Browsing by Author "Ejalu, David Livingstone"

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Clinical presentation and bacteriology of diabetic foot ulcers at Mulago Hospital: a prospective case series study
(Student's Journal of Health Research (SJHR), 2022-12-11) Aldoa Pario, Justin; Nambuya, Agatha P.; Nakwagalaa, Frederick Nelson; Kamyaa, Moses; Ejalu, David Livingstone
Diabetic foot ulcer is a common cause of mortality among patients admitted to Mulago hospital. Pe-ripheral neuropathy and peripheral arterial disease are the major risk factors for diabetic foot ulceration and the severity of these two conditions may determine treatment options and ulcer outcomes. The study assessed the clinical presentation of foot ulcers in diabetic patients and identified then common bacterial isolates from diabetic foot ulcers and their susceptibility patterns. This was a prospective study involving 60 consecutive patients with diabetic foot ulcers admitted to the endocrinology unit at Mulago hospital between July and December 2010. Patients were recruited after the provision of written informed consent. Deep tissue swabs from the ulcers were then taken at debridement for both aerobic and anaerobic cultures and susceptibility tests using standardmicrobiological methods.Results:Of the 60 patients, 57% had neuroischemic foot ulcers, 18% had neuropathic ulcers, 18% had is-chemic ulcers and 7% had unclassified ulcers. 98.3% of the samples grew 93 aerobic bacteria and noanaerobe was isolated. Polymicrobial infection occurred in 41% of samples of which 10% had mixedgrowth. 80.6% of the isolates were Gram-negative aerobes, mainly E.coli Klebsiella, Pseudomonas, and Proteus while eighteen (19.4%) were Gram-positive, mainly Staphylococcus aureus and Entero-coccus faecalis. The prevalence of MuMultidrug-resistant organisms (MDRO) was 84% and Methicillin-resistant staphylococcus aureus (MRSA) was 60% while Extended-spectrum beta-lactamases (ESBL)was 43.5%. Diabetic foot ulcers were mostly neuroischemic with moderate neuropathy severity. Infection was mostly due to aerobic Gram-negative organisms with a high prevalence of MDRO, ESBL, and MRSA. Most isolates were susceptible to vancomycin, imipenem, and ciprofloxacin. Deep tissue culture and sensitivity tests should be done to make appropriate antibiotic choices for diabetic patients with foot ulcers.
Cost-effectiveness of GeneXpert Omni compared with GeneXpert MTB/Rif for point-of-care diagnosis of tuberculosis in a low-resource, high-burden setting in Eastern Uganda: a cost-effectiveness analysis based on decision analytical modelling
(BMJ, 2022-08-08) Ejalu, David Livingstone; Irioko, Aaron; Kirabo, Rhoda; Mukose, Aggrey David; Ekirapa, Elizabeth; Kagaayi, Joseph
To determine the cost-effectiveness of Xpert Omni compared with Xpert MTB/Rif for point-of-care diagnosis of tuberculosis among presumptive cases in a low-resource, high burden facility. Cost-effectiveness analysis from the provider’s perspective. Setting A low-resource, high tuberculosis burden district in Eastern Uganda. Participants A provider’s perspective was used, and thus, data were collected from experts in the field of tuberculosis diagnosis purposively selected at the local, subnational and national levels. A decision analysis model was contracted from TreeAge comparing Xpert MTB/Rif and Xpert Omni. Cost estimation was done using the ingredients’ approach. Oneway deterministic sensitivity analyses were performed to identify the most influential model parameters. Outcome measure The outcome measure was incremental cost per additional test diagnosed expressed as the incremental cost-effectiveness ratio. The total cost per test for Xpert MTB/Rif was US$14.933. Cartridge and reagent kits contributed to 67% of Xpert MTB/Rif costs. Sample transport costs increased the cost per test of Xpert MTB/Rif by $1.28. The total cost per test for Xpert Omni was $16.153. Cartridge and reagent kits contributed to over 71.2% of Xpert Omni’s cost per test. The incremental costeffectiveness ratio for using Xpert Omni as a replacement for Xpert MTB/Rif was US$30.73 per additional case detected. There was no dominance noted in the cost-effectiveness analysis, meaning no strategy was dominant over the other. The use of Xpert Omni at the point-of-care health facility was more effective but with an increased cost compared with Xpert MTB/Rif at the centralised referral testing facility.
Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study
(BMC Springer Nature, 2023-10-17) Twineamatsiko, Andrew; Mugenyi, Nathan; Kuteesa, Yvonne Nabachwa; Ejalu, David Livingstone
Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middleincome countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical ofcers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. Most of the respondents were females (62.90%), married (84.62%), with certifcate level (55.74%), and nurses as qualifcation (36.60%) as well as attached to Health Center 3 level (61.28%). Signifcant individual factors associated with retention included having a certifcate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staf, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. The study established that indeed several individual and social demographics, health system and careerrelated factors are signifcantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.
Factors influencing the prevalence of anaemia among Pregnant Women in western Uganda. A cross-sectional study at Kabale Regional Referral Hospital
(Student's Journal of Health Research (SJHR), 2022-12-17) Ainebyoonaa, Blendar; Ssekyanzi, Henry; Ssaka, Mustafa; Muhumuza, Nafutari; Bwenjee, Paul; Ejalu, David Livingstone
Anaemia is a global health problem affecting 1.62 billion people where by 41.8% (56 million people) of the general population are pregnant women. It’s more prevalent among pregnant women because during pregnancy, iron requirements increase much more significantly as compared to non-pregnant women. The aim of conducting this study was to determine the factors influencing the prevalence of anaemia among pregnant women attending antenatal care (ANC) services at Kabale Regional Referral Hospital (KRRH) in Kabale district. A hospital based cross-sectional study was conducted among pregnant mothers. Data was collected using a systematic random sampling technique. Blood samples were collected from 200 pregnant women and analyzed using a CBC analyzer sysmex Xs1000 to determine the Haemoglobin concentration. Interviews were conducted with mothers to determine factors influencing the prevalence of anaemia. Findings showed that the general prevalence of anaemia was 27% whereby 31% were mildly anaemic, 50% were moderately anaemic and 19% were severely anaemic. Concerning the socio-economic factors influencing the prevalence of anaemia among pregnant women, it was found out that the prevalence of anaemia was higher among participants who were peasants, rural dwellers, those having low education and low monthly income. The level of awareness about anaemia among pregnant women was 68% whereby the majority (25.5%) had heard it from ANC clinic. The overall prevalence of anaemia (27%) among pregnant women attending antenatal care services at Kabale Regional Referral Hospital in Kabale district was found to be a moderate health problem in the area of study.
Integrating hepatitis B care and treatment with existing HIV services is possible: cost of integrated HIV and hepatitis B treatment in a low-resource setting: a cross-sectional hospital-based cost-minimisation assessment
(BMJ Publishing Group Ltd, 2022-07-01) Ejalu, David Livingstone; Mutyoba, Joan N; Wandera, Claude; Seremba, Emmanuel; Kambugu, Andrew; Muganzi, Alex; Beyagira, Racheal; Amandua, Jacinto; Mugagga, Kaggwa; Easterbrook, Philippa; Ocama, Ponsiano
Hepatitis B and HIV care share health system challenges in the implementation of primary prevention, screening, early linkage to care, monitoring of therapeutic success and long-term medication adherence. Arua regional referral hospital (RRH) and Koboko district hospital (DH), the West Nile region of Uganda. A cross-sectional hospital-based cost minimisation study from the providers’ perspective considers financial costs to measure the amount of money spent on resources used in the stand-alone and integrated pathways. Clinic inputs and procurement invoices, budgetary documents, open market information and expert opinion. Data were extracted from 3121 files of HIV and hepatitis B virus (HBV) monoinfected patients from the two study sites. To estimate provider costs associated with running an integrated HBV and HIV clinical pathway for patients on lifelong treatment in low-resource setting in Uganda. Outcome measures The annual cost per patient was simulated based on the total amount of resources spent for all the expected number of patient visits to the facility for HBV or HIV care per year. Findings showed that Arua hospital had a higher cost per patient in both clinics than did Koboko Hospital. The cost per HBV patient was US$163.59 in Arua and US$145.76 in Koboko while the cost per HIV patient was US$176.52 in Arua and US$173.23 in Koboko. The integration resulted in a total saving of US$36.73 per patient per year in Arua RRH and US$17.5 in Koboko DH.nThe application of the integrated Pathway in HIV and HBV patient management could improve hospital cost efficiency compared with operating stand-alone clinics.
Integrating hepatitis B care and treatment with existing HIV services is possible: cost of integrated HIV and hepatitis B treatment in a low-resource setting: a cross-sectional hospital-based cost-minimisation assessment
(BMJ, 2022-07-01) Ejalu, David Livingstone; Mutyoba, Joan N; Wandera, Claude; Seremba, Emmanuel; Kambugu, Andrew; Muganzi, Alex; Beyagira, Racheal; Amandua, Jacinto; Mugagga, Kaggwa; Easterbrook, Philippa; Ocama, Ponsiano
Hepatitis B and HIV care share health system challenges in the implementation of primary prevention, screening, early linkage to care, monitoring of therapeutic success and long-term medication adherence. Setting was Arua regional referral hospital (RRH) and Koboko district hospital (DH), the West Nile region of Uganda. The research design used was a cross-sectional hospital-based cost minimisation study from the providers’ perspective considers financial costs to measure the amount of money spent on resources used in the stand-alone and integrated pathways. Data sources were clinic inputs and procurement invoices, budgetary documents, open market information and expert opinion. Data were extracted from 3121 files of HIV and hepatitis B virus (HBV) monoinfected patients from the two study sites. The objective was to estimate provider costs associated with running an integrated HBV and HIV clinical pathway for patients on lifelong treatment in low-resource setting in Uganda. The outcome measures were the annual cost per patient was simulated based on the total amount of resources spent for all the expected number of patient visits to the facility for HBV or HIV care per year. Findings showed that Arua hospital had a higher cost per patient in both clinics than did Koboko Hospital. The cost per HBV patient was US$163.59 in Arua and US$145.76 in Koboko while the cost per HIV patient was US$176.52 in Arua and US$173.23 in Koboko. The integration resulted in a total saving of US$36.73 per patient per year in Arua RRH and US$17.5 in Koboko DH. In conclusion, the application of the integrated Pathway in HIV and HBV patient management could improve hospital cost efficiency compared with operating stand-alone clinics.
Missed opportunity: low uptake of VMMC among men attending the OPD of a public health facility offering free VMMC services in Uganda
(BioMed Central Ltd. - Part of Springer Nature, 2023-01-18) Kiyai Nyaiti, Ruth; Ejalu, David Livingstone; Kimuli, Derrick
Studies in various countries including Uganda and Kenya have shown a much lower incidence of the human immunodeficiency virus (HIV) among men that underwent voluntary medical male circumcision (VMMC) compared to uncircumcised men. Wakiso district, the district with the highest prevalence of HIV in Uganda (7%), has a very low estimated proportion of men who have undergone VMMC (30.5%). Within the district, various public health facilities provide free VMMC services. This study examined the prevalence and factors associated with the uptake of VMMC among men attending the outpatient department (OPD) of a public facility offering VMMC services. Methods We conducted a cross-sectional study between July to August 2021 using a sample of men attending the OPD at Kira Health Centre IV. We defined VMMC uptake as the removal of all or part of the foreskin of the penis by a trained healthcare professional. We determined factors independently associated with VMMC uptake using a modified Poisson regression analysis with robust standard errors at a 5% statistical significance level. Adjusted prevalence risk ratios (APRR) were reported as the measure of outcome. Results Overall, 389 participants were enrolled in the study. The mean age of the participants was 27.2 (standard deviation±9.02) years. The prevalence of VMMC uptake was 31.4% (95% Confidence Interval [CI] 26.8–36.2). In the adjusted analysis, the uptake of VMMC among men attending the OPD of Kira HC IV was less likely among married participants compared to unmarried participants (APRR 0.64, 95% CI 0.48–0.88), among participants from Western tribes (APRR 0.50, 95% CI 0.41–0.86) or Eastern tribes (APPR 0.31, 95% CI 0.13–0.72) compared to participants from the Central tribes and among participants who didn’t disclose their sexual partner number compared to those that had one or no sexual partner (APRR 0.62, 95% CI 0.40–0.97). On the other hand, the prevalence of uptake of VMMC was 7 times among participants who were aware of VMMC compared to those who were not aware of VMMC (APRR 7.85 95% CI 1.07–9.80) and 2.7 times among participants who knew their HIV status compared to those that didn’t know (APRR 2.75, 95% CI 1.85–4.0). Also, the uptake of VMMC was 85% more among participants who knew that Kira HC IV provided free VMMC services compared to those that didn’t (APRR 1.85, 95% CI 1.85–4.08). Conclusion VMMC among men attending the OPD at the largest public healthcare facility proving free VMMC services in Kira Municipality was low. The OPD may provide a quick win for improving VMMC uptake. Collaborative efforts among the administration of Kira HC IV, the Ministry of Health and VMMC implementation partners could work towards developing health-facility-based strategies that can improve VMMC awareness and uptake with emphasis on the OPD.
Optimal complementary feeding practices among caregivers and their children aged 6–23 months in Kisoro district, Uganda
(BioMed Central Ltd - part of Springer Nature, 2022-08-16) Birungi, Tracy Lukiya; Ejalu, David Livingstone
There are many risk factors for stunting, and studies most often corroborate complementary feeding practices as a significant risk factor. Information on the prevalence of optimal complementary feeding practices and factors that lend to caregivers meeting their requirements in Kisoro district, a district with high stunting rates, is mostly lacking. An analytical cross-sectional study that used secondary data from a USAID-funded project. Entries for 384 caregivers of children aged 6–23 months in Kisoro district were abstracted from the project database. The data was analysed using SPSS version 20. The association between independent factors and optimal complementary feeding practices was determined using multivariable logistic regressions at the three levels of the Socio-Ecological Model. Although 95% of the infants were introduced to semi-solid foods promptly, their diet was nutritionally inadequate as evidenced by the low minimum dietary diversity of 4.43%. Some of the key covariates associated with these outcomes included, the type of occupation (AOR=21.21; CI=2.03—221.26; p=0.011), community groups (AOR=0. 43; CI=0.22—0.83; p=0.012), not being married (AOR=13.25; CI=1.76—100.25; p=0.012), age of the child (AOR=2.21; CI=1.1—4.45; p=0.026); among others. The prevalence of MAD and MDD was very low in Kisoro district, even compared to national figures, putting these children at a very high risk of stunting. Increased advocacy is needed to support the community-level implementation of the IYCF guidelines.