Browsing by Author "Kitara, Lagoro David"

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An Analysis of the Short Term Outcomes of Laparotomy Among Surgeons in Mulago Hospital Using POSSUM Scoring System
(International Research Journals, 2011-09-01) Kitara, Lagoro David; Kakande, Ignatius; Mugisa, D. Didas
More than 600 laparotomy operations are conducted in Mulago National Referral Hospital (MNRH) every year. However, there are no criteria for judging the outcomes (morbidity and mortality) and comparing the short-term outcomes of these operations among surgeons in the Department of Surgery. The Physiological Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM) was used to analyze the short-term outcomes of laparotomy among surgeons in MNRH. A cross-sectional study was conducted using 76 consecutively recruited patients who underwent emergency and elective laparotomy. POSSUM scoring system was used and patients followed-up to 30th post-operative day. Day-care surgeries, patients who died on table before induction of anesthesia, and patients below 13 years of age were excluded from the study. Informed consent and assent was obtained from each patient before surgery and ethical approval was obtained from the research and review committee of Makerere University Medical School. There were 51 emergencies (67.1%) and 25 (32.9%) electives. 13 patients (17.1%) were operated by consultants, 8 (10.5%) by registrars and 55 (72.4%) by senior residents. Short-term outcome (morbidity) among the surgeons was: consultants (t= -0.081, p=0.243), registrars (t= -0.039, p=0.368), and senior residents (t= -0.041, p=0.362). Mortality outcomes for surgeons were consultants (t= -0.012, p=0.460), registrar (t=.-0.012, p=0.460) and senior residents (t= 0.087, p=0.228). POSSUM successfully analyzed the short-term outcomes of laparotomy among surgeons in MNRH. All the surgeons were performing well within the predictive power of Possum.
The Enigmatic Nodding Syndrome Outbreak in Northern Uganda: An analysis of the Disease Burden and National Response Strategies
(Oxford University Press, 2015-06-27) Mwaka, Amos Deogratius; Kitara, Lagoro David; Orach, Garimoi Christopher
To date, the cause of nodding syndrome (NS) remains unknown; however, efforts continue to establish risk factors and optimal symptomatic treatments. We documented the burden and national response strategies including involvement of key stakeholders in the management of the NS epidemic in order to inform future interventions against epidemics of undetermined aetiology. Data were collected through semi-structured interviews with selected leaders in the affected districts and at the Ministry of Health, and through review of documents. We participated in and analysed the proceedings of the first international scientific conference on NS held in Kampala in August 2012. We then analysed the chronology of the NS notification and the steps undertaken in the response plan. Over 3000 children have been affected by NS in northern Uganda; with an estimated case fatality of 6.7%. The first cases of NS were reported in 1997 in internally displaced people’s camps in Kitgum district; however, response efforts by the Ministry of Health and partners towards understanding the disorder and establish management only commenced in 2009. Key strategies in response to the NS epidemic have included formation of a national and district task forces, development of training manual on NS and training of primary healthcare professionals on case diagnosis and clinical management, establishment of treatment and rehabilitation centres, surveillance and promotion of researches to further inform management of the syndrome.
Is the Glass Half Full or Half Empty? A Qualitative Exploration on Treatment Practices and Perceived Barriers to Biomedical Care for Patients With Nodding Syndrome in Post-Conflict Northern Uganda
(BioMed Central Ltd, 2015-08-29) Mwaka, Amos Deogratius; Okello, S. Elialilia; Abbo, Catherine; Odwong, Okot Francis; Olango, Willy; Etolu, Wilson John; Oriyabuzu, Rachel; Kitara, Lagoro David; Mutamba, Brian Byamah; Idro, Richard; Opar, Toliva Bernard; Aceng, Ruth Jane; Lukwago, Assuman; Neema, Stella
Background Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations. Methods We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes. Results Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities. Conclusions Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.
Mortality Prediction using Possum Scoring System for Laparotomy Patients in Mulago National Referral Hospital, Uganda
(University of Papua New Guinea, 2012-03) Kitara, Lagoro David; Kakande, Ignatius; Mugisa, B Didas
Prediction of serious complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of dying contributes significantly to the quality of surgical care and cost reduction. The postoperative mortality of patients who underwent laparotomy in Mulago Hospital was studied using Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM). Consecutive patients who underwent laparotomy in Mulago Hospital were recruited and consent obtained. Patients operated were followed up to the 30th postoperative day. Postoperative deaths were promptly investigated and findings recorded. Follow-up of patients was conducted by phone and surgical review once a week in outpatient. Ethical approval was obtained from the Institutional Review Board (IRB) of Makerere University Medical School. Seventy-six patients participated and the observed mortality was 14.5% and the predictive value of POSSUM using Receiver Operative Characteristics (ROC) curve was 0.817 (95% Confidence Interval 0.711, 0.924) and the Hosmer and Lemeshow test predicted 18.2% of mortality and survival 100%. Postoperative mortality can be predicted in the modern management of surgery using POSSUM. It is markedly influenced by the preoperative, operative and postoperative conditions of the patients.
Nodding Syndrome (NS) in Northern Uganda: A Probable Metabolic Disorder
(Journal of Advances in Medicine and Medical Research, 2013-07-04) Kitara, Lagoro David; Mwaka, Amos Deogratius; Anywar, Arony Denis; Uwonda, Gilbert; Abwang, Bernard; Kigonya, Edward
Aims: To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10th to 20th June 2012. Methodology: We recruited consecutively 101 children with probable NS in the 2 sub counties in Gulu and Amuru districts. Controls were from the same population but without symptoms of NS and were matched by age, sex and residents. History and physical examinations were conducted; anthropometry, blood samples and skin snips were obtained from cases and controls. Researchers were pediatricians, psychiatrists, nurses, laboratory scientists and epidemiologists. The research proposal was approved by the Ministry of Health and the IRB of Gulu University. Results: There was a statistically significant association between NS with malnutrition (t=0.142; p=0.044), Onchocerciasis (Χ 2 = 152.74, p<0.001; OR 7.025 95% CI 3.891, 12.682) and High Anion Gap (Χ2=146.752, p<0.001; OR 6.313 95%CI 4.027, 9.895). Conclusion: Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.
Pyomyositis in Nodding Syndrome (NS) Patient - A Case Report
(African Field Epidemiology Network (AFENET)., 2013-10-23) Kitara, Lagoro David; Mwaka, Amos Deogratius; Wabinga, R Henry; Bwangamoi, Okot Paul
We report a case of Pyomyositis in a 13-year-old boy diagnosed using WHO surveillance definition of Probable Nodding syndrome. Complete blood count showed Leukocytosis with immature granulocytes and atypical lymphocytes. Except for the liver enzymes which were high the renal functions and serum electrolytes were within normal range values. Culture of a pus-swab grew Staphylococcus aureus. Abdominal ultrasound scan showed a focal mass on the internal and external oblique muscles of the right abdominal wall. Incision and drainage was performed. Histology of the muscle showed non-specific inflammation of the external and internal oblique muscles. This finding may highlight some of the other tropical diseases that occur in children with Nodding syndrome.