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.

Genetic risk of prostate cancer in Ugandan men.

Abstract: BACKGROUND Men of African-ancestry have elevated prostate cancer (PCa) incidence and mortality compared to men of other racial groups. There is support for a genetic contribution to this disparity, with evidence of genetic heterogeneity in the underlying risk alleles between populations. Studies of PCa among African men may inform the contribution of genetic risk factors to the elevated disease burden in this population. METHODS We conducted an association study of >100 previously reported PCa risk alleles among 571 incidence cases and 485 controls among Uganda men. Unconditional logistic regression was used to test genetic associations and a polygenic risk score (PRS) was derived to assess the cumulative effect of the known risk alleles in association with PCa risk. In an exploratory analysis, we also tested associations of 17 125 421 genotyped and imputed markers genome-wide in association with PCa risk. RESULTS Of the 111 known risk loci with a frequency >1%, 75 (68%) had effects that were directionally consistent with the initial discovery population,14 (13%) of which were nominally significantly associated with PCa risk at P 4-fold increase in risk. The 8q24 risk region was also found to be a major contributor to PCa risk in Ugandan men, with the African ancestry-specific risk variant rs72725854 estimated to account for 12% of PCa in this population.

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.

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.

Foetal haemoglobin and disease severity in sickle cell anaemia patients in Kampala Uganda

Abstract: Sickle cell anaemia (SCA) is a major chronic health problem in Uganda. In patients with SCA, the level of foetal haemoglobin (HbF) has been found to be important in influencing the clinical course of the disease. Thus populations with high levels of HbF like those in Saudi Arabia have been described as having a milder clinical course with fewer complications as compared to populations with lower levels. Disease modifying drugs can increase the Hb F levels and modify the presentation of SCA. This was a cross sectional study in which we determined foetal haemoglobin levels and examined the relationship between HbF levels and disease severity in SCA patients in Mulago Hospital, Kampala, Uganda. We consecutively enrolled 216 children aged 1 year to 18 years with SCA attending the Sickle Cell Clinic at Mulago Hospital whose guardians had given consent. The history included age at onset of initial symptoms and diagnosis, number of hospitalisations and blood transfusions and other complications of SCA (cardiovascular accidents, avascular hip necrosis and priapism). A detailed physical examination was performed to assess the current state and help describe the disease severity for each patient. Blood samples were drawn for HbF levels. HbF levels ≥10% was defined as high. Of the 216 children, (80) 37% had HbF levels ≥10%. Significant correlations were observed between HbF level and several clinical parameters independent of age including age at diagnosis (p value 0.013), number of hospitalisations (p value 0.024) and transfusions (p value 0.018) since birth. A third of the children with SCA attending the Sickle cell clinic in Mulago Hospital have high HbF levels. Higher HbF level is associated with later onset of symptoms and presentation, and less severe disease characterised by fewer hospitalisations and blood transfusions. We suggest HbF levels should be determined at initial contact for patients with SCA to guide counselling and identify those who may need closer follow up and consideration for disease modifying drugs.

Discovering Voice: A Participatory Action Research Study with Nurses in Uganda:

Abstract: In this article the authors present findings from a qualitative research study carried out with Ugandan nurses from September 2003 until June 2004. They highlight the process and philosophical basis of participatory action research (PAR) by reflecting on the challenges, opportunities, outcomes, and ethical issues encountered during the conduct of the research. In this study PAR fostered a climate in which nurses could engage in collective reflection on their practice, make sense of their experiences, and thereby change their understanding of their work.