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.

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

Abstract: Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths’ wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda’s 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16–24 in Bidi Bidi refugee settlement. We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16–24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16–24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

Maternal, reproductive and obstetric factors associated with preterm births in Mulago Hospital, Kampala, Uganda: a case control study

Abstract: Introduction: Preterm birth, a leading cause of neonatal mortality accounts for 35 percent of all neonatal deaths worldwide. Uganda's high preterm birth rate of 13.6 per 1000 live births ranks 28th in the world. Efforts at reducing these pre-term births must entail interventions that target any associated risk factors. This study therefore aimed at identifying and describing the risk factors for preterm births among mothers delivering in Mulago Hospital. Methods: This was a case control study among postpartum women in Mulago Hospital. Ninety nine women with preterm newborns were recruited as cases and 193 with full term babies were the controls. A semi-structured questionnaire was used to collect data. Data was entered into Epidata version 3.1 and exported to STATA 11 for univariate analysis and multivariate analysis by logistic regression. Results: Risk factors for preterm birth included maternal height less than 1.5 meters (OR 131.08 (20.35-844.02)), rural residence (OR 6.56(2.68-16.10)) and failure to attend antenatal care clinic (OR 8.88(1.44-54.67)). Pregnancy related risk factors included PPROM (OR 287.11(49.26-1673.28)), antepartum haemorrhage (OR 7.33(1.23-43.72)) and preeclampsia/eclampsia (OR 16.24(3.11-84.70)). Conclusion: Preterm birth is more likely to occur in women of short stature, living in rural areas and those who do not attend antenatal care clinic. The preterm birth risk is higher for women who get PPROM, APH and preeclampsia/eclampsia in pregnancy. Early recognition and management of these high risk conditions among pregnant women may lead to a reduction in preterm birth rates. Keywords: Preterm birth, postpartum, risk factors, newborn, Uganda

Acute reversible heart failure in severe iron-deficiency anemia associated with hookworm infestation in Uganda Africans.

Abstract: Severe iron deficiency anemia is a common sequel to the heavy hookworm infestations prevalent in Uganda, and in some hypoxia can be so severe that heart failure supervenes. The clinical manifestations in 15 cases are described. Comment is made on reversible electrocardiographic changes.

Effect of protein deficient cassava diet on Cercopithecus aethiops hearts and its possible role in the aetiology and pathogenesis of endomyocardial fibrosis in man.

Abstract: Despite the current hypotheses for its causation, the exact cause of endmyocardial fibrosis is unknown. However, endomyocardial fibrosis being a disease of the low socio-economic groups who feed on low protein high carbohydrate diets consisting exclusively of cassava in Uganda and the demonstration by the author of a bimodal age distribution among the female patients and monomodal pattern in the male patients, led the author to suspect protein deficiency and cassava as aetiological factors thereby attributing the first mode to the increased but unmet protein needs for childhood growth and the second mode to the increased but unmet protein needs for pregnancies and lactation in the 20-40 year age groups. Consequently a new hypothesis that "prolonged ingestion of tuber (cassava/tapioca) crops associated with extreme deprivation of protein causes EMF" was formulated. In order to verify this hypothesis, three Cercopithecus aethiops were fed on uncooked banana diet while another three were fed on uncooked cassava and hearts harvested for histology whenever the animal health deteriorated. Changes in the endomyocardium included cell vacuolation, interstitial fibrosis and endocardial thickening by the 130th day in the animals on cassava but the animals on bananas were free from such changes. By the 160th day, the former exhibited marked thickening of the endocardium, interstitial fibrosis, fibrous septa formation, pappillary muscle fibrosis as well as apical fibrosis of the left ventricle, which findings occur in the human disease. Calcification and inflammatory cells were absent. A repeat of the experimental feeding with cassava using a batch of five animals, one of which survived up to seven months revealed cardiac findings similar to those seen at 160 days. Thus, the pathogenetic process, hitherto obscure, begins with cardiac cell necrosis followed by fibrosis consequent upon the failure of cardiac cell repair due to protein deficiency caused by the protein free cassava diets since the animals on bananas, which also lacked protein did not develop similar changes. The low plasma amino acid profiles in EMF prone subjects, the poor blood supply and the great apical mechanical stress are incriminated for the severe apical lesions. This study shows that the disease can be experimentally induced in the monkey thereby validating the postulated hypothesis.

Blood glucose, lactate and pyruvate in kwashiorkor.

Abstract: 1. The blood sugar, lactate and pyruvate levels of sixty-nine Ugandan children, during treatment for kwashiorkor, have been studied. 2. The majority of untreated cases had low levels of blood glucose but high levels of lactate and pyruvate. Children with the lowest glucose levels had the lowest serum protein values and gained weight more slowly. 3. The response of the blood glucose to glucagon or adrenaline was twice as great at the end of treatment as at the beginning. 4. In children whose treatment was successful the lactate and pyruvate levels gradually fell to the normal range. There was a rise in the blood glucose value but after 3 weeks the level was still below that found in normal African children. In a few children who died or whose treatment was complicated by pyrexia and general apathy there was a rapid fall in lactate and pyruvate concentration to abnormally low levels.