Mulago Hospital

About: Mulago Hospital is a healthcare organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Health care. The organization has 542 authors who have published 545 publications receiving 34804 citations.

Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial.

Abstract: Introduction Stroke burden is rapidly increasing globally. Modifiable risk factors offer an opportunity to intervene, and targeting hypertension is a key actionable target for stroke risk reduction in sub-Saharan Africa. This 3-site planned randomized controlled trial builds on promising preliminary data. Methods A total of 246 Ugandan adults will be recruited randomized to experimental intervention vs. enhanced treatment control. Intervention participants will receive six weekly group-format stroke risk reduction self-management training sessions, and the controls will receive information on cardiovascular risk. The primary study outcome is systolic B.P. measured at baseline, 13-week, 24 weeks (6 months). Secondary outcomes include other biological and behavioral stroke risk factors. Discussion The curriculum-guided self-management TargetEd MAnageMent Intervention (TEAM) program is anticipated to reduce the stroke burden in Uganda. Trial registration ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.

Assessment of the impact of the new paediatric surgery unit and the COSECSA training programme at Mbarara Hospital, Uganda

Abstract: Background: This study aimed to assess the impact of a new pediatric surgical unit (PSU) established upcountry in a unique way in a government hospital with a non-governmental organization as the main stakeholder. The unit is run by one pediatric surgeon trained through COSECSA. It is the second PSU in the country. This PSU brought pediatric surgical services and training closer to the Mbarara community. Methods: The study was conducted at Mbarara regional referral hospital (MRRH). It was a cross-sectional mixed design study. For the qualitative arm, Key Informant interviews were done with the main stakeholders who established the PSU. Impact on training was assessed using a questionnaire to former postgraduate trainees (Alumni). Quantitative arm assessed number of surgeries by a historical audit of hospital operating room registers comparing volume of surgeries before and after the establishment of the unit. Results: Six main stakeholders were interviewed and confirmed that collaborations between the Government and private partners are feasible and sustainable. The number of pediatric surgeries nearly tripled after the establishment of the pediatric surgical department. Patients no longer had to travel to the capital city to access services. A total 2,732 pediatric surgical operations were performed within the 8 years of our evaluation. Of these, 736 (26∙9%) was performed four years before the unit was established and 1,996 (73∙1%) were performed after PSU establishment. Overall, alumni that rotated in Mbarara had higher ratings than those in Mulago PSU on all aspects of the rotation, that is teaching, theatre hand-on-experience, mentorship, and skills attained (p=0.0028). Conclusions: The pediatric surgical unit has contributed significantly to patient care and postgraduate medical education in Mbarara. This kind of model is sustainable and can be replicated.

Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living with HIV and Rheumatic Heart Disease in Uganda

Abstract: Background Rheumatic Heart Disease (RHD) affects 41 million people worldwide, mostly in low- and middle-income countries, where it is co-endemic with HIV. HIV is also a chronic inflammatory disorder associated with cardiovascular complications, yet the epidemiology of patients affected by both diseases is poorly understood. Methods Utilizing the Uganda National RHD Registry, we described the echocardiographic findings, clinical characteristics, medication prescription rates, and outcomes of all 73 people carrying concurrent diagnoses of HIV and RHD between 2009 and 2018. These individuals were compared to an age- and sex-matched cohort of 365 subjects with RHD only. Results The median age of the HIV-RHD group was 36 years (IQR 15) and 86% were women. The HIV-RHD cohort had higher rates of prior stroke/transient ischemic attack (12% vs 5%, p=0.02) than the RHD-only group, with this association persisting following multivariable adjustment (OR 3.08, p=0.03). Prevalence of other comorbidities, echocardiographic findings, prophylactic penicillin prescription rates, retention in clinical care, and mortality were similar between the two groups. Conclusions Patients living with RHD and HIV in Uganda are a relatively young, predominantly female group. Although RHD-HIV comorbid individuals have higher rates of stroke, their similar all-cause mortality and RHD care quality metrics (such as retention in care) compared to those with RHD alone suggest rheumatic heart disease defines their clinical outcome more than HIV does. We believe this study to be one of the first reports of the epidemiologic profile and longitudinal outcomes of patients who carry diagnoses of both conditions.

The Use of Lidocaine and Bupivacaine Mix in Adult Safe Male Circumcision: Less Is More

Abstract: Introduction. Lignocaine is (with or without bupivacaine) the only drug recommended for local anesthesia for safe adult male circumcision (SMC). This study evaluated the effectiveness of postoperative pain control when using two different concentrations. Methods. An observational analytical study conducted at an urban high volume site. Pain was assessed using the Visual Analogue Scale. Mixtures of lignocaine 2%, bupivacaine 0.5% (LiB), and water in ratios of 4 : 4 : 2 and 3 : 3 : 4 were compared. Results. Data from 217 clients were analyzed: 100 in the 4 : 4 : 2 group and 117 in the 3 : 3 : 4 group. Clients in the 4 : 4 : 2 group had more pain, at 60 minutes, compared to the 3 : 3 : 4 group ( ). The 3 : 3 : 4 mix used 70% less lignocaine and 90% less bupivacaine (60 mg and 15 mg); the allowable maximum dosages are 200 mg and 150 mg, respectively. Conclusion. The 3 : 3 : 4 mix was superior to the 4 : 4 : 2 mix. This has implications for supply chain management and potential reduction of LA toxicity. We therefore recommend the 3 : 3 : 4 mix for routine adult SMC.