Journal Article

Permanent URI for this collectionhttp://hdl.handle.net/20.500.12280/2899

Browse

Now showing 1 - 20 of 92

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).
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.
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.
Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study
(BMC Springer Nature, 2023-03-10) Bienfait Mumbere, Vahwere; Ssebuufu, Robinson; Namatovu, Alice; Kyamanywa, Patrick; Ntulume, Ibrahim; Mugwano, Isaac; Pius, Theophilus; Sikakulya Katembo, Franck; Okedi, Francis Xaviour; Mulumba, Yusuf; Jorge, Soria; Agaba, Gidio; Nasinyama, George William
Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda. This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value<0.2 at bivariate analysis were considered for multivariate analysis. The right foot was affected in 47.9% (n=56) of patients, 44.4% (n=52) had the DFU on the plantar region of the foot and 47.9% (n=56) had an ulcer of >5 cm in diameter. The majority (50.4%, n=59) of patients had one ulcer. 59.8% (n=69) had severe DFU, 61.5% (n=72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p=0.011) and secondary (p<0.001) school educational levels, moderate (p=0.003) and severe visual loss (p=0.011), 2 ulcers on one foot (p=0.011), and eating vegetables regularly were protective against developing severe DFU (p=0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p<0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5–10 cm (p=0.047) and in those with >10 cm diameter (p=0.002), respectively. Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of >5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.
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.
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
Use of face masks to limit the spread of the COVID-19 among western Ugandans: Knowledge, attitude and practices
(PLOS One, 2021-03-24) Sikakulya, Franck Katembo; Ssebuufu, Robinson; Binezero Mambo, Simon; Pius, Theophilus; Kabanyoro, Annet; Kamahoro, Elizabeth; Mulumba, Yusuf; Kakule Muhongya, Jean; Kyamanywa, Patrick
The world is grappling with an ever-changing COVID-19 pandemic using preventive measures such as personal hygiene, face masks, restrictions on travel and gatherings in communities, in addition to a race to find a vaccine. The purpose of this study was to evaluate the knowledge, attitudes and practices of the western Uganda community on the proper use of face masks to mitigate the spread of COVID-19. A cross-sectional study using a structured questionnaire was carried out from 1st July to 10th July 2020 among western Ugandans of consent age of 18 years and above. Data was analysed using Stata version 14.2. Results Among the respondents (n = 1114), the mean age was 30.7 (SD 11.1), 51% were males, 53.9% married and 43% had attained secondary education. Most participants (60.1%, n = 670) had satisfactory knowledge on the use of face masks and participants at a tertiary education level [AOR 2.6 (95% CI: 1.42–4.67; p = 0.002)] were likely to have satisfactory knowledge than participants who had not education. On attitude, most respondents (69.4%) were confident enough to correctly put on a face mask; 83.4% believed that a face mask can protect against COVID-19 and 75.9% of respondents had never shared their face mask. The majority of respondents (95.2%) agreed wearing face masks in public places was important to protect themselves against COVID-19; 60.3% reported washing their hands before wearing and after removing the face mask. Unfortunately, 51.5% reported removing the face mask if they needed to talk to someone. Despite the satisfactory knowledge, good attitude and practices, there is still much more to be done in terms of knowledge, attitude and practices among participants. Government, non-governmental organizations and civil society should improve sensitization of populations on how to behave with face masks while talking to avoid the spread of the COVID-19 among western Ugandans.
Design of a Novel Online, Modular, Flipped-classroom Surgical Curriculum for East, Central, and Southern Africa
(Wolters Kluwer Medknow Publications , Wolters Kluwer India Pvt Ltd , A-202, 2nd Flr, Qube, C T S No 1498a-2 Village Marol, Andheri East, Mumbai, India, Maharashtra, 400059, 2022) Parker, Andrea S; Hill, Katherine A; Steffes, Bruce C; Mangaoang, Deirdre; O’Flynn, Eric; Bachheta, Niraj; Bates, Maria F; Bitta, Caesar; Carter, Nicholas H; Davis, Richard E; Dressler, Jeremy A; Eisenhut, Deborah A; Fadipe, Akinniyi E; Kanyi, John K; Kauffmann, Rondi M; Kazal, Frances; Kyamanywa, Patrick; Lando, Justus O; Many, Heath R; Mbithi, Valentine C; McCoy, Amanda J; Meade, Peter C; Ndegwa, Wairimu YB; Nkusi, Emmy A; Ooko, Philip B; Osilli, Dixon JS; Parker, Madison ED; Rankeeti, Sinkeet; Smith, James D; Snyder, David; Kimutai, R Sylvester; Wakeley, Michelle E; Wekesa, Marvin K; Torbeck, Laura; White, Russell E; Bekele, Abebe; Parker, Robert K; Shafer, Katherine
Objective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods: We utilized Kern’s 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination. Conclusions: We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
Interventions to Reduce Pedestrian Road Traffic Injuries: A Systematic Review of Randomized Controlled Trials, Cluster Randomized Controlled Trials, Interrupted Time-series, and Controlled Before-after Studies
(Public Library Science, 1160 Battery Street, Ste 100, San Francisco, Usa, Ca, 94111, 2022) Namatovu, Stellah; Balugaba, Bonny E; Muni, Kennedy; Ningwa, Albert; Nsabagwa, Linda; Oporia, Fredrick; Kiconco, Arthur; Kyamanywa, Patrick; Mutto, Milton; Osuret, Jimmy; Rehfuess, Evan A; Burns, Jacob; Kobusingye, Olive
Background Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined. Objectives To assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians. Methods We considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables. Results A total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control. Conclusions Although the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety.
Psychological Distress and Associated Factors Among Hospital Workers in Uganda During the COVID-19 Lockdown–A Multicentre Study
(Elsevier Science Inc , Ste 800, 230 Park Ave, New York, USA, NY, 10169, 2022) Kirabira, Joseph; Forry, Jimmy Ben; Ssebuufu, Robinson; Akimana, Benedict; Nakawuki, Madrine; Anyayo, Lucas; Mpamizo, Emmanuel; Onen, Bruno Chan; Ingabire, Jane; Gumisiriza, Nolbert; Waiswa, Ali; Mawanda, Anatoli; Ashaba, Scholastic; Kyamanywa, Patrick
Objective To assess the prevalence of psychological distress (PD), and its associated demographic, psychosocial, hospital and health-related factors among hospital workers in Uganda during the COVID-19 related lockdown. Methods An online cross-sectional study was conducted among three hundred ninety six participants recruited from eight hospitals and PD was assessed using the Kessler 6 distress scale from May to June 2020. Results PD was present in 92.7% of the participants with majority (78.3%) having mild to moderate PD whereas 14.4% had severe PD. Severe PD had statistically significant association with having financial liabilities (O.R = 3.69 (1.55–8.77), p = 0.003). However, ability to maintain contact with family members and friends (O.R = 0.43 (0.22–0.84), p value = 0.013), and having enough personal protective equipment and safety tools at work place (O.R = 0.44 (0.23–0.84), p value = 0.012) were protective against severe PD. having excessive worry about getting infected with COVID-19, conflicts within a home, segregation by friends or community, longer working hours or involvement in management of suspected or confirmed case were not associated with severe PD. Conclusion The findings indicate the need to take into consideration the mental wellbeing of health workers during this COVID-19 outbreak. Whereas hospital workers continue to provide their services during the COVID-19 pandemic and related lockdown, it is important that they maintain contact with social support networks and be provided with counselling and mental health and psychosocial services in order to optimise their mental health during this pandemic.
Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross-sectional study
(African Field Epidemiology Network-Afenet , Po Box 12874, Kampala, Uganda, 00000, 2021) Vahwere, Bienfait Mumbere; Sikakulya, Franck K; Ssebuufu, Robinson; Soria, Jorge; Okedi, X Francis; Abdullah, Shaban; Kyamanywa, Patrick
Introduction: the cancellation of elective surgery is still a worldwide challenge and this is associated with emotional and economical trauma for the patients and their families as well as a decrease in the efficiency of the operating theatre. This study aimed at determining the prevalence and factors associated with cancellation and deferment of elective surgery in a rural private tertiary teaching hospital in Western Uganda. Methods: a crosssectional study design was conducted. Data was collected from 1st July 2019 to 31st December 2019. Patients scheduled for elective surgery and either cancelled or deferred on the actual day of surgery were included in the study. Statistical analysis was done using STATA version 15. Results: four hundred patients were scheduled for elective surgery during the study period, among which 90 (22.5%) were cancelled and 310 (78.5%) had their surgeries as scheduled. The highest cancellation of elective surgical operations was observed in general surgery department with 81% elective cases cancelled or deferred, followed by orthopedic department 10% and gynecology department 9%. The most common reasons for cancellation were patient-related (39%) and health worker-related (35%) factors. Other factors included administrative (17%) and anesthesia related factors (9%). Cancellation was mainly due to lack of finances which accounted for 23.3% of the patients, inadequate patient preparation (16.6%) and unavailability of surgeons (15.5%). Major elective surgeries were cancelled 1.7 times more than minor electives surgeries [adjusted prevalence ratio 1.7 (95%CI: 1.07-2.73) and p-value: 0.024]. Conclusion: cancellation and deferment of elective surgeries is still of a major concern in this private rural tertiary hospital with most of the reasons easily preventable through proper scheduling of patients, improved communication between surgical teams and with patients; and effective utilization of available resources and man power.
Surgery of COVID-19-infected patients in Africa: a scoping
(Annals of African Surgery, 2021) Sikakulya, Franck K; Soria, Jorge; Ssebuufu, Robinson; Kiyaka, Sonye Magugu; Molen, Selamo Fabrice; Kyamanywa, Patrick
Objective: The aim of this scoping review was to highlight the nature and scope of research and publications about surgery in COVID-19-infected patients in Africa in order to inform guidelines applicable in Africa. Methods: We considered peerreviewed and gray literature from PubMed, Google Scholar, and Word Health Organization COVID-19 online databases published from February 1, 2020, to February 28, 2021, about surgery for/in COVID-19- infected patients. The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Results: of 530 studies screened, only 11 (2.08%) were found eligible, including 4 cohort studies, 3 cross-sectional studies, 2 letters to the editor, 1 case series, and 1 review. The key emphasis areas by the eligible studies were vaccination, testing prior to surgery, clinical guidelines to reduce complications related to COVID-19 among infected patients, and protection of the surgical team. Conclusion: There is a dearth of studies on surgery in COVID-19-infected patients in Africa. There is an urgent need for more reports and publications from the African experiences so as to inform contextualized guidelines for surgical care in low-resource settings during the COVID-19 pandemic.
Building trauma and EMS systems capacity in Rwanda: lessons and recommendations
(Ubiquity Press Ltd , Unit 3.22, East London Works, 65-75 Whitechapel Road, London, England, E1 1du, 2021) Jayaraman, Sudha; Ntirenganya, Faustin; Nkeshimana, Menelas; Rosenberg, Ashley; Dushime, Theophile; Kabagema, Ignace; Uwitonze, Jean Marie; Uwitonize, Eric; Nyinawankusi, Jeanne d'Arc; Riviello, Robert; Bagahirwa, Irene; Williams, Kenneth L; Krebs, Elizabeth; Maine, Rebecca; Banguti, Paulin; Rulisa, Stephen; Kyamanywa, Patrick; Byiringiro, Jean Claude
Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations. Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/ research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for empowerment of staff, improving clinical service delivery, and investing in systems and infrastructure. Funding was sought and incorporated into the Sector Wide Approaches to Planning process at the Ministry of Health of Rwanda. Findings: A shared mental model was created through a fully funded immersion program for Rwandese leaders from emergency medicine, nursing, prehospital care, and injury policy. Prehospital care delivery was standardized within Kigali through a train-thetrainers program with four new context-appropriate short courses in trauma, medical, obstetric/neonatal, and pediatric emergencies and expanded across the country to reach >600 staff at district and provincial hospitals. Forty-two protocols and checklists were implemented to standardize prehospital care across specialties. The WHO Trauma Registry was instituted across four major referral centers in the country capturing over 5,000 injured patients. Long-term research capacity development included Masters’ Degree support for 11 staff. Conclusions and Recommendations: This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in EMS, and investing in systems and infrastructure. This can be a useful model for trauma and EMS system capacity development in other LMICs.
Opportunities for surgical research in the Covid-19 era
(Annals of African Surgery, 2021) Kyamanywa, Patrick
The World Health Organization (WHO) declared the coronavirus (COVID-19) pandemic on 11 March 2020 (1). This was followed by near total disruption of all sectors, including the health sector, that will have lasting impact. The WHO further warns that COVID-19 will be here for a long time. Without a known cure, preventive measures such as travel restrictions, social distancing and isolation have had obvious and hidden consequences, including disrupting access to and continuity of health care.
Enterocutaneous fistula due to a strangulated Ritcher’s femoral hernia: a case report
(Authorea, 2021) Murwanashyaka, Emmanuel; Ssebuufu, Robinson; Kyamanywa, Patrick
Richter’s hernia has a misleading presentation with absence of typical intestinal obstructive symptoms leading to delay in making a diagnosis, tendency to strangulation and eventual spontaneous fistula formation. This article explores a case of enterocutaneous fistula that was managed non-operatively until spontaneous closure.
The double burden of Ebola and COVID-19 viral infections and the readiness for safe surgical care provision in Uganda and the Eastern Democratic Republic of the Congo: an online cross-sectional survey
(Research Square, 2021) Sikakulya, Franck K; Ssebuufu, Robinson; Longombe, Albert Ahuka Ona; Okedi, Francis; Kalongo, Michel; Valimungighe, Moise Muhindo; Furaha, Nzanzu Blaise Pascal; Vahwere, Bienfait Mumbere; Mambo, Simon Binezero; Mulumba, Yusuf; Muyisa, Muhindo Muhasa; Sonia, Fatuma Djuma; Sekabira, John; Fualal, Jane; Kyamanywa, Patrick
Objective: This study aimed at highlighting the extent to which Uganda and the Eastern DR Congo are ready for safe surgical care provision during the double burden of Ebola and COVID-19. Methods: An online cross-sectional study was conducted in selected National, Regional Referral and General Hospital facilities of Uganda and in the Eastern part of D.R. Congo from 1st August 2020 to 30 October 2020. Data was analysed using Stata version 14.2. Results: A participation rate of 37.5% for both countries (72/192). The mean bed capacity of participating health facilities (HF) was 184 in Eastern DR. Congo and 274 in Uganda with an average surgical ward bed capacity of 22.3% (41/184) of the beds in the DR. Congo and 20.4% (56/274) in Uganda. The mean number of operating rooms was 2 and 3 in Eastern DR. Congo and Uganda respectively. Nine hospitals (12.5%) reported being able to test for Ebola and 25 (34.7%) being able to test for COVID-19. Only 7 (9.7%) hospitals reported having a specific operating room for suspect or confirmed cases of Ebola or COVID-19. Provision of appropriate Personal Protection Equipment to personnel were reported to be available in 60 (83.3%) hospitals. The mean of readiness score for provision of surgical care was 7.8/16 (SD: 2.3) or 60% in both countries with no statistical significance in multiple linear regression analysis (p>0.05). Conclusion: The majority of participating hospitals in both countries had a low level of readiness to provide safe surgical care due to lack of supplies to limit the exposure of Healthcare workers (HCW) to Ebola and Covid-19 viral infections, and poor funding. Governments and non-governmental organizations should work together to enhance health facility supplies and readiness for safe surgical provision in resourcelimited settings.
State of Pedestrian Road Safety in Uganda: A Qualitative Study of Existing Interventions
(Makerere Univ, Coll Health Sciences,Sch Med , Po Box 7072, Kampala, Uganda, 00000, 2021) Osuret, Jimmy; Namatovu, Stellah; Biribawa, Claire; Balugaba, Bonny E; Zziwa, Esther Bayiga; Muni, Kennedy; Ningwa, Albert; Oporia, Fredrick; Mutto, Milton; Kyamanywa, Patrick; Guwatudde, David; Kobusingye, Olive
Background: Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions. Methods: We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with par- ticipants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software. Results: Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key program- matic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions. Conclusion: The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda’s pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.
What are the key leadership competencies required by Medical School Deans in Uganda? a qualitative cross-sectional study
(Makerere Univ, Coll Health Sciences,Sch Med , Po Box 7072, Kampala, Uganda, 00000, 2021) Kyamanywa, Patrick; Redding, Peter
Background: Effective leadership is vital for organizational growth and sustainability. Globally, medical schools are faced with leadership challenges due to the pace of globalization, technological advances, reduced funding and changed funding cycles, increasing student enrolment, demands of accreditation, academic collaboration, innovations and research. This makes identification and selection for the right leadership competencies a priority. Objectives: To investigate the key leadership competencies required by deans of medical schools in Uganda. Method: A qualitative study using semi-structured interviews with the current deans and purposively selected former deans of medical schools in Uganda was conducted between March and June, 2020. We analysed the data using Grounded theory. Results: Thirteen (13) deans (9 of the 12 current deans and 4 former deans) participated in the study. We established ten (10) key roles of a dean of a medical school categorised as academic leadership, administrative leadership and professional leadership. Eleven (11) key competencies were identified as necessary for effective leadership of medical schools in Uganda, and categorized as personality-related competencies, organizational management competencies and medical/health expertise. Conclusions: A dean of a medical school in Uganda should possess a combination of personality, medical expertise, health professions training and organizational management competencies and have training in leadership, financial and resources management.
Factors that influenced access and utilisation of sexual and reproductive health services among Ugandan youths during the COVID-19 pandemic lockdown: an online cross-sectional survey
(Research Square, 2021) Binezero Mambo, Simon; Sikakulya, Franck K.; Ssebuufu, Robinson; Mulumba, Yusuf; Wasswa, Henry; Thompson, Kelly; Rusatira, Jean Christophe; Bhondoekhan, Kamyuka, Fiona; Louis K.; Olabisi Akib, Surat; Kirimuhuzya, Claude; Nakawesi, Jane; Kyamanywa, Patrick;
Background The COVID-19 pandemic has disrupted health care access in many countries. The aim of this study was to explore factors that influenced access and utilisation of sexual and reproductive health services among Ugandan youths during the COVID-19 pandemic lockdown. Methods This was across-sectional study carried out from April 2020 to May 2020 in Uganda. A questionnaire was administered online to participants aged 18 to 30 years. Subjects were recruited using a snowballing approach. STATA version 14.2 was used for statistical analysis. Results Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n=195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown. 27.2% could not obtain contraceptive supplies. Access to HIV services and menstrual supplies were also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. Conclusion Access to SRH information and services for Ugandan youths was restricted during the COVID-19 lockdown and may have increased the incidence of poor SRH outcomes. Lack of transportation, distance to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.

Browse

Recent Submissions