Browsing by Author "Nattabi Barbara"

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Competing Demands and Limited Resources in the Context of War, Poverty and Disease: the Case of Lacor Hospital
(Uganda Martyrs University, Department of Health Sciences, 2003) Accorsi Sandro; Corrado Bruno; Massimo Fabiani; Iriso Robert; Nattabi Barbara; Ayella Odong Emintone; Ogwang Martin; Onek Paul Awil; Bongomin Pido; Declich Silvia
Difficult choices have to be made among competing demands for health care in the context of severely limited resources and persistent humanitarian crisis prevailing in Northern Uganda. In particular, the challenge of a burden of disease from largely preventable and treatable conditions, the spread of emerging or re-emerging infections, the appearance of new, previously unknown, diseases (such as Ebola), and the heavy burden of poverty and war on health, make it imperative for getting information for identifying priorities and for decision making. However, major information gaps exist, and the little data available has been provided from scattered surveys and from incomplete reporting systems. In this context, readily available information collected using standardized procedures, such as data from hospital discharge records, becomes extremely important, in that these data can provide useful indications on the health situation at a low cost, in a long-term, sustainable way. This study is based on 155,205 medical records of inpatients admitted to the Lacor Hospital during the period 1992-2002, and its objective is to describe the health profile of the population of Northern Uganda, in order to estimate the impact of war, poverty, and social disruption in terms of morbidity and mortality. It analyses also the performance of Lacor Hospital in coping with this emergency situation, exploring pathways and mechanisms that link disease patterns, hospital performance, quality of care, and health outcomes, therefore providing an example of the thinking process leading from information to decision to action.
Evaluating HIV testing algorithms for research, diagnosis and surveillance
(Uganda Martyrs University Press, 2005-04) Massimo Fabiani; Nattabi Barbara; Biryahwaho Benon; Ouma Jacob; Ninci Antonella; Declich Silvia
The objective of the study was to evaluate the validity of the HIV testing algorithms used at St. Mary's Hospital Lacor (Gulu district, North Uganda) for research, diagnosis and surveillance. The validity of a new testing algorithm based on rapid tests for research and diagnosis was determined by testing 560 samples from the antenatal clinic at Lacor Hospital and using the old ELISA algorithm as a gold standard. The validity of a new testing algorithm for HIV surveillance, assuming the previously used Wellcozyme as a gold standard, was determined using 360 samples from the same antenatal clinic. Using the old ELISA algorithm as a gold standard, the new rapid test algorithm for diagnosis and research has a sensitivity of 90.6% and a specificity of 98.8%, yielding an accuracy rate in correctly classifying the results of 96.6%. In comparison to the Wellcozyme kit, the new testing algorithm for HIV surveillance has a sensitivity of 77.3% and a specificity of 96.8%, with no difference in the prevalence of HIV infection between the two testing schemes.The two testing algorithms evaluated in this study show good performances according to the purposes of their use. It is important that before full introduction of new HIV testing kits and algorithms into a setting, field evaluation studies are carried out to determine their validity.