Showing papers by "Mulago Hospital published in 2007"

Anaesthesia services in developing countries: defining the problems

Abstract: We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. The questionnaire identified shortages of personnel, drugs, equipment and training that have not been quantified or accurately described before. The method used provides an easy and effective way to gain essential data for any country or national anaesthesia society wishing to investigate anaesthesia services in its hospitals. Solutions require improvements in local management, finance and logistics, and action to ensure that the importance of anaesthesia within acute sector healthcare is fully recognised. Major investment in terms of personnel and equipment is required to modernise and improve the safety of anaesthesia for patients in Uganda.

Nursing care of AIDS patients in Uganda.

Abstract: This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.

The effect of HIV on morbidity and mortality in children with severe malarial anaemia

Abstract: Malaria and HIV are common causes of mortality in sub-Saharan Africa. The effect of HIV infection on morbidity and mortality in children with severe malarial anaemia was assessed. Children <5 years old were followed as part of a prospective cohort study to assess the transfusion-associated transmission of blood-borne pathogens at Mulago Hospital, Kampala, Uganda. All children were hospitalized with a diagnosis of severe malarial anaemia requiring blood transfusion. Survival to different time points post-transfusion was compared between HIV-infected and uninfected children. Generalized estimating equations were used to analyse repeated measurement outcomes of morbidity, adjusting for confounders. Of 847 children, 78 (9.2%) were HIV-infected. Median follow-up time was 162 days (inter-quartile range: 111, 169). HIV-infected children were more likely to die within 7 days (Hazard ratio [HR] = 2.86, 95% Confidence interval [CI] 1.30–6.29, P = 0.009) and within 28 days (HR = 3.70, 95% CI 1.91–7.17, P < 0.001) of an episode of severe malarial anaemia, and were more likely to die in the 6 months post-transfusion (HR = 5.70, 95% CI 3.54–9.16, P < 0.001) compared to HIV-uninfected children. HIV-infected children had more frequent re-admissions due to malaria within 28 days (Incidence rate ratio (IRR) = 3.74, 95% CI 1.41–9.90, P = 0.008) and within 6 months (IRR = 2.66, 95% CI 1.17 – 6.07, P = 0.02) post-transfusion than HIV-uninfected children. HIV-infected children with severe malarial anaemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.

Discovering Voice: A Participatory Action Research Study with Nurses in Uganda:

Abstract: In this article the authors present findings from a qualitative research study carried out with Ugandan nurses from September 2003 until June 2004. They highlight the process and philosophical basis of participatory action research (PAR) by reflecting on the challenges, opportunities, outcomes, and ethical issues encountered during the conduct of the research. In this study PAR fostered a climate in which nurses could engage in collective reflection on their practice, make sense of their experiences, and thereby change their understanding of their work.

Missed injuries: a Ugandan experience.

Abstract: Summary Background Missed injuries (MIs) have been noted worldwide in all trauma centres that have studied them, and they are a significant cause of patient morbidity and mortality. Objective To establish the prevalence, contributing factors and short-term outcome of missed injuries in cases of multiple and major trauma. Method Longitudinal prospective study involving 403 patients over 5 months. Results Missed injuries were discovered in 78 cases (prevalence 19.4%). Contributing factors included incomplete assessment (52.5%), radiological errors, surgical failures and patient's arrival time. The most affected body regions were the head and neck, extremities and pelvic girdle and contents; in the abdomen, 49.1% of injuries were missed. Among the 28 deaths in the study, 21 occurred in cases with missed injuries, and 13 (62%) of these deaths were directly attributable to missed injuries ( R 2 = 12.5, p = 0.0001, 95% CI 5.5–28.35). Conclusion There is need for improvement in patient assessment and monitoring, in efficiency of the trauma team, and for staff redistribution to address the increase in night arrivals.

Lack of appropriate treatment for people with comorbid HIV/AIDS and epilepsy in sub-Saharan Africa.

Abstract: It is surprising how little we know regarding the optimal treatment for patients with epilepsy. This lack of information has been highlighted recently in this journal with respect to management of patients with newly diagnosed epilepsy (Glauser et al., 2006). There is probably even less evidence regarding the optimal management of patients who have failed the first drug tried (Kwan and Brodie, 2000). In this article, we propose a new approach to determining how patients with epilepsy should be managed.

Effects of Nevirapine, Compared with Lamivudine, on Lipids and Lipoproteins in HIV-1—Uninfected Newborns: The Stopping Infection from Mother-to-Child via Breast-Feeding in Africa Lipid Substudy

Abstract: The objective of the present study was to assess whether the high-density lipoprotein cholesterol (HDL-c)-increasing effect of nevirapine (NVP) as observed in human immunodeficiency virus type 1 (HIV-1)-infected subjects at least in part may relate to intrinsic properties of NVP. At 2 6 and 12 weeks after birth complete lipid profiles as well as plasma apolipoproteins levels were assessed in 80 HIV-uninfected newborns half of whom received NVP and half lamivudine (3TC) respectively. Newborns were randomly selected from a randomized trial in which NVP or 3TC had been administered to HIV-uninfected infants born to HIV-infected mothers to try and prevent HIV-1 transmission from occurring during breast-feeding. After 6 weeks of therapy the expected physiological decline in HDL-c levels in the newborns was attenuated in infants treated with NVP compared with levels in those treated with 3TC. Apolipoprotein A-I (apoA-I) levels were higher at all time points in the NVP arm than they were in the 3TC arm (P = .02) reaching peak levels at 6 weeks. The difference in HDL-c was no longer significant at 12 weeks. apoA-I levels and HDL-c were elevated in HIV-1-uninfected newborns receiving NVP compared with those receiving 3TC. These data support that NVP may indeed have intrinsic apoA-I and HDL-c elevating properties in humans. (authors)

Clinical management of HIV infection in children.

Abstract: Purpose of reviewThe aim of this article is to review recent advances in the clinical care of HIV-infected children.Recent findingsObstacles to diagnosing HIV in children and providing clinical care to those HIV infected relate to a number of technical and operational factors. Most countries now hav