Showing papers by "Mulago Hospital published in 2011"

Surgical Capacity Building in Uganda Through Twinning, Technology, and Training Camps

Abstract: Neurosurgical capacity is extremely deficient in East African countries where 27 neurosurgeons serve more than 250 million people. To build capacity, the Duke University Medical Center and New Mulago Hospital in Uganda applied a two-pronged twinning approach that placed usable surplus equipment in a developing country’s National Hospital, combined with dedicated comprehensive surgical training camps. Neurosurgery, anesthesiology, nursing, and clinical engineering personnel supported three training camps. More than 21 tons of essential equipment was delivered to New Mulago Hospital in Uganda. Data was collected during the 2-year period preceding and following the initiation of the program. During the 2 years after the program began, neurosurgery demonstrated a significant increase (180%) in the number and complexity of cases performed (p 0.1), but there was a dramatic increase in the overall number of procedures performed by all surgical specialties (106%, p < 0.0001). Through a twinning program combining delivery of surplus equipment and training camps, capacity building was accomplished and maintained. The program not only built overall surgical capacity, it improved the efficiency and increased the complexity of operative cases performed at the National Hospital in Uganda. This program could serve as a model for twinning, capacity building, and training in other developing countries where surgical disparities are among the greatest.

Quality assurance of qualitative research: a review of the discourse

Abstract: Increasing demand for qualitative research within global health has emerged alongside increasing demand for demonstration of quality of research, in line with the evidence-based model of medicine. In quantitative health sciences research, in particular clinical trials, there exist clear and widely-recognised guidelines for conducting quality assurance of research. However, no comparable guidelines exist for qualitative research and although there are long-standing debates on what constitutes 'quality' in qualitative research, the concept of 'quality assurance' has not been explored widely. In acknowledgement of this gap, we sought to review discourses around quality assurance of qualitative research, as a first step towards developing guidance. A range of databases, journals and grey literature sources were searched, and papers were included if they explicitly addressed quality assurance within a qualitative paradigm. A meta-narrative approach was used to review and synthesise the literature. Among the 37 papers included in the review, two dominant narratives were interpreted from the literature, reflecting contrasting approaches to quality assurance. The first focuses on demonstrating quality within research outputs; the second focuses on principles for quality practice throughout the research process. The second narrative appears to offer an approach to quality assurance that befits the values of qualitative research, emphasising the need to consider quality throughout the research process. The paper identifies the strengths of the approaches represented in each narrative and recommend these are brought together in the development of a flexible framework to help qualitative researchers to define, apply and demonstrate principles of quality in their research.

Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study.

Abstract: Background Each year, 10%–20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated. Methods and Findings From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12–33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10–5.22), HIV infection (2.16; 1.01–4.61), age (aOR for 10-year increase 1.59; 1.13–2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04–1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0–53.4) and HIV-uninfected (14.7; 4.1–52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0–18.8) and Karnofsky score <70 (2.1; 1.1–4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1–10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0–3.5). Conclusions The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients. Please see later in the article for the Editors' Summary

Femoral Fracture Fixation in Developing Countries: An Evaluation of the Surgical Implant Generation Network (SIGN) Intramedullary Nail

Abstract: Background: The Surgical Implant Generation Network (SIGN) intramedullary nailing system was designed to treat femoral fractures in developing countries where real-time imaging, power equipment, and fracture tables are often not available. We performed a retrospective analysis of prospectively collected data on femoral shaft fractures treated with the SIGN intramedullary nailing system. Methods: Seventy consecutive patients with a closed diaphyseal femoral fracture were treated with the SIGN intramedullary nail at Mulago National Hospital in Uganda between February 2007 and March 2008, and fifty of these patients (the study cohort) were followed for at least six months or until fracture-healing. Results: The mean time to surgery was 13.2 days (range, zero to thirty-three days). All fractures healed, although two required dynamization for treatment of delayed union. No hardware failures occurred. An interlocking screw missed the nail in two patients, but both fractures healed without complications. One superficial and one deep infection developed; the latter required nail removal after fracture union. Including these patients, complications requiring further treatment occurred in 14% (seven) of the fifty patients. Conclusions: The SIGN intramedullary nailing system promotes predictable healing of femoral fractures in settings with limited resources including lack of real-time imaging, lack of power reaming, and delayed presentation to the operating room. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

S1P is associated with protection in human and experimental cerebral malaria.

Abstract: Cerebral malaria (CM) Is associated with excessive Inflammatory responses and endothelial activation. Sphingosine 1-phosphate (S1P) is a signaling sphingolipid implicated in regulating vascular integrity, inflammation and T-cell migration. We hypothesized that altered S1P signaling during malaria contributes to endothelial activation and inflammation, and show that plasma S1P levels were decreased in Ugandan children with CM compared with children with uncomplicated malaria. Using the Plasmodium berghei ANKA (PbA) model of experimental CM (ECM), we demonstrate that humanized S1P lyase (hS1PL)−/− mice with reduced S1P lyase activity (resulting in increased bio-available S1P) had improved survival compared with wild-type littermates. Prophylactic and therapeutic treatment of infected mice with compounds that modulate the S1P pathway and are in human trials for other conditions (FTY720 or LX2931) significantly improved survival in ECM. FTY720 treatment improved vascular integrity as indicated by reduced levels of soluble intercellular adhesion molecule (sICAM), increased angiopoietin 1 (Ang1) (regulator of endothelial quiescence) levels, and decreased Evans blue dye leakage into brain parenchyma. Furthermore, treatment with FTY720 decreased IFNγ levels in plasma as well as CD4+ and CD8+ T-cell infiltration into the brain. Finally, when administered during infection in combination with artesunate, FTY720 treatment resulted in increased survival to ECM. These findings implicate dysregulation of the S1P pathway in the pathogenesis of human and murine CM and suggest a novel therapeutic strategy to improve clinical outcome in severe malaria.

Heterogeneities and Consequences of Plasmodium Species and Hookworm Coinfection: A Population Based Study in Uganda

Abstract: Approximately 21% of the world's population is exposed to stable malaria due to Plasmodium falciparum [1], and an estimated 740 million individuals are infected with hookworms (Necator americanus and Ancylostoma duodenale) [2] A common complication of P falciparum malaria is anemia, particularly among children and pregnant women [3–5], whereas hookworm infection results in intestinal blood loss and is probably second only to malaria as an infectious cause of anemia [6] The widespread occurrence and congruent spatial extents of Plasmodium species and hookworm infections make coinfection common, especially in sub-Saharan Africa: for example, an estimated 45 million school-aged children are at risk of coinfection [7] Despite this ubiquity of coinfection and its potential consequences for public health, we know little about epidemiology of malaria-hookworm coinfection Previous studies have suggested that infection with 1 species may exacerbate infection and disease related to the other [8, 9] Furthermore, the distinct mechanisms by which Plasmodium species and hookworm infections cause anemia may enhance the risk of anemia and iron deficiency among individuals harboring both species [10–12] If shown to be correct, these interactions have considerable implications for parasite control in the tropics Yet there are few detailed epidemiological studies specifically addressing malaria-hookworm coinfection [13, 14], with most existing studies of malaria-helminth coinfection typically focusing on concomitant infection with Schistosoma species and other soil-transmitted helminths [15–18] These studies have been either retrospective analyses of previously collected data, clinic based, or conducted among specific subgroups, and consequently they are subject to potential bias and confounding due to individual, household, and geographic factors These features make the contradictory findings of negative, positive, and no associations reported in the literature difficult to interpret [19–21] Recent studies in Ghana and Uganda do, however, suggest that among pregnant women coinfection with malaria and hookworm occurs more frequently than would be expected by chance after accounting for demographic and socioeconomic characteristics [13, 14] We report results from a purposively designed, age-stratified study of the epidemiology of Plasmodium-hookworm coinfection in Uganda The study aims to determine the patterns, risk factors, and hematological consequences of coinfection in a rural community where malaria and hookworm are endemic We place emphasis on differences by age group and residential location, using a hierarchical, spatially explicit modeling approach

Mortality in an antiretroviral therapy programme in Jinja, south-east Uganda: a prospective cohort study

Abstract: There have been few reports of long-term survival of HIV-infected patients on antiretroviral therapy (ART) in Africa managed under near normal health service conditions. Participants starting ART between February 2005 and December 2006 in The AIDS Support (TASO) clinic in Jinja, Uganda, were enrolled into a cluster-randomised trial of home versus facility-based care and followed up to January 2009. The trial was integrated into normal service delivery with patients managed by TASO staff according to national guidelines. Rates of survival, virological failure, hospital admissions and CD4 count over time were similar between the two arms. Data for the present analysis were analysed using Cox regression analyses. 1453 subjects were enrolled with baseline median count of 108 cells/μl. Over time, 119 (8%) withdrew and 34 (2%) were lost to follow-up. 197/1453 (14%) died. Mortality rates (95% CI) per 100 person-years were 11.8 (10.1, 13.8) deaths in the first year and 2.4 (1.8, 3.2) deaths thereafter. The one, two and three year survival probabilities (95% CI) were 0.89 (0.87 - 0.91), 0.86 (0.84 - 0.88) and 0.85 (0.83 - 0.87) respectively. Low baseline CD4 count, low body weight, advanced clinical condition (WHO stages III and IV), not being on cotrimoxazole prophylaxis and male gender were associated independently with increased mortality. Tuberculosis, cryptococcal meningitis and diarrhoeal disease were estimated to be major causes of death. Practical and affordable interventions are needed to enable earlier initiation of ART and to reduce mortality risk among those who present late for treatment with advanced disease.

Oral Manifestations in HIV/AIDS-Infected Children.

Abstract: OBJECTIVES To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala. METHODS This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications. RESULTS About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per μl of blood. CONCLUSIONS The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions.

Autopsy acceptance rate and reasons for decline in Mulago Hospital, Kampala, Uganda.

Abstract: OBJECTIVE To determine the autopsy acceptance rate and reasons for decline at Mulago Hospital, Kampala, Uganda. METHODS The next of kin of patients who died in a combined infectious diseases and gastro-enterology ward of Mulago Hospital were approached to answer a questionnaire concerning characteristics of their deceased relative. During the interview their consent was asked to perform a complete autopsy. If autopsy was declined, the next of kin were asked to provide their reason for the decline. RESULTS Permission to perform an autopsy was requested in 158 (54%) of the 290 deaths that occurred during the study period. In 60 (38%) cases autopsy was accepted. Fifty-nine autopsies were performed. For 82% of refusals a reason was listed; mainly 'not wanting to delay the burial' (58%), 'no use to know the cause of death' (16%) and 'being satisfied with the clinical cause of death' (10%). CONCLUSION The autopsy rate achieved under study conditions was 38% compared to rates of 5% in Mulago Hospital over the past decade. Timely request and rapid performance of autopsies appear to be important determinants of autopsy acceptance. A motivated team of pathologists and clinicians is required to increase autopsy acceptance.

Selenium Deficiency a Factor in Endemic Goiter Persistence in Sub-Saharan Africa

Abstract: Goiter is still common in Uganda, despite the present iodized salt coverage of at least 95% Where there is endemic goiter after adequate iodine supplementation, selenium deficiency could be a factor for the continued occurrence of goiter The objectives of the present study, therefore, were to determine the serum selenium levels among goitrous patients and nongoitrous controls and to determine the association between goiter and selenium levels among these patients The investigation was designed as a case control study in which 92 subjects were enrolled, 46 cases and 46 controls of similar age and sex distribution Subjects were interviewed and examined Blood samples were taken and selenium concentrations were determined by electrothermal atomic absorption spectrometry The overall mean serum selenium levels were 7725 μg/l (SD 1678) for the goiter patients and 9550 μg/l (2447) for the nongoiter controls The difference between goitrous and nongoitrous populations was statistically significant (p = 00001) Selenium levels above 1028 μg/l had a statistically significant protective effect against goiter with adjusted odds ratio 03 (013–069); p = 0005 Other factors, such as age, main food constituent, and use of iodized salt, had no association with goiter There were significant differences between selenium levels among goitrous patients and nongoitrous controls High selenium levels seem to have a protective effect against goiter Selenium supplementation as a preventive strategy is worth further exploration

Knowledge and Antibiotics Prescription Pattern among Ugandan Oral Health Care Providers: A Cross-sectional Survey.

Abstract: Background and aims. Irrational prescription of antibiotics by clinicians might lead to drug resistance. Clinicians do prescribe antibiotics for either prophylactic or therapeutic reasons. The decision of when and what to prescribe leaves room for misuse and therefore it is imperative to continuously monitor knowledge and pattern of prescription. The aim of the pre- sent study was to determine the knowledge of antibiotic use and the prescription pattern among dental health care practitio- ners in Uganda. Materials and methods. A structured and pretested questionnaire was sent to 350 dental health care practitioners by post or physical delivery. All the questionnaires were sent with self-addressed and prepaid postage envelopes to enable re- spondents to mail back the filled questionnaires. Chi-squared test was used to test for any significant differences between groups of respondents based on qualitative variables. Results. The response rate was 40.3% (n=140). Of these 52.9 % were public health dental officers (PHDOs) and 47.1% were dental surgeons. The males constituted 74.3% of the respondents. There were statistically significant differences be- tween dental surgeons and (PHDOs) in knowledge on prophylactic antibiotic use (P = 0.001) and patient influence on pre- scription (P = 0.001). Amoxicillin, in combination with metronidazole, was the most common combination of antibiotics used followed by co-trimoxazole with metronidazole. Conclusion. The knowledge of dental health care practitioners in antibiotic use in this study was generally low. A combi- nation of amoxicillin with metronidazole was the most commonly prescribed antibiotics subsequent to different dental pro- cedures.

Antibiotic use knowledge and behaviour at a Ugandan University

Abstract: the study evaluated knowledge, attitude and behaviour of antibiotic usage in two student groups at Makerere University in Uganda. Out of 30,000 students enrolled at the university, 1000 were asked to participate by filling a self administered questionnaire. The sampling group was divided into Group A which included students from the College of health sciences and group B made of students of other faculties. the response rate was 72.1% and 58.8% were male. the sample size distribution didn’t differ from the university gender distribution Z=1.57, p< 0.05. the use of antibiotics to avoid illness was reported by 24.0% in group A and 31.8% in group B (P<0.05). When asked the course of action if they felt the antibiotic being used was not helpful, 35.1% in group A and 50.6% in B said they would go back to the same health care worker for advice while 1.4% and 9.9% respectively would switch health care provider. Up to 69.3% of the respondents reported antibiotics use in the last twelve month. the most common symptoms reported as the primary reason for antibiotic use was cough at 16%, followed by sore throat at 7.1% and common cold at 6.1%. the high reliance on health care personnel for prescription was rather encouraging and it gives health workers a window of opportunity to promote rational antibiotic use when prescribing to patients. However, for this to materialize the health workers must be aware of antibiotic resistance and ways to combat it. therefore constant training and encouragement must be given to the health care workers and the public.

The new female condom (FC2) in Uganda: perceptions and experiences of users and their sexual partners.

Abstract: The new version of the female condom (FC2) was introduced in Uganda in October 2009, following an unsuccessful female condom programme begun in 1998. The failure of the earlier programme was partly attributed to low acceptance of the first type of female condom (FC1). We evaluated the acceptability of FC2 and the experiences of users and their sexual partners. This was a qualitative cross-sectional evaluation. We conducted 16 in-depth interviews with FC2 users (8 women and 8 male partners). We also conducted eight focus group discussions with women who used FC2, and 22 key informant interviews with service providers. All the female users appreciated FC2 as a tool to empower them to avoid sexually transmitted infections (STIs) and unwanted pregnancies. They liked FC2 because it has no smell, is not noisy, and does not rupture easily. The men also liked FC2 because of its soft texture and lubrication. Some women found FC2 insertion cumbersome, while others feared that it would slip in on itself during sex. Concurrent use of male condoms with FC2 and the reuse of FC2 were also mentioned. Providers reported a high demand for FC2; their main challenges were inadequate supplies and distribution mechanisms. This evaluation shows generally high acceptance of FC2. The experiences of users and their partners were largely positive, although some fears and incorrect practices arose. FC2 should be added to the existing HIV/STI-prevention and family-planning options in Uganda and other countries, with sufficient training and support to ensure correct use.

Feasibility of magnetic bead technology for concentration of mycobacteria in sputum prior to fluorescence microscopy

Abstract: Direct sputum smear microscopy is the mainstay of TB diagnosis in most low and middle income countries, and is highly specific for Mycobacterium tuberculosis in such settings. However it is limited by low sensitivity, particularly in HIV co-infected patients. Concentration by centrifugation has been reported to be more sensitive than direct smear preparation, but is only suitable for referral laboratories. Simpler concentration methods that could be applied in peripheral laboratories are urgently needed. We evaluated the feasibility of an early prototype ligand-coated magnetic bead technology to concentrate M. tuberculosis prior to detection by LED-based fluorescence microscopy compared with direct Ziehl-Neelsen microscopy and direct and concentrated fluorescence microscopy in a reference laboratory in Kampala, Uganda. Results were compared with MGIT 960 liquid culture and Lowenstein-Jensen culture. Compared to culture, concentrated FM had significantly higher sensitivity than direct ZN (74.8% and 51.4%), magnetic bead-FM (65.4%) and direct FM (58.9%). The sensitivity of magnetic bead FM was significantly higher than direct ZN (p < 0.001) but not significantly higher than direct FM (p = 0.210). The specificity of magnetic bead FM and concentrated FM was significantly lower than direct ZN (88.6%, 94.3% and 98.9% respectively) and direct FM (99.4%). There was no significant difference in specificity between magnetic bead FM and concentrated FM. Allowing for blinded resolution of discrepant results, the specificity of magnetic bead FM increased to 93.1%. Direct microscopy was simpler than concentrated FM and Magnetic bead FM which both had a similar number of steps. The sensitivity of the early prototype magnetic bead FM was lower than concentrated FM, similar to direct FM, and significantly higher than direct ZN. Both magnetic bead and concentration by centrifugation led to reduced specificity compared with the direct smear methods. Some magnetic bead FM false positive results were not easily explained and should be further investigated. The prototype version of the magnetic bead procedure tested here was of similar complexity to concentration by centrifugation. As such, if the sensitivity of the magnetic bead FM could be improved in future versions of the technology, this may offer a viable alternative to centrifugation.

Cardiac Conduction Safety during Coadministration of Artemether-Lumefantrine and Lopinavir/Ritonavir in HIV-Infected Ugandan Adults

Abstract: Background. We aimed to assess cardiac conduction safety of coadministration of the CYP3A4 inhibitor lopinavir/ritonavir (LPV/r) and the CYP3A4 substrate artemether-lumefantrine (AL) in HIV-positive Ugandans. Methods. Open-label safety study of HIV-positive adults administered single-dose AL (80/400 mg) alone or with LPV/r (400/100 mg). Cardiac function was monitored using continuous electrocardiograph (ECG). Results. Thirty-two patients were enrolled; 16 taking LPV/r -based ART and 16 ART naive. All took single dose AL. No serious adverse events were observed. ECG parameters in milliseconds remained within normal limits. QTc measurements did not change significantly over 72 hours although were higher in LPV/r arm at 24 (424 versus 406; 𝑃 = . 0 2 ) and 72 hours (424 versus 408; 𝑃 = . 0 0 4 ) after AL intake. Conclusion. Coadministration of single dose of AL with LPV/r was safe; however, safety of six-dose AL regimen with LPV/r should be investigated.

HIV seroprevalence and its effect on outcome of moderate to severe burn injuries: A Ugandan experience

Abstract: HIV infection in a patient with burn injuries complicates the care of both the patient and the treating burn team. This study was conducted to establish the prevalence of HIV among burn patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative. This was a prospective cohort study involving burn injury patients admitted to Mulago Hospital between November 2005 and February 2006. Patients were stratified into HIV positive (exposed) group and HIV-negative (unexposed) group. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 11.5. Of the 130 patients included in the study, 17 (13.1%) patients tested HIV positive and this formed the study (exposed) group. The remaining 113 patients (86.9%) formed the control (unexposed) group. In the HIV positive group, females outnumbered males by a ratio of 1.4:1 and the mean age was 28.4 ± 21.5 years (range 3 months-34 years). 64.7% of HIV positive patients reported to have risk factors for HIV infection. Of these, multiple sexual partners [Odds Ratio 8.44, 95% C.I. (3.87-143.23), P = 0.011] and alcoholism [Odds Ratio 8.34, 95% C.I. (5.76-17.82), P = 0.002] were found to be independently and significantly associated with increased risk to HIV infection. The mean CD4 count for HIV positive and HIV negative patients were 394 ± 328 cells/μL and 912 ± 234 cells/μL respectively which is statistically significant (P = 0.001). There was no difference in the bacteria cultured from the wounds of HIV positive and negative patients (P = 0.322). Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.001). ). Skin grafting was carried out in 35.3% of HIV negative patients and 29.4% of HIV positive patients with no significant difference in skin graft take and the degree of healed burn on discharge was the same (P = 0.324). There was no significant difference in hospital stay between HIV positive and negative patients (P = 0.674). The overall mortality rate was 11.5%. Using multivariate logistic regression analysis, mortality rate was found to be independently and significantly related to the age of the patient, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (p-value < 0.001). HIV infection is prevalent among burn injury patients in our setting and thus presents an occupational hazard to health care workers who care for these patients. All burn health care workers in this region need to practice universal precautions in order to reduce the risk of exposure to HIV infection and post-exposure prophylaxis should be emphasized. The outcome of burn injury in HIV infected patients is dependent upon multiple variables such as age of the patient, inhalation injury and %TBSA and not the HIV status alone.

Erratum to “Malaria Burden in Pregnancy at Mulago National Referral Hospital in Kampala, Uganda”

Abstract: We provide an updated Table 2. The manuscript text has been modified as follows. Method section 2.4, page 3, line 3, (left column): <2500 was changed into ≤2500. Result section 3.1, page 3, line 6-7 (right column): …more literate (0.001),…, used less IPT (<0.0001), was changed into more literate (0.0003),…, used less IPT (0.0002). Discussion, page 8, line 21 (right column): <2500 was changed into ≤2500. Discusson, page 9, line 22–24 (left column): Of note, significantly fewer primigravidae used IPT as compared to multigravidae (Table 2; G1 = 31.6%, G2-3 = 49.3%, ≥G4 = 55.7%) was changed into Of note, significantly fewer primigravidae used IPT as compared to multigravidae (Table 2; G1 = 31.6%, G2-3 = 49.3%, ≥G4 = 55.9%). Page 6, line 24,(headline of Table 5): <2500 was changed into ≤2500. The total number of cases in each gravidity group in Table 2 should be G1 = 196, G2-3 = 142, and ≥G4 = 59. Two cases of G3 were misclassified as G4 giving rise to reduced nr in the G2-3 group and increased nr in the G4 group. The total number of cases as depicted in the first row of the original Table 2 is still correct and should be (G1 = 196, G2-3 = 142, and ≥G4 = 59). The misclassification occurred when a reanalysis of part of Table 2 was performed and the new data was entered in the old table. The headline hence contained the correct total number of cases in each group, but the reanalysed part was based on the misclassified dataset. Since the data was entered as proportions only, the mismatch between the total number of cases in the headline and rest of the table was not detected immediately. In the corrected table, the total number in the G4 group has now decreased by 2 and in the G2-3 increased by 2. In the case of ANC-visit versus gravidity, only one case was shifted between groups as data on the second misclassified case was missing from the start. Of note, the data on placental malaria versus gravidity was not analysed on the same occasion as the other variables in the table and was thus on the correct dataset from the start.

Bioethics training in Uganda: report on research and clinical ethics workshops.

Abstract: This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one “bottom-up” effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience of Ugandan professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries.