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.

Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study.

Abstract: Introduction Providing optimal critical care in developing countries is limited by lack of recognition of critical illness and lack of essential resources. The Modified Early Warning Score (MEWS), based on physiological parameters, is validated in adult medical and surgical patients as a predictor of mortality. The objective of this study performed in Uganda was to determine the prevalence of critical illness on the wards as defined by the MEWS, to evaluate the MEWS as a predictor of death, and to describe additional risk factors for mortality. Methods We conducted a prospective observational study at Mulago National Referral Teaching Hospital in Uganda. We included medical and surgical ward patients over 18 years old, excluding patients discharged the day of enrolment, obstetrical patients, and patients who self-discharged prior to study completion. Over a 72-hour study period, we collected demographic and vital signs, and calculated MEWS; at 7-days we measured outcomes. Patients discharged prior to 7 days were assumed to be alive at study completion. Descriptive and inferential statistical analyses were performed. Results Of 452 patients, the median age was 40.5 (IQR 29-54) years, 53.3% were male, 24.3% were HIV positive, and 45.1% had medical diagnoses. MEWS ranged from 0 to 9, with higher scores representing hemodynamic instability. The median MEWS was 2 [IQR 1-3] and the median length of hospital stay was 9 days [IQR 4-24]. In-hospital mortality at 7-days was 5.5%; 41.4% of patients were discharged and 53.1% remained on the ward. Mortality was independently associated with medical admission (OR: 7.17; 95% CI: 2.064-24.930; p = 0.002) and the MEWS ≥ 5 (OR: 5.82; 95% CI: 2.420-13.987; p Conclusion There is a significant burden of critical illness at Mulago Hospital, Uganda. Implementation of the MEWS could provide a useful triage tool to identify patients at greatest risk of death. Future research should include refinement of MEWS for low-resource settings, and development of appropriate interventions for patients identified to be at high risk of death based on early warning scores.

Distribution of the sickle-cell trait in Uganda, and its ethnological significance.

Abstract: IT has been known since 1910 that the red blood corpuscles of some Negroes assume a peculiar sickle shape when deprived of oxygen. The condition is hereditary, transmitted on Mendelian lines, and is estimated to affect some 7·5 per cent of North American Negroes1. In the majority of those affected no disability is present ; but a small proportion is alleged to develop a chronic haemolytic anaemia, and it is this aspect, rather than the inherited abnormality itself, that has claimed the attention of most medical writers on the subject. Although our interest was primarily medical, some of our findings appear to have a bearing on anthropology, and are therefore presented here.

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.

Rate and amplification of drug resistance among previously-treated patients with tuberculosis in Kampala, Uganda.

Abstract: Drug-resistant Mycobacterium tuberculosis has emerged as a major global public health threat. Resistant strains have been identified in most countries [1]. For decades, tuberculosis (TB) control programs have focused their efforts on patients with newly diagnosed TB, who are responsible for most of the disease burden. However, compared with patients with new TB cases, patients presenting with TB who have a history of treatment experience poorer treatment outcomes and have increased mortality and higher rates of drug resistance [2]. Importantly, multidrug-resistant (MDR) TB, defined as resistance to at least rifampicin and isoniazid, occurs 5–10-fold more frequently among patients who previously received treatment for TB than among patients with new TB [1]. Recently, extensively drug-resistant TB has also emerged as a global concern [3, 4]. The growing worldwide threat of TB drug resistance has prompted the World Health Organization (WHO) to call on national TB control programs to address the problem [5]. Drug resistance develops primarily through the selection of naturally occurring mutations in the presence of inadequate treatment [6]. Once initial resistance has developed, acquisition of resistance to additional drugs is more likely, and treatment with standard regimens may be suboptimal [7, 8]. Previous studies on the acquisition of drug resistance are limited by their retrospective design, a focus on new TB cases, selection bias of the study population, missing or incomplete M. tuberculosis strain genotyping, small sample size, or undue influence by the Beijing strain of M. tuberculosis, which may be associated with increased rates of drug resistance [9-13]. The WHO has classified Uganda as a country with a high burden of TB [14]. Common wisdom has been that MDR TB is infrequent in most of sub-Saharan Africa [15]. However, there currently is little information available regarding drug resistance in Uganda, and drug susceptibility testing is not routinely performed. Previous data on drug resistance among previously treated patients with TB in Uganda are limited to a survey involving only 45 patients [16]. We report here the frequency and factors associated with drug resistance among treatment-experienced patients with TB in Kampala, Uganda, and describe the acquisition of drug resistance in M. tuberculosis in a subset of patients during or after retreatment.

Successful Delivery of RRT in Ebola Virus Disease

Abstract: AKI has been observed in cases of Ebola virus disease. We describe the protocol for the first known successful delivery of RRT with subsequent renal recovery in a patient with Ebola virus disease treated at Emory University Hospital, in Atlanta, Georgia. Providing RRT in Ebola virus disease is complex and requires meticulous attention to safety for the patient, healthcare workers, and the community. We specifically describe measures to decrease the risk of transmission of Ebola virus disease and report pilot data demonstrating no detectable Ebola virus genetic material in the spent RRT effluent waste. This article also proposes clinical practice guidelines for acute RRT in Ebola virus disease.