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.

Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit.

Abstract: Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p < 0.001 and 21.7 % vs. 50.5 %; P < 0.001 respectively after the second audit. There was no improvement in vital sign monitoring, delivery within two hours or blood grouping and cross matching. There was a decline in bladder catheterization (94 % vs. 68.9 %; p < 0.001. The overall mean care score in the first and second audits was 55.1 and 48.2 % respectively, p = 0.19. Healthcare factors (negative attitude, low numbers, poor team work, low motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

Pathogenic Variants in Cancer Predisposition Genes and Prostate Cancer Risk in Men of African Ancestry.

Abstract: PURPOSEIn studies of men of European ancestry, rare pathogenic variants in DNA repair pathway genes have been shown to be associated with risk of aggressive prostate cancer. The contribution of rar...

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

The Prevalence and Clinical Course of HIV-Associated Pulmonary Cryptococcosis in Uganda

Abstract: Background: The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well described. Methods: Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough ≥2 weeks were enrolled. Patients with negative sputum smears for acid-fast bacilli were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and fungi. Patients were followed 2 and 6 months after hospital discharge. Results: Of 407 patients enrolled, 132 (32%) underwent bronchoscopy. Of 132 BAL fungal cultures, 15 (11 %) grew Cryptococcus neoformans. None of the patients were suspected to have pulmonary cryptococcosis on admission. The median CD4 count among those with pulmonary cryptococcosis was 23 cells per microliter (interquartile range = 7―51). Of 13 patients who completed 6-month follow-up, 4 died and 9 were improved, including 5 who had started antiretroviral therapy but had not received antifungal medication. Conclusions: Pulmonary cryptococcosis is common in HIV-infected tuberculosis suspects in Uganda. Early initiation of antiretroviral therapy in those with isolated pulmonary infection may improve outcomes, even without antifungal therapy. This finding suggests that some HIV-infected patients with C. neoformans isolated from respiratory samples may have colonization or localized infection.