Showing papers by "Mbarara University of Science and Technology published in 2001"

The challenge of chloroquine-resistant malaria in sub-Saharan Africa

Abstract: For the last decade chloroquine-resistant Plasmodium falciparum (CRPF) has spread explosively in sub-Saharan Africa. In some areas of the continent, CRPF is so intense that chloroquine can hardly be said to have any efficacy. There is emerging evidence that CRPF is linked with increased incidence of mortality, severe disease and emergence of epidemics. Whereas the normal response to this trend of events would be replacing chloroquine with another effective drug, such a decision is hampered by the limited number of antimalarials currently available. There is a fear that changing too early would lead to depletion of available drugs. Yet a delay may be costly and catastrophic. Since the development of new antimalarials is deemed commercially unviable by high-income countries, there is need for a pan-African project aimed at the development of new antimalarials. Such a project could be jointly funded from African governments and the donor community under the coordination of either the World Health Organization or the Organization of African Unity. To delay the emergence and spread of resistance by P. falciparum to new and old drugs, there is need for: improving rational drugs use; limiting mass use of drugs as in chemoprophylaxis and in medicated salt; and increasing the use of impregnated bed nets.

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda.

Abstract: Patient-based partner referral (PBPR) which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs) has limited effectiveness. The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala Uganda. A total of 383 patients (187 women 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. The two groups had similar background characteristics. Of the 237 partners elicited 176 (74%) were reported treated in the PDPM group. In the PBPR group in which 234 partners were elicited 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR] 2.44; 95% confidence interval [CI] 1.95-3.07; P < 0.001). Furthermore PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women 86 of 103 partners in the PDPM group were reported treated compared with 23 of 104 partners in the PBPR group (RR 4.55; 95% CI 2.92-7.08; P < 0.001). For casual partners 18 of 51 (34%) were reported treated in the PDPM group compared with only three of 45 partners (7%) who were referred in the PBPR group (RR 1.43; 95% CI 1.40-2.65; P < 0.01). Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners. (authors)

Regeneration of indigenous trees in Mgahinga Gorilla National Park, Uganda

Abstract: This study examines the regeneration of indigenous tree species in the formerly encroached area in Mgahinga Gorilla National Park (MGNP), south-western Uganda. Before gazetting in 1992, MGNP had basically been agricultural land for well over 50 years. The distribution of exotic vegetation was established using a Geographical Positioning System receiver and indigenous vegetation was sampled by establishment of quadrats along transect lines. Observations indicated that approximately 2% of the old cropland was covered by exotic woodlots. Black wattle (Acacia mearnsii) and Eucalyptus trees were found to be the most widely distributed and Pinus patula the least distributed species in the park. Species numbers of indigenous trees (n = 26) were high in the old cropland, compared with twelve species observed in exotic woodlots. The natural forest supported the highest (75%) stem density and the lowest (4%) stem density was recorded in exotic woodlots. Seedling class (< 2 cm, d.b.h.) accounted for the majority of juveniles, with the lowest stem density (1350 seedlings ha−1) recorded in exotic woodlots compared with 6609 seedlings ha−1 in the old cropland and 24,625 seedlings ha−1 in the natural forest. The levels of tree diversity and stocking characteristics recorded under the exotic species suggest that a low diverse community of native species may exploit this environment. Resume Cette etude examine la regeneration des especes indigenes d’arbres dans la zone precedemment empietee du Mgahinga Gorilla National Park (MGNP), au sud-ouest de l’Ouganda. Avant son enregistrement en 1992, le MGNP avait ete une zone principalement agricole pendant bien plus de 50 ans. On a etabli la distribution de vegetation exotique au moyen d’un systeme GPS (Geographical Positioning System) et on a recolte de la vegetation indigene en creant des quadrats le long de lignes de transects. Les observations ont montre que pres de 2% des anciennes cultures etaient couverts de parcelles de bois exotiques. On a trouve que les Acacia mearnsii et les Eucalyptusetaient les plus largement distribues et que les Pinus patula constituaient l’espece la moins distribuee dans le parc. Le nombre d’especes d’arbres indigenes (n = 26) etait eleve dans les anciennes cultures, compare aux 12 especes observees dans les parcelles de bois exotiques. C’est dans la foret naturelle que l’on trouvait la plus forte densite de repousse (75%) et dans les parcelles de bois exotiques qu’elle etait la plus faible (4%). La classe des jeunes plants (< 2 cm de diametre a 1 m de haut) comptait la majorite des juveniles, et la densite la plus faible de jeunes pousses (1350 jeunes plants/ha) se retrouvait dans les parcelles de bois exotiques, comparee aux 6.609 jeunes plants/ha dans les anciennes terres de culture et aux 24.625 jeunes plants/ha de la foret naturelle. Le taux de diversite des arbres et les caracteristiques de reserve releves parmi les especes exotiques suggerent que seule une faible diversite d’especes natives est a meme d’exploiter cet environnement.

The culture of technology: defining transformation in nursing, from "the lady with a lamp" to "robonurse"?

Abstract: Rozzano C. Locsin, RN-C, PhD Fulbright Scholar and Visiting Professor of Nursing Faculty of Medicine Mbarara University of Science and Technology Mbarara, Uganda and Associate Professor of Nursing Florida Atlantic University Boca Raton, Florida T HE issues of learning, education, practice, and leadership heighten the appreciation of transformations in professional nursing. A critical issue taking center stage is the continuously debated association among the concepts of technology, caring, and nursing. Often, it is awareness of the “culture of technology in nursing” that upholds the transformation of professional nursing as an imperative for contemporary knowledgeable practice. Culture is “how a group of people think, believe, and behave,” (1,p.13) while technology refers to the Greek concepts techne, the know-how of making things, and logus, the study or rational order of things. 2

The dilemma of decision-making: processing thinking critical to nursing

Abstract: Rozzano C. Locsin, RN-C, PhD Fulbright Scholar and Visiting Professor Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology Mbarara, Uganda and Associate Professor of Nursing Florida Atlantic University Boca Raton, Florida I propose that within the ambiguous and uncertain world of nursing practice, a scientific and rational approach to decision-making is inappropriate. More importantly, professional judgment in the decisionmaking process cannot be prescribed, as practitioners cope with the uncertainties and challenges of everyday clinical practice in a very complex and individual way.1(p. 289)

Childhood bacterial meningitis in Mbarara Hospital, Uganda: antimicrobial susceptibility and outcome of treatment

Abstract: Background : The recommended antibiotic treatment of bacterial meningitis has come under scrutiny following frequent reports of in-vitro resistance by the common causative organisms to penicillin and chloramphenicol. Objective : The study recorded the causative organisms, antibiotic sensitivity patterns and outcome of treatment of bacterial meningitis in children and examined the impact of various factors on the recorded outcome. Design : This was a retrospective review of all case records of patients treated for bacterial meningitis over a one-year period. Setting : The study was set in the paediatric wards of Mbarara University Teaching Hospital, in south western Uganda. Results : A total of 77 patients were treated. Among 56 patients with available CSF results the frequency of bacterial causes was as follows: H. influenzae 13(23.2%), coliforms 7(12.5%), uncultured Gram-negative bacilli 7(12.5%), S. pneumoniae 5(8.9%) and N. meningitidis 3(5.4%). Most isolates tested were resistant to both penicillin and chloramphenicol, but all were sensitive to ciprofloxacin and perfloxacin. Twenty eight(36.8%) patients died, 22(28.9%) survived with sequelae and 15(19.7%) improved without sequelae. 14/18 who received perfloxacin and/or ciprofloxacin survived compared with 23/47 who did not: p=0.04). Conclusions : The high case-fatality rates and the high frequency of resistance to penicillin and chloramphenicol make a case for a review of the currently recommended antibiotic treatment of bacterial meningitis in this region. Fluoroquinolones need further evaluation as potential alternatives to chloramphenicol in the treatment of bacterial meningitis. African Health Sciences 2001: 1(1): 9-11.

Culture-centrism and holistic care in nursing practice.

Abstract: Rozzano C. Locsin, RN C, PhD Fulbright Scholar, Visiting Professor of Nursing Faculty of Medicine, Mbarara University of Science and Technology Mbarara, UGANDA and Associate Professor of Nursing Florida Atlantic University Boca Raton, FL CERTAIN DISEASES are more common in some cultures than in others. Hypertension, for example, is the most common cardiovascular disease in black Africans, occurring in more than 15% of the adult population. Hypertension in black Africans appears at a younger age (compared with the fourth and fifth decades in Western countries) and rapidly causes significant mortality and morbidity. In contrast, however, black Africans have developed an altered transport mechanism for sodium that enables them to survive in a subtropical or tropical environment. 1,2

Non-functioning ovarian fibroma with extensive calcification: case report

Abstract: A case of a non-functioning ovarian fibroma with extensive calcification in a young Ugandan female is described. Ovarian fibromas occasionally may be bilateral and associated with benign ascites and pleural effusion called Meigs' syndrome or related to a rare hereditary condition known as Gorlin's syndrome. Rarely if functioning, the tumour may produce hormones to cause diabetes mellitus or hypoglycaemia or secrete carbohydrate antigen 125 to clinically simulate ovarian carcinoma.

Burkitt's lymphoma involving the breast in a 15-year-old girl.

Abstract: Dr Dennis Burkitt, a British surgeon working in Uganda in 1958, first described the clinical syndrome of jaw and abdominal tumours in African children; this was to be known later as Burkitt's lymphoma. Wright in 1962 described that the tumour possesses cytological and histological characteristics which are considered diagnostiel. The disease is endemic in Africa and several reports have reported the tumour in many organs of the body, e.g. in the orbit, ovaries, kidneys, adrenals, thyroid and testes ( 3. The tumour may be muticentric in origin, sometimes involving many organs in one patient. The involvement of the breast in both sexes is said to be very rare. We describe Burkitt's lymphoma involving the breast and with multiple abdominal tumours in a 15year-old Ugandan girl.