Showing papers by "Mulago Hospital published in 2010"

Sero-prevalence and risk factors for hepatitis B virus infection among health care workers in a tertiary hospital in Uganda

Abstract: Background: Hepatitis B virus (HBV) infection is a global public health challenge. Prevalence of current hepatitis B virus infection in the general population in Uganda is about 10%. Health care workers (HCW) have an extra risk of getting infected from their workplace and yet they are not routinely vaccinated against HBV infection. This study aimed at estimating prevalence of hepatitis B virus infection and associated risk factors among health care workers in a tertiary hospital in Uganda. Methods: Data were obtained from a cross sectional survey conducted in Mulago, a national referral and teaching hospital in Uganda among health care workers in 2003. A proportionate to size random sample was drawn per health care worker category. A structured questionnaire was used to collect data on socio-demographic characteristics and risk factors. ELISA was used to test sera for HBsAg, anti-HBs and total anti-HBc. Descriptive and logistic regression models were used for analysis. Results: Among the 370 participants, the sero-prevalence of current hepatitis B virus infection was 8.1%; while prevalence of life time exposure to hepatitis B virus infection was 48.1%. Prevalence of needle stick injuries and exposure to mucous membranes was 67.8% and 41.0% respectively. Cuts were also common with 31.7% of doctors reporting a cut in a period of one year preceding the survey. Consistent use of gloves was reported by 55.4% of respondents. The laboratory technicians (18.0% of respondents) were the least likely to consistently use gloves. Only 6.2% of respondents were vaccinated against hepatitis B virus infection and 48.9% were susceptible and could potentially be protected through vaccination. Longer duration in service was associated with a lower risk of current infection (OR = 0.13; p value = 0.048). Being a nursing assistant (OR = 17.78; p value = 0.007) or a laboratory technician (OR = 12.23; p value = 0.009) were associated with a higher risk of current hepatitis B virus infection. Laboratory technicians (OR = 3.99; p value = 0.023) and individuals with no training in infection prevention in last five years (OR = 1.85; p value = 0.015) were more likely to have been exposed to hepatitis B virus infection before. Conclusions: The prevalence of current and life time exposure to hepatitis B virus infection was high. Exposure to potentially infectious body fluids was high and yet only a small percentage of HCW were vaccinated. There is need to vaccinate all health care workers as a matter of policy and ensure a safer work environment.

Plasmodium infection and its risk factors in eastern Uganda

Abstract: Malaria is a leading cause of disease burden in Uganda, although surprisingly few contemporary, age-stratified data exist on malaria epidemiology in the country. This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Uganda, with a specific focus on how risk factors differ between demographic groups in this population. In 2008, a cross-sectional survey was conducted in four contiguous villages in Mulanda, sub-county in Tororo district, eastern Uganda, to investigate the epidemiology and risk factors of Plasmodium species infection. All permanent residents were invited to participate, with blood smears collected from 1,844 individuals aged between six months and 88 years (representing 78% of the population). Demographic, household and socio-economic characteristics were combined with environmental data using a Geographical Information System. Hierarchical models were used to explore patterns of malaria infection and identify individual, household and environmental risk factors. Overall, 709 individuals were infected with Plasmodium, with prevalence highest among 5-9 year olds (63.5%). Thin films from a random sample of 20% of parasite positive participants showed that 94.0% of infections were Plasmodium falciparum and 6.0% were P. malariae; no other species or mixed infections were seen. In total, 68% of households owned at least one mosquito although only 27% of school-aged children reported sleeping under a net the previous night. In multivariate analysis, infection risk was highest amongst children aged 5-9 years and remained high in older children. Risk of infection was lower for those that reported sleeping under a bed net the previous night and living more than 750 m from a rice-growing area. After accounting for clustering within compounds, there was no evidence for an association between infection prevalence and socio-economic status, and no evidence for spatial clustering. These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria among school-aged children. Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds. Taken together, these findings emphasize the importance of increasing net coverage, especially among school-aged children.

A review of compliance to anti tuberculosis treatment and risk factors for defaulting treatment in Sub Saharan Africa

Abstract: Background: The aim of this study is to assess anti TB treatment compliance and the factors predictive for poor adherence in Sub-Saharan Africa in the last 10 years. Methods: We searched Medline for articles written in English using the terms: “Patient Compliance”[Mesh] OR “Medication Adherence”[Mesh])) AND “Tuberculosis”[Mesh]) AND “Africa South of the Sahara”[Mesh]. Results: We identified 4 published manuscript and we included 1 study from the Infectious Diseases Institute. The proportion of patients defaulting varied from 11.3% (8) to 29.6%. Risk factors for defaulting treatment were: distance from the hospital, not being on the first course of TB medications, lack of repeated smears, unit transfer after the intensive phase, experiencing side effects, having no family support , poor knowledge about TB treatment, being more than 25 years old, and use of public transport. Conclusions: This review reveals high rate of losses to follow up in Sub-Saharan Africa; the information currently available is however too heterogeneous to draw conclusions on the reasons for this high rate of defaulters. It is imperative to understand predictive factors for treatment default so that programs can implement specific measure to target the population at risk

Performance of three LED-based fluorescence microscopy systems for detection of tuberculosis in Uganda.

Abstract: Background: Direct smear microscopy using Ziehl-Neelsen (ZN) staining is the mainstay of tuberculosis (TB) diagnosis in most high burden countries, but is limited by low sensitivity in routine practice, particularly in high human immunodeficiency virus (HIV) prevalence settings. Methods: We compared the performance of three commercial light emitting diode (LED)-based microscopy systems (Primostar TM iLED, Lumin TM and AFTERH) for fluorescent detection of Mycobacterium tuberculosis with ZN microscopy on slides prepared from sputum of TB suspects. Examination time for LED-based fluorescent microscopy (LED FM) and ZN slides was also compared, and a qualitative user appraisal of the LED FM systems was carried out. Results: LED FM was between 5.6 and 9.4% more sensitive than ZN microscopy, although the difference was not statistically significant. There was no significant difference in the sensitivity or specificity of the three LED FM systems, although the specificity of Fraen AFTER was somewhat lower than the other LED FM methods. Examination time for LED FM was 2 and 4 times less than for ZN microscopy. LED FM was highly acceptable to Ugandan technologists, although differences in operational performance of the three systems were reported. Conclusions: LED FM compares favourably with ZN microscopy, with equivalent specificity and a modest increase in sensitivity. Screening of slides was substantially quicker using LED FM than ZN, and LED FM was rated highly by laboratory technologists. Available commercial systems have different operational characteristics which should be considered prior to programmatic implementation.

Sensitivity and specificity of herpes simplex virus-2 serological assays among HIV-infected and uninfected urban Ugandans

Abstract: Background—Herpes Simplex Virus-2 (HSV-2) is a risk factor for HIV-1 infection; HSV-2 serology may be useful for HIV-1 prevention. We characterized HSV-2 serology assay performance in HIV-positive and HIV-negative Africans. Methods—Serostatus for HSV-2 and HIV-1 was determined in 493 serum specimens stored from a community HSV-2 prevalence survey in Kampala, Uganda. HSV-2 serology by Focus HerpeSelect ELISA, Biokit HSV-2 rapid assay, and Kalon HSV-2 were compared to Western Blot (WB) by HIV-1 serostatus. Results—Sensitivity/specificity were: 99.5%/70.2% for Focus, 97.0%/86.4% for Biokit, and 97.5%/96.2% for Kalon. Focus with Biokit confirmation improved sensitivity/specificity (99.4%/ 96.8%, respectively). Use of a higher Focus index value cutoff of 2.2 instead of 1.1 increased specificity from 70.2% to 92.4%. Kalon had higher specificity than Focus (p<.001). Conclusion—Of commercially available HSV-2 serologic assays, Kalon alone, or Focus ELISA followed by Biokit confirmation perform best. Improved HSV-2 assays are needed for HSV-2 and HIV-1 public health activities in Africa.

The prevalence and clinical course of HIV-associated pulmonary cryptococcosis in Uganda.

Abstract: Background The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well-described.

EBV, HHV8 and HIV in B cell non Hodgkin lymphoma in Kampala, Uganda

Abstract: B cell non Hodgkin lymphomas account for the majority of lymphomas in Uganda. The commonest is endemic Burkitt lymphoma, followed by diffuse large-B-cell lymphoma (DLBCL). There has been an increase in incidence of malignant lymphoma since the onset of the HIV/AIDS pandemic. However, the possible linkages of HHV8 and EBV to the condition of impaired immunity present in AIDS are still not yet very clearly understood. 1. To describe the prevalence of Epstein-Barr virus, Human Herpes virus 8 and Human Immunodeficiency Virus-1 in B cell non Hodgkin lymphoma biopsy specimens in Kampala, Uganda. 2. To describe the histopathology of non Hodgkin lymphoma by HIV serology test result in Kampala, Uganda Tumour biopsies specimens from 119 patients with B cell non Hodgkin lymphoma were classified according to the WHO classification. Immunohistochemistry was used for detection of HHV8 and in situ hybridization with Epstein Barr virus encoded RNA (EBER) for EBV. Real time and nested PCR were used for the detection of HIV. The patients from whom the 1991-2000 NHL biopsies had been taken did not have HIV serology results therefore 145 patients biopsies where serology results were available were used to describe the association of HIV with non Hodgkin lymphoma type during 2008-2009. In this study, the majority (92%) of the Burkitt lymphomas and only 34.8% of the diffuse large B cell lymphomas were EBV positive. None of the precursor B lymphoblastic lymphomas or the mantle cell lymphomas showed EBV integration in the lymphoma cells. None of the Burkitt lymphoma biopsies had HIV by PCR. Of the 121 non Hodgkin B cell lymphoma patients with HIV test results, 19% had HIV. However, only 1(0.04%) case of Burkitt lymphoma had HIV. All the tumours were HHV8 negative. The majority of the Burkitt lymphomas and two fifths of the diffuse large B cell lymphomas had EBV. All the tumours were HHV8 negative. Generally, the relationship of NHL and HIV was weaker than what has been reported from the developed countries. We discuss the role of these viruses in lymphomagenesis in light of current knowledge.

The Prevalence and Clinical Course of HIV-Associated Pulmonary Cryptococcosis in Uganda

Abstract: Background: The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well described. Methods: Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough ≥2 weeks were enrolled. Patients with negative sputum smears for acid-fast bacilli were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and fungi. Patients were followed 2 and 6 months after hospital discharge. Results: Of 407 patients enrolled, 132 (32%) underwent bronchoscopy. Of 132 BAL fungal cultures, 15 (11 %) grew Cryptococcus neoformans. None of the patients were suspected to have pulmonary cryptococcosis on admission. The median CD4 count among those with pulmonary cryptococcosis was 23 cells per microliter (interquartile range = 7―51). Of 13 patients who completed 6-month follow-up, 4 died and 9 were improved, including 5 who had started antiretroviral therapy but had not received antifungal medication. Conclusions: Pulmonary cryptococcosis is common in HIV-infected tuberculosis suspects in Uganda. Early initiation of antiretroviral therapy in those with isolated pulmonary infection may improve outcomes, even without antifungal therapy. This finding suggests that some HIV-infected patients with C. neoformans isolated from respiratory samples may have colonization or localized infection.

Blood loss and contributing factors in femoral fracture surgery

Abstract: Background: Substantial blood losses frequently accompany orthopedic procedures. Methods: We prospectively noted peri-operative hemoglobin changes in 93 patients undergoing surgery for femoral fracture with an aim of establishing blood loss and related factors. Results: The mean total blood loss assessed 72 hours after the surgical procedure was 3.31 (SD 1.56) units of whole blood. A multiple regression analysis revealed diathermy use and a simple fracture pattern as significant factors in reducing blood loss (p<0.01). Conclusions: Open intramedullary fixation of femur fractures leads to considerable peri-operative blood loss. This is can be reduced by use of diathermy during surgery. African Health Sciences 2010; 10(1): 18 - 25

Malaria Burden in Pregnancy at Mulago National Referral Hospital in Kampala, Uganda

Abstract: Pregnancy-associated malaria is a major global health concern. To assess the Plasmodium falciparum burden in pregnancy we conducted a cross-sectional study at Mulago Hospital in Kampala, Uganda. Malaria prevalence by each of three measures—peripheral smear, placental smear, and placental histology was 9% (35/391), 11.3% (44/389), and 13.9% (53/382) respectively. Together, smear and histology data yielded an infection rate of 15.5% (59/380) of active infections and 4.5% (17/380) of past infections; hence 20% had been or were infected when giving birth. A crude parity dependency was observed with main burden being concentrated in gravidae 1 through gravidae 3. Twenty-two percent were afflicted by anaemia and 12.2% delivered low birthweight babies. Active placental infection and anaemia showed strong association (OR = 2.8) whereas parity and placental infection had an interactive effect on mean birthweight (P = .036). Primigravidae with active infection and multigravidae with past infection delivered on average lighter babies. Use of bednet protected significantly against infection (OR = 0.56) whilst increased haemoglobin level protected against low birthweight (OR = 0.83) irrespective of infection status. Albeit a high attendance at antenatal clinics (96.8%), there was a poor coverage of insecticide-treated nets (32%) and intermittent preventive antimalarial treatment (41.5%).

Diagnostic ultrasound patterns of parotid glands in human immunodeficiency virus-positive patients in Mulago, Uganda

Abstract: Objectives: The purpose of this study was to determine sonographically, in parotid glands of human immunodeficiency virus-positive patients, the condition of glands with or without enlargement, and propose a classification system for the patterns observed using diagnostic ultrasound imaging. Methods: In this prospective clinical study, ultrasound scans were performed on 200 patients aged 4–62 years at Mulago Hospital, Uganda. Results: There were four main distinct ultrasound pathological patterns in the parotids, i.e. lymphocytic aggregations (LAs), lymphoepithelial cysts (LECs), fatty infiltration (FI) and lymphadenopathy only. There were additional subdivisions depending on the presence of echogenic foci and intraparotid lymphadenopathy. Of those patients (n = 64) without parotid enlargement, only 8% showed normal ultrasound features, whereas 34% showed LECs and 31% showed LAs. Of those (n = 136) with parotid enlargement, 46% showed LECs, 23% showed FI and 15% showed LAs. The overall prevalence of LECs ...

Injection-induced sciatic nerve injury in Ugandan children.

Abstract: In developing countries, sciatic nerve injury following gluteal intramuscular injection is a persistent problem. A study over 6 months involving 133 children seen in Mulago hospital with acute flaccid paralysis revealed 124 (93%) children with injection-induced sciatic nerve injury. The identity of the drug in 79 cases (59.4%) was quinine. It is recommended that the gluteal region should not be used as an intramuscular injection site in children.

Incidence of clubfoot in Uganda.

Abstract: Background: While the congenital clubfoot deformity is a common deformity recorded in Uganda, the incidence of the condition had never been accurately determined. The objective of this study was to measure the overall incidence of congenital clubfoot deformity in a representative sample of births. Methods: A study of all babies born with foot anomalies took place from March 2006 to October 2007. The study was based at 8 Regional Hospitals with active maternity units and a functioning clubfoot clinic. All babies with foot deformities at birth at any of eight centres as detected by the delivery room staff were referred to the respective centre’s clubfoot clinic. The children were examined by clubfoot clinic orthopedic officers who diagnosed the specific deformity. Children referred to the clinic from any source and born at the maternity unit were included in the study. The denominator was all live births at the centre during the study period. Results: The total number of live births during the study period was 110,336. The maternity units of the centres identified 290 infants with a foot deformity. One hundred and thirty infants born during the study period were diagnosed in the clubfoot clinic as having a congenital clubfoot deformity. The proportion of infants with a clubfoot deformity was 1.2 per 1000 births over the 20-month period. The male to female ratio was 2.4:1. Recommendation: The rate of clubfoot deformities in the newborn can be used to estimate the numbers of children who should be treated and to estimate resource needs for the identification and management of this treatable congenital malformation. By comparing the number of those treated with the expected number of cases, the numbers of children with neglected clubfoot can be calculated. Key words: Clubfoot; incidence; gender ratio

Mycobacterium tuberculosis Microbiologic and Clinical Treatment Outcomes in a Randomized Trial of Immediate versus CD4+-Initiated Antiretroviral Therapy in HIV-Infected Adults with a High CD4+ Cell Count

Abstract: In a prospective randomized, controlled trial of ART during TB treatment versus TB treatment alone in Ugandan patients with CD4 >350 cells/μL, ART did not accelerate microbiologic, radiographic or clinical responses to TB therapy. 18% of participants had positive sputum smears after 5 months of TB therapy despite negative cultures.

Plasma levels of DDE/DDT and liver function in malaria control personnel 6 months after indoor residual spraying with DDT in northern Uganda, 2008

Abstract: Objective . We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS). Method . This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrations of amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) were analysed using routine clinical chemistryautomated methods (Konelab, Vantaa, Finland). Results . All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (±26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) ig/l. Conclusion . Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available.

Pharmacokinetics of lamivudine, abacavir and zidovudine administered twice daily as syrups versus scored tablets in HIV-1-infected Ugandan children

Abstract: 7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Contiguous bifacet cervical fracture dislocations

Abstract: Bifacet dislocations of the cervical spine are severe debilitating injuries often associated with complete cord injury. Contiguous bilateral facet dislocations are extremely rare and, to the best of our knowledge, have only been described once before. We present a patient who was involved in a road traffic accident. Pre-operative radiographs suggested contiguous bifacet injury and this was confirmed intra-operatively. This should alert physicians to the possibility of contiguous injuries to the cervical spine. Introduction Bifacet dislocation of the cervical spine is associated with a complete cord injury in up to 85% of injuries with the majority of the other patients suffering some form of neurological compromise. During dislocation, the inferior articular facets of the upper vertebra separate and displace anteriorly while rotating primarily in flexion, relative to the superior facets of the lower vertebra and become locked in the intervertebral foramina. At the time of the dislocation, dynamic spinal-canal narrowing occurs, producing cord compression and complete or incomplete cord lesions. At the dislocated spinal level, the spinal cord is dynamically compressed between the anterior edge of the neural arch of the upper vertebra and the posterosuperior corner of the lower vertebral body. These injuries are hence quite debilitating. We describe a contiguous bifacet dislocation of the C4/5 and C5/6 regions. This is rare and, to our knowledge, has only been described once before. Case report A 23-year-old man was admitted to the emergency ward after being involved in a road traffic crash. He was a motorcycle (bodaboda) rider who fell off his motorcycle after being knocked from behind by a speeding motor vehicle. He immediately had neck pain and an inability to move all four limbs. Initial assessment on admission to the Accident and Emergency Ward revealed a Glasgow Coma Scale of 15, and quadriplegia with a sensory level of T4. The patient was transferred to the spine unit after resuscitation and initial imaging of the spine. SAOJ Spring 2010 8/5/10 4:24 PM Page 83