Browsing by Author "Lule, Herman"

Now showing 1 - 7 of 7

Awareness of Breast Disease Among Female Undergraduate Students in Kampala, Uganda: A Descriptive, Cross-sectional Study
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2020) Okedi, X Francis; Lule, Herman; Wachaya, David; Kyamanywa, Patrick
Introduction: Uganda has recognized the importance of breast disease as a public health issue and has implemented efforts to increase awareness, early detection, and improved treatment. However, there are few published reports on awareness and screening of breast disease among women in Uganda. Methods: This descriptive cross-sectional study was conducted between July 2016 and May 2017 to evaluate breast disease awareness among female undergraduate students attending Kampala International University, Western Campus, in Uganda. A stratified random sample was drawn to proportionately represent students from each academic faculty. Participants completed a self-administered questionnaire assessing awareness of breast disease and self-breast examination (SBE). A 3-level scale for overall breast disease awareness was constructed to categorize students as “not aware”, “moderately aware”, or “very aware”, based on their responses to a 3-item assessment. Data were analysed to determine the proportion of students with awareness of various breast disease-related topics and to evaluate associations between demographic factors and awareness. Results: In total, 209 participants were enrolled, among whom 108 (51.7%) were 21 to 25 years old, and 192 (92.3%) were single. Most participants (n=197, 92.8%) had heard about breast disease; the main sources of information were friends (n=59, 27.8%), television (n=33,15.8%), and health workers (n=33, 15.8%). Only 27 participants (12.9%) reported familial history of breast disease. Over half (n=117, 55%) had heard about SBE, among whom 71 (60.9%) could perform it; 23 students reported performing it monthly. Overall, breast disease awareness was low, with only 2 participants (0.96%) categorized as “very aware”, 76 (16.3%) as “moderately aware”, and 173 (82.8%) as “not aware”. Breast disease awareness was significantly associated with older age (P=0.023), enrolment in a health-related faculty (P<0.0001), and having children (P=0.016). Conclusions: Female undergraduate students at Kampala International University had little awareness about breast disease. Efforts should be undertaken to raise breast disease awareness among undergraduate students in Uganda.
Effect of rural trauma team development on outcomes of motorcycle related injuries: a protocol for a multi-center cluster randomized controlled clinical trial (The MOTOR trial)
(medRxiv preprint, 2023-12-09) Lule, Herman; Mugerwa, Micheal A.; SSebuufu, Robinson; Kyamanywa, Patrick; Bärnighausen, Till; Posti, Jussi P.; Wilson, Michael Lowery
Injury is a global health concern whose mortality disproportionately impact low-income countries. Compelling evidence from high-income countries show that rural trauma team development courses (RTTDC) increase clinicians’ knowledge. There is a dearth of evidence from controlled clinical trials to demonstrate the effect of RTTDC on process and patient outcomes. We document a protocol for a multi-center cluster randomized controlled clinical trial which aims to examine the impact of RTTDC on process and patient outcomes of motorcycle-related injuries. This will be a two-armed parallel multiple period cluster randomized controlled clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We shall recruit regional referral hospitals and include road traffic injured patients, interns, medical trainees, and road traffic law enforcement professionals who serve as trauma care frontliners. Three hospitals will be cluster randomized to RTTDC (intervention group) and the remaining three to standard care (control group). The primary outcomes will be prehospital interval from accident scene to arrival at emergency department, and referral-exit interval from the time the referral decision is made to hospital exist in hours as a measure of process improvement. The secondary outcomes will be all cause mortality, and morbidity of neurological, and orthopedic injuries based on the Glasgow outcome scale and trauma outcome measure scores respectively at 90-days post injury. All outcomes will be measured as final values. We shall compare baseline characteristics and outcomes both at individual, and at cluster level as intervention versus control group. We shall use the mixed effects regression models in Stata 15.0 to report any absolute or relative differences along with 95% CIs. We shall perform subgroup analyses to control for confounding due to injury mechanisms and severity. In parallel to the trial, we shall establish a motorcycle trauma outcome registry (MOTOR) in consultation with community traffic police. Our results could inform the design, implementation, and scalability of future rural trauma teams and education programs.
Feasibility of rural trauma team development amongst medical trainees and traffic law enforcement professionals in a low-income country: a prospective multi-centre study of interrupted time series of interventional training
(Research Square Preprints, 2023-10-05) Lule, Herman; Mugerwa, Michael; SSebuufu, Robinson; Kyamanywa, Patrick; Jussi, Posti. P; Wilson, Michael Lowery
Research shows that trauma team formation could potentially improve effectiveness of injury care in rural settings. The aim of this study was to determine the feasibility of the use of rural medical trainees and road traffic law enforcement professionals in the formation of rural trauma teams in Uganda. Multi-center interrupted time series of interventional rural health professions education, using the American College of Surgeons’ 4th edition of rural trauma team development course model. Trauma related multiple choice questions (MCQs) were administered pre-and post-training between September 2019- August 2023. Acceptability of the training for promulgation to other rural regions and its relevance to participants’ work needs were evaluated on 5- and 3-point Likert scales respectively. The median MCQ scores (IQR) were compared before and after training at 95% CI, regarding p < 0.05 as statistically significant. Triangulation with open-ended questions was obtained. Time series regression models were applied to test for autocorrelation in performance using Stata 15.0. Ethical approval was obtained from Uganda National Council for Science and Technology (Ref: SS 5082). A total of 500 participants including: 66 (13.2%) traffic police officers, 30 (6.0%) intern doctors, 140 (28.0%) fifth year and 264 (52.8%) third-year medical students were trained. The overall median pre- and post-test scores were 60%, IQR (50–65) and 80%, IQR (70–85) respectively. Overall, the mean difference between pre- and post-test scores was statistically significant (z = 16.7%, P|z|=<0.0001). Most participants strongly agreed to promulgation 389 (77.8%), relevance to their educational 405 (81.0%), and work needs 399 (79.8%). All the course elements scored above 76.0% as being very relevant. This study demonstrates that rural trauma team development training had a positive effect on the test scores of course participants. The training is feasible, highly acceptable and regarded as relevant amongst medical trainees and traffic law enforcement professionals who provide first-aid to trauma patients in resource-limited settings. The findings could inform the design of future trauma teams in rural communities.
Injury characteristics, severity and thirty-day mortality of non-sexual assault related injuries in Uganda
(SSRN - Elsevier, 2023-02-06) Asiimwe, Daniel; Abio, Anne; Subramanian, Sadhvi; Nelson, Kevin; Wilson, Michael Lowery; Kyamanywa, Patrick; Lule, Herman
Non-sexual assault is increasingly becoming a global public health concern in the context of human rights advocacy. The objective of this study was to determine the injury characteristics, severity and factors associated with thirty-day mortality of non-sexual assault attributable injuries at two tertiary hospitals in Uganda. Prospective observational cohort study of 140 consecutive patients with history of non-sexual assault (Ethical clearance No.UG-REC023/2021-17). We used the Kampala Trauma Score (KTS II) to assess injury severity, coded as mild (9-10), moderate (7-8) or severe (≤6). The main outcome was mortality after 30 days from time of arrival at the trauma units. We analyzed data using Stata V.17.0 (StataCorp, TX, USA) at 95% confidence interval, regarding p<0.05 as statistically significant. Mean age was 29.98 years +/-12.76 SD. Males were the majority 77.4% (n=108). Mortality occurred in 5.7% (n=8) of patients. The Kampala Trauma Score was moderate in 20.7% (n=29), and severe in 35.0% (n=49) of the cases respectively. Factors significantly associated with mortality at 30 days were: a severe Kampala Trauma Score (OR = 100.79, 95% CI 4.88, 2080.57; P=0.003), pelvic injuries (OR = 112.80, 95% CI 1.02, 12434.31; p=0.049] and being accompanied by a relative [OR=0.004, 95%CI (<0.01,0.48)]. Severe injuries due to non-sexual assault occur in 35% of cases in Uganda and predominantly affect males. These injuries are associated with higher mortality of 57 per 1000 affected individuals
Local anesthesia versus saddle block for open hemorrhoidectomy: cost-analysis from a randomized, double blind controlled trial
(BMC Springer Nature, 2023-11-22) Sikakulya, Franck Katembo; Ssebuufu, Robinson; Okedi, Francis Xaviour; Baluku, Moris; Lule, Herman; Kiyaka, Sonye Magugu; Muhumuza, Joshua; Molen, Selamo Fabrice; Bassara, Godefroy Nyenke; Waziri, Musa Abbas; Kithinji, Stephen Mbae; Mugisho Munyerenkana, Leocadie; Kagenderezo, Byamungu Pahari; Munihire, Jeannot Baanitse; Vahwere, Bienfait Mumbere; Kiswezi, Ahmed; Kyamanywa, Patrick
Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids. This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0. Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p<0.05). The mean operating time was 15.52±5.34(SD) minutes versus 33.72±11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42±8.90 US$ compared to 63.38±12.77US$ in SB group. The use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals.
Pain assessment following open hemorrhoidectomy under local anesthesia versus saddle block: a multicenter randomized controlled trial
(BMC Springer Nature, 2023-05-12) Sikakulya, Franck Katembo; Ssebuufu, Robinson; Okedi, Francis Xaviour; Baluku, Moris; Lule, Herman; Kiyaka, Sonye Magugu; Kyamanywa, Patrick
There is disparity in evidence on pain assessment post open hemorrhoidectomy (OH) using local anesthesia and its use in developing countries compared to developed countries. Therefore, we conducted this study to assess the occurrence of postoperative pain following open hemorrhoidectomy under local anesthesia versus saddle block for uncomplicated 3rd or 4th degree hemorrhoids. This was a prospective equivalence randomized, double blind controlled trial conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. Pain severity was assessed at 2, 4 and 6 h post open hemorrhoidectomy using visual analogue scale (VAS). Data was analysed using SPSS version 26 at a p<0.05 as statically signifcant using visual analogue scale (VAS). We recruited 58 participants in this study who underwent open hemorrhoidectomy under local anesthesia or saddle block (29 participants per group). The sex ratio was of 1.15 of female to male and a mean age of 39±13. VAS was found to be diferent at 2 h post OH compare to other time of pain assessment but not statically signifcant by area under the cover (AUC) (95% CI=486–0.773: AUC=0.63; p=0.09) with a none signifcance by Kruskal–Wallis’s test (p:0.925). Local anesthesia was found to be having a similar pain severity occurrence in post operative period among patients undergoing open hemorrhoidectomy for primary uncomplicated 3rd or 4th degree hemorrhoids. Close monitoring of pain in postoperative period is mandatory especially at 2 h to assess need of analgesia.
Rural trauma team development training amongst medical trainees and traffic law enforcement professionals in a low-income country: a protocol for a prospective multicenter interrupted time series
(National Library of Medicine - PubMed Central, 2024-02-08) Lule, Herman; Mugerwa, Michael; SSebuufu, Robinson; Kyamanywa, Patrick; Posti, Jussi P; Wilson, Michael L
Road traffic injuries and their resulting mortality disproportionately affect rural communities in low-middle-income countries (LMICs) due to limited human and infrastructural resources for postcrash care. Evidence from high-income countries show that trauma team development training could improve the efficiency, care, and outcome of injuries. A paucity of studies have evaluated the feasibility and applicability of this concept in resource constrained settings. The aim of this study protocol is to establish the feasibility of rural trauma team development and training in a cohort of medical trainees and traffic law enforcement professionals in Uganda. Muticenter interrupted time series of prospective interventional trainings, using the rural trauma team development course (RTTDC) model of the American College of Surgeons. A team of surgeon consultants will execute the training. A prospective cohort of participants will complete a before and after training validated trauma related multiple choice questionnaire during September 2019-November 2023. The difference in mean prepost training percentage multiple choice questionnaire scores will be compared using ANOVA-test at 95% CI. Time series regression models will be used to test for autocorrelations in performance. Acceptability and relevance of the training will be assessed using 3 and 5-point-Likert scales. All analyses will be performed using Stata 15.0. Ethical approval was obtained from Research and Ethics Committee of Mbarara University of Science and Technology (Ref: MUREC 1/7, 05/05-19) and Uganda National Council for Science and Technology (Ref: SS 5082). Retrospective registration was accomplished with Research Registry (UIN: researchregistry9490).