acinetobacter species (spp), were carbapenem resistant. 8/28 (28.6%) isolates, predominantly Citrobacter spp, were multidrug resistant. Resistance to ciprofloxacin and cefepime was low at 3.6% and 4.4%, respectively. CONCLUSION: Gram-negative organisms, predominantly Acinetobacter, Citrobacter, and Pseudomonas spp, were prevalent on the hands of HCWs who access the cardiac ICU irrespective of the staff category. Antimicrobial resistance was high, with multidrug resistance and carbapenem resistance common among Citrobacter spp and Acinetobacter spp, respectively. Resistance to cefepime and ciprofloxacin was low.

3.
Anesth Analg ; 125(2): 533-539, 2017 08.
Article in English | MEDLINE | ID: mdl-28682955

ABSTRACT

BACKGROUND: Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer's lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a low-resource setting. Our hypothesis was that RL would result in 30% less acidosis than NS. METHODS: This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012. Five hundred parturients were studied; 252 were randomly assigned to NS and 248 to RL groups. Preoperative and postoperative maternal venous blood gases and placental umbilical arterial cord blood gases were analyzed. The primary outcome was incidence of maternal acidosis, as defined by a postoperative drop in venous pH below 7.32 or reduction in base excess below -3 in a previously normal parturient. Maternal 24-hour postoperative morbidity, neonatal pH, and neonatal base excess were the main secondary outcomes. The study was registered in ClinicalTrials.gov as NCT01585740. RESULTS: The overall incidence of maternal acidosis was 38% in NS and 29% in RL (relative risk, 1.29; 95% confidence interval, 1.01-1.66; P = .04). Thirty-two percent of parturients in NS experienced a drop in venous pH below 7.32 postoperatively, compared with 19% in RL (relative risk, 1.65; 95% confidence interval, 1.18-2.31; P = .003). The comparative drop in base excess postoperatively below -3 between the 2 groups was not statistically significant. There were no significant differences in the incidence of maternal 24-hour postoperative morbidity events and neonatal outcomes between the 2 groups. CONCLUSIONS: NS may be a safe choice for intraoperative fluid therapy in urgent cesarean delivery as RL, albeit with an increased incidence of metabolic acidosis.


Subject(s)
Anesthesia, Obstetrical/methods , Cesarean Section , Isotonic Solutions/therapeutic use , Sodium Chloride/therapeutic use , Acidosis/epidemiology , Acidosis/prevention & control , Adult , Blood Gas Analysis , Crystalloid Solutions , Double-Blind Method , Electrolytes , Female , Fetal Blood , Fluid Therapy/methods , Humans , Hydrogen-Ion Concentration , Incidence , Labor, Obstetric , Perioperative Period , Postoperative Period , Pregnancy , Prospective Studies , Ringer's Lactate , Sample Size , Young Adult
4.
Anesth Analg ; 124(1): 290-299, 2017 01.
Article in English | MEDLINE | ID: mdl-27918334

ABSTRACT

BACKGROUND: The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS: A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561). RESULTS: Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country. CONCLUSIONS: We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.


Subject(s)
Anesthesia, Obstetrical/economics , Delivery of Health Care/economics , Developing Countries/economics , Health Care Costs , Practice Patterns, Physicians'/economics , Adult , Africa, Eastern , Anesthesia, Obstetrical/adverse effects , Anesthesia, Obstetrical/mortality , Anesthesia, Obstetrical/standards , Anesthesiologists/economics , Anesthesiologists/education , Anesthetics/economics , Anesthetics/supply & distribution , Checklist , Cross-Sectional Studies , Delivery of Health Care/standards , Female , Health Care Surveys , Health Services Needs and Demand/economics , Healthcare Disparities/economics , Humans , Maternal Mortality , Middle Aged , Needs Assessment/economics , Personnel Staffing and Scheduling/economics , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Pregnancy , Respiration, Artificial/economics , Risk Assessment , Risk Factors , Ventilators, Mechanical/economics , Ventilators, Mechanical/supply & distribution
5.
BMC Anesthesiol ; 16(1): 100, 2016 10 18.
Article in English | MEDLINE | ID: mdl-27756210

ABSTRACT

BACKGROUND: Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Due to paucity of data Mulago Hospital's post spinal shivering burden is unknown yet it causes discomfort and morbidity. METHODS: Ethical approval was obtained to perform the study among consenting mothers due for elective caesarean section from March to May 2011. We recruited ASA class I & II parturients and excluded non-consenting or spinal contra-indication patients. A standard spinal anaesthetic of 2mls of 0.5 % bupivacaine was given, intraoperative vitals were recorded every 5 min and we monitored for perioperative shivering till PACU discharge. RESULTS: We recruited 270 patients with majority being emergency caesarean deliveries (90.74 %), mainly due to failed progress from cephalopelvic disproportion. We noted 8.15 % shivering occuring mostly at 20 min, with hypotension plus hypothermia as associated factors. Intravenous pethidine (Meperidine) 25 mg effectively treated shivering and we had drowsiness, nausea and vomiting as PACU side effects that resolved on discharge to the ward. CONCLUSION: Post spinal shivering had a prevalence of 8.15 %, commonly occurred at 20 min postoperatively with hypotension plus hypothermia as main associated factors and intravenous Pethidine controlled it.


Subject(s)
Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Cesarean Section/methods , Shivering , Adjuvants, Anesthesia/administration & dosage , Adult , Africa South of the Sahara , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Cross-Sectional Studies , Female , Humans , Hypotension/epidemiology , Hypothermia/epidemiology , Meperidine/administration & dosage , Pregnancy , Prevalence , Prospective Studies , Tertiary Care Centers
6.
BMC Anesthesiol ; 16(1): 60, 2016 08 11.
Article in English | MEDLINE | ID: mdl-27515450

ABSTRACT

BACKGROUND: Mortality from anaesthesia and surgery in many countries in Sub-Saharan Africa remain at levels last seen in high-income countries 70 years ago. With many factors contributing to these poor outcomes, the World Health Organization (WHO) launched the "Safe Surgery Saves Lives" campaign in 2007. This program included the design and implementation of the "Surgical Safety Checklist", incorporating ten essential objectives for safe surgery. We set out to determine the knowledge of and attitudes towards the use of the WHO checklist for surgical patients in national referral hospitals in East Africa. METHODS: A cross-sectional survey was conducted at the main referral hospitals in Mulago (Uganda), Kenyatta (Kenya), Muhimbili (Tanzania), Centre Hospitalier Universitaire de Kigali (Rwanda) and Centre Hospitalo-Universitaire de Kamenge (Burundi). Using a pre-set questionnaire, we interviewed anaesthetists on their knowledge and attitudes towards use of the WHO surgical checklist. RESULTS: Of the 85 anaesthetists interviewed, only 25 % regularly used the WHO surgical checklist. None of the anaesthetists in Mulago (Uganda) or Centre Hospitalo-Universitaire de Kamenge (Burundi) used the checklist, mainly because it was not available, in contrast with Muhimbili (Tanzania), Kenyatta (Kenya), and Centre Hospitalier Universitaire de Kigali (Rwanda), where 65 %, 19 % and 36 %, respectively, used the checklist. CONCLUSION: Adherence to aspects of care embedded in the checklist is associated with a reduction in postoperative complications. It is therefore necessary to make the surgical checklist available, to train the surgical team on its importance and to identify local anaesthetists to champion its implementation in East Africa. The Ministries of Health in the participating countries need to issue directives for the implementation of the WHO checklist in all hospitals that conduct surgery in order to improve surgical outcomes.


Subject(s)
Anesthesia/standards , Checklist , Health Knowledge, Attitudes, Practice , Surgical Procedures, Operative/standards , Adult , Africa, Eastern , Anesthesiology/standards , Anesthetists/standards , Anesthetists/statistics & numerical data , Attitude of Health Personnel , Cross-Sectional Studies , Female , Health Care Surveys , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , World Health Organization
7.
World J Surg ; 37(3): 488-97, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23192167

ABSTRACT

BACKGROUND: Surgery and perioperative care have been neglected in the arena of global health despite evidence of cost-effectiveness and the growing, substantial burden of surgical conditions. Various approaches to address the surgical disease crisis have been reported. This article describes the strategy of Global Partners in Anesthesia and Surgery (GPAS), an academically based, capacity-building collaboration between North American and Ugandan teaching institutions. METHODS: The collaboration's projects shift away from the trainee exchange, equipment donation, and clinical service delivery models. Instead, it focuses on three locally identified objectives to improve surgical and perioperative care capacity in Uganda: workforce expansion, research, collaboration. RESULTS: Recruitment programs from 2007 to 2011 helped increase the number of surgery and anesthesia trainees at Mulago Hospital (Kampala, Uganda) from 20 to 40 and 2 to 19, respectively. All sponsored trainees successfully graduated and remained in the region. Postgraduate academic positions were created and filled to promote workforce retention. A local research agenda was developed, more than 15 collaborative, peer-reviewed papers have been published, and the first competitive research grant for a principal investigator in the Department of Surgery at Mulago was obtained. A local projects coordinator position and an annual conference were created and jointly funded by partnering international efforts to promote collaboration. CONCLUSIONS: Sub-Saharan Africa has profound unmet needs in surgery and perioperative care. This academically based model helped increase recruitment of trainees, expanded local research, and strengthened stakeholder collaboration in Uganda. Further analysis is underway to determine the impact on surgical disease burden and other important outcome measures.


Subject(s)
Anesthesiology , Capacity Building/organization & administration , General Surgery , Health Resources/economics , Health Workforce/organization & administration , Partnership Practice/organization & administration , Adult , Anesthesiology/education , Career Choice , Cooperative Behavior , Delivery of Health Care , Developing Countries , Education, Medical, Graduate/organization & administration , Female , General Surgery/education , Health Services Needs and Demand , Humans , Male , Middle Aged , Poverty , Uganda
8.
World J Surg ; 35(3): 505-11, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21181159

ABSTRACT

BACKGROUND: The burden of global injury-related deaths predominantly affects developing countries, which have little infrastructure to evaluate these disparities. We describe injury-related mortality patterns in Kampala, Uganda and compare them with data from the United States and San Francisco (SF), California. METHODS: We created a database in Kampala of deaths recorded by the City Mortuary, the Mulago Hospital Mortuary, and the Uganda Ministry of Health from July to December 2007. We analyzed the rate and odds ratios and compared them to data from the U.S. Centers for Disease Control and Prevention and the California Department of Public Health. RESULTS: In Kampala, 25% of all deaths were due to injuries (812/3303) versus 6% in SF and 7% in the United States. The odds of dying of injury in Kampala were 5.0 times higher than in SF and 4.2 times higher than in the United States. Age-standardized death rates indicate a 93% greater risk of dying from injury in Kampala than in SF. The mean age was lower in Kampala than in SF (29 vs. 44 years). The adult injury death rate (rate ratio, or RR) was higher in Kampala than in SF (2.3) or the United States (1.5). Head/neck injury was reported in 65% of injury deaths in Kampala compared to 34% in SF [odds ratio (OR) 3.7] and 28% in the US (OR 4.8). CONCLUSIONS: Urban injury-related mortality is significantly higher in Uganda than in the United States. Injury preferentially affects adults in the prime of their economically productive years. These findings serve as a call for stronger injury prevention and control policies in Uganda.


Subject(s)
Cause of Death , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Neglected Diseases/epidemiology , Wounds and Injuries/mortality , Adolescent , Adult , Age Factors , Child , Databases, Factual , Developing Countries , Female , Hospital Mortality/trends , Humans , Injury Severity Score , Male , Middle Aged , Risk Assessment , San Francisco , Sex Factors , Socioeconomic Factors , Survival Analysis , Uganda , United States , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Young Adult
11.
PLoS One ; 4(9): e6955, 2009 Sep 11.
Article in English | MEDLINE | ID: mdl-19759831

ABSTRACT

BACKGROUND: We previously showed that in the absence of a formal emergency system, lay people face a heavy burden of injuries in Kampala, Uganda, and we demonstrated the feasibility of a basic prehospital trauma course for lay people. This study tests the effectiveness of this course and estimates the costs and cost-effectiveness of scaling up this training. METHODS AND FINDINGS: For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program. At six months, 188 (62%) of the trainees were followed up. Their knowledge retention remained high or increased. The mean correct score on a basic fund of knowledge test was 92%, up from 86% after initial training (n = 146 pairs, p = 0.0016). 97% of participants had used at least one skill from the course: most commonly haemorrhage control, recovery position and lifting/moving and 96% had used at least one first-aid item. Lack of knowledge was less of a barrier and trainees were significantly more confident in providing first-aid. Based on cost estimates from the World Health Organization, local injury data, and modelling from previous studies, the projected cost of scaling up this program was $0.12 per capita or $25-75 per life year saved. Key limitations of the study include small sample size, possible reporter bias, preliminary local validation of study instruments, and an indirect estimate of mortality reduction. CONCLUSIONS: Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries.


Subject(s)
Community Health Workers/education , Emergency Medical Services/organization & administration , First Aid/economics , Inservice Training/organization & administration , Transportation of Patients/organization & administration , Wounds and Injuries/therapy , Cohort Studies , Community Health Workers/economics , Cost-Benefit Analysis , Curriculum , Emergency Medical Services/economics , Humans , Needs Assessment , Prospective Studies , Time Factors , Uganda , Wounds and Injuries/epidemiology
12.
World J Surg ; 33(12): 2512-21, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19669228

ABSTRACT

BACKGROUND: Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program. METHODS: We conducted a cross-sectional survey of current prehospital care providers in Kampala: police officers, minibus taxi drivers, and Local Council officials, and collected data on types and frequencies of emergencies witnessed, barriers to aid provision, history of training, and current availability of first-aid supplies. A context-appropriate course on basic first-aid for trauma was designed and implemented. We measured changes in trainees' fund of knowledge before and after training. RESULTS: A total of 309 lay people participated in the study, and during the previous 6 months saw 18 traumatic emergencies each; 39% saw an injury-related death. The most common injury mechanisms were road crashes, assault, and burns. In these cases, 90% of trainees provided some aid, most commonly lifting (82%) or transport (76%). Fifty-two percent of trainees had previous first-aid training, 44% had some access to equipment, and 32% had ever purchased a first-aid kit. Before training, participants answered 45% of test questions correctly (mean %) and this increased to 86% after training (p < 0.0001). CONCLUSIONS: Lay people witness many emergencies and deaths in Kampala, Uganda and provide much needed care but are ill-prepared to do so. A context-appropriate prehospital trauma care course can be developed and improve lay people's knowledge of basic trauma care. The effectiveness of such a training program needs to be evaluated prospectively.


Subject(s)
Allied Health Personnel/education , Emergency Medical Services/organization & administration , Wounds and Injuries/therapy , Clinical Competence , Cross-Sectional Studies , Curriculum , Developing Countries , Education , Educational Measurement , Emergency Medical Services/standards , Feasibility Studies , Humans , Surveys and Questionnaires , Uganda
13.
World J Surg ; 32(6): 1208-15, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18299920

ABSTRACT

BACKGROUND: Africa's health workforce crisis has recently been emphasized by major international organizations. As a part of this discussion, it has become apparent that the workforce required to deliver surgical services has been significantly neglected. METHODS: This paper reviews some of the reasons for this relative neglect and emphasizes its importance to health systems and public health. We report the first comprehensive analysis of the surgical workforce in Uganda, identify challenges to workforce development, and evaluate current programs addressing these challenges. This was performed through a literature review, analysis of existing policies to improve surgical access, and pilot retrospective studies of surgical output and workforce in nine rural hospitals. RESULTS: Uganda has a shortage of surgical personnel in comparison to higher income countries, but the precise gap is unknown. The most significant challenges to workforce development include recruitment, training, retention, and infrastructure for service delivery. Curricular innovations, international collaborations, and development of research capacity are some of the initiatives underway to overcome these challenges. Several programs and policies are addressing the maldistribution of the surgical workforce in urban areas. These programs include surgical camps, specialist outreach, and decentralization of surgical services. Each has the advantage of improving access to care, but sustainability has been an issue for all of these programs. Initial results from nine hospitals show that surgical output is similar to previous studies and lags far behind estimates in higher-income countries. Task-shifting to non-physician surgical personnel is one possible future alternative. CONCLUSIONS: The experience of Uganda is representative of other low-income countries and may provide valuable lessons. Greater attention must be paid to this critical aspect of the global crisis in human resources for health.


Subject(s)
Delivery of Health Care , Developing Countries , General Surgery , Personnel Management , Surgical Procedures, Operative/statistics & numerical data , Humans , Medically Underserved Area , Professional Practice Location , Program Development , Rural Health Services , Uganda , Workforce
15.
Mulago Hospital Bulletin ; 4(1): 31-34, 2001.
Article in English | AIM (Africa) | ID: biblio-1266611

ABSTRACT

In the year 2000; 285 patients were admitted to the I.C.U. of Mulago hospital. On average 23.8 patients were admitted per month. The aptients comprised 203 adults (71). There were 122 adult male (55) patients. This indicates that there were more adults males than females with critical illnesses. 192(67.1) of the patients had surgical conditions of which general surgical and neurosurgical cases were the commonest. Amongst the medical conditions ischaemic heart disease was the commonest. The medical conditions had a very wide spectrum of diagnoses. The need for a clearly defined admission criteria and management protocols cannot be over-emphasised. The apparent low paediatric admissions (83 patients - 29) is partly consequence of the hospital design. The need for a paediatrict I.C.U. is a reality


Subject(s)
Critical Care , Delivery of Health Care , Heart Diseases
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