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.

Glucose and starch tolerance after recovery from Kwashiorkor

Abstract: Carbohydrate tolerance tests have been performed on 52 African children in Uganda. Thirty-one of the children had been treated for Kwashiorkor 5.2 to 12.2 (mean 8.5) years before, and 21 had no history of severe malnutrition in the past. Intravenous-glucose tolerance (K) was significantly impaired in the children who had had Kwashiorkor. There was a tendency for the tolerance to improve after admission to hospital which was unexpected for the home-diets were all presumed to be rich in carbohydrate; this change was not statistically significant. There was a significant inverse correlation between the individual intravenous-glucose tolerance K values and the blood-glucose rise at 2 1 2 hours after its oral administration. The mean rise at 2 1 2 hours was significantly greater in the children who had had Kwashiorkor than in those who had not. Blood-glucose curves after oral-starch were more often relatively flat in the children who had had Kwashiorkor than the controls. A significant correlation was found between the individual K values and ratios of maximum rise in blood-glucose after oral-starch to that after oral-glucose ( S G ). The interpretation of these results is discussed; it is thought probable that children who have had Kwashiorkor, even if adequately treated, have a higher incidence of pancreatic disease than those who have not. Protein malnutrition may be of importance in the etiology of chronic pancreatic disease in Uganda.

Echocardiographic pattern and severity of valve dysfunction in children with rheumatic heart disease seen at Uganda Heart Institute, Mulago hospital.

Abstract: Background : Rheumatic heart disease (RHD) is the commonest acquired heart disease in children worldwide but in Uganda, data is scarce regarding its morbidity and mortality. The disease has a progressive course and patients usually require valve repair/replacement in the future. Objectives :To describe the frequency of echocardiographic valvular dysfunction in children with RHD. To explore the relationship between the severity of valvular dysfunction by the age and sex of the children with RHD Methods : Echocardiographic findings of children ≤15 years with RHD seen at Uganda Heart Institute from January 2007 to December 2011 were retrospectively analyzed. Results : 376 children had a diagnosis of RHD. The mean age of the children was 11.0±2.7 years and 216 (57.4%) were females. Mitral regurgitation was the commonest lesion seen in 98.9% (severe in 73.1%) of the children. Aortic regurgitation (AR) was found in 51.3% (severe in 7.2%), mitral stenosis (MS) was found in 10.6% (severe in 5.9%), tricuspid regurgitation was found in 86.7% (severe in 8.2%) while aortic stenosis was seen in 1.3% (severe in 0.3%). Severe AR was less common in females (OR=0.32, 95%CI 0.13-0.78) and children with MS were older than those without MS (12.7±2.0 Vs. 10.7±2.7 years, p<0.00). Conclusions : Mitral valve dysfunction was found in almost all the cases of RHD and majority of the children had severe valve disease at the time of their first presentations. Children with MS were predominantly above 10 years and severe AR was more common in males. Keywords : Rheumatic heart disease, Valvular dysfunction

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

Abstract: Persons living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, healthcare providers, and hypertensive PLHIV (n = 83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives and rewards, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy, and planning. The barriers include lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV’s inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN, and inadequate planning for integrated HTN/HIV services. Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability, and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers, and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.