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.

The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda

Abstract: Objective To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention.

A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods

Abstract: Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews. A significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013). The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.

The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda.

Abstract: At Mulago Hospital in Kampala Uganda 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of STD during the preceding 5 years were more likely to be HIV infected (43%) than those without such a history (26% OR 2.08 95% CI 1.17 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in males and females (OR 2.21 95% CI 1.08 4.53 and OR 8.54 95% CI 1.45 87.55 respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50% vs 28% p<0.05) but once controlled for STDS this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding in the presence of no association between other STD syndromes and HIV infection suggest that genital ulcers may be truly associated with HIV infection rather than just be a marker of high-risk activities. (authors)

Provider-initiated HIV testing for paediatric inpatients and their caretakers is feasible and acceptable.

Abstract: Summary objectives Early diagnosis of HIV-infected children remains a major challenge in Africa. Children who are hospitalised represent an opportunity for HIV diagnosis and appropriate treatment. We introduced HIV Counselling and Testing (HCT) for hospitalised children and their caretakers in Mulago teaching hospital in Uganda to assess its feasibility. methods We analysed routine program data for children and caretakers who were tested between February 2005 and February 2008 to assess the proportion of children and caretakers who were HIVinfected. We also assessed the level of immune suppression (CD4 percentage) in a subset of HIV infected children tested between January 2007 and December 2007. results Caretakers agreed to HIV testing for 8990 (92.8%) of the 9687 children who were offered HIV testing. Among the caretakers, 89.8% agreed to be tested. At the time of hospitalization, 41.3% of the caretakers had previously tested for HIV. Although 313 parents (mothers and fathers) reported that they had previously tested HIV positive, only 113 (36.3%) of these had tested their children prior to hospitalization. Overall HIV prevalence among caretakers was 16.7%. HIV prevalence among children was 12.4%, highest on the nutrition ward (30.8%). Of those children who underwent CD4 counts, 56.4% had a CD4 percentage of <20%. conclusion HCT for hospitalized children and their caretakers identified a significant number of HIV infected children and caretakers. More than half of the children had advanced HIV disease. More intensive efforts are needed to ensure earlier diagnosis and linkage to care for HIV infected children.