Background: Early isolation and appropriate care for Ebola Disease patients at Ebola Treatment Units (ETU) curb outbreak spread and reduce deaths. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda.Methods: We included persons with RT-PCR-confirmed SVD with onset after the outbreak was declared during September 20–November 30, 2022. We categorized days from symptom onset to ETU entry (‘delays’) as short (≤2), moderate (3-5), and long (≥6); the latter two were ‘delayed isolation’. We categorized the timing of symptom onset as ‘earlier’ or ‘later,’ using October 15 as a cut-off. We assessed demographics, timing of symptom onset, and knowledge of one’s status as a contact as predictors for delayed isolation using modified Poisson regression. We conducted key informant interviews with SVD case-patients with short (n=8) and long (n=9) delays to explore reasons for early vs late isolation.Results: Among 118 case-patients, 25 (21%) case-patients had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Having onset earlier in the outbreak increased risk of delayed isolation [cRR=1∙8, 95%CI (1∙2-2∙8)]. Knowing that one was a case contact, knowing SVD symptoms, encouragement from trusted persons, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors.Conclusion: Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could facilitate more rapid presentation to ETUs.Funding: None.Declaration of Interest: None.Ethical Approval: We sought permission to conduct the study from the Ministry of Health, District Health officer, as well as the chairpersons and village health officers of the given villages. We obtained verbal consent from participants of the qualitative component. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. § §See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.
Abstract Introduction and hypothesis This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting. Methods We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence. Results Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged <60 years (RR = 2.34; 95% CI: 1.16–4.72; p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5–4.3; p = 0.001) were at risk of recurrence. Conclusion Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.
AbstractBackground: In February 2022, a high number of deaths among children was reported to the Ministry of Health from Namutumba District. The cause was later confirmed as severe malaria. We investigated the scope of severe malaria deaths, identified associated factors, and recommended evidence-based control measures to inform malaria-prevention programming in Namutumba District. Methods: We conducted an unmatched case-control study in March 2022 in the most affected subcounty (Ivukula Subcounty). We defined a case as death with a history of fever and any of the following: convulsions, difficulty breathing, yellow eyes, tea-colored urine, anemia, loss of consciousness, or reduced urine output in a child ≤12 years from September 2021 to February 2022 in Ivukula Subcounty, Namutumba District. Controls were survivors with the same signs and symptoms, recruited in a 2:1 ratio with cases. We actively searched for cases and controls door-to-door with the help of community health workers. We interviewed caretakers for cases and controls to obtain socio-demographic and clinical data, including health-seeking behavior and health systems risk factors. Drugs and bloodstock status information was obtained from health workers using an interview guide. We identified factors associated with death using multivariate logistic regression and thematic analysis for qualitative data. Results: Among 46 cases, 29 (63%) were <5 years, and 23 (50%) were female.Death among children with severe malaria was significantly associated with treatment non-completion (aOR=9.7, 95%CI: 1.8–53) and failure to receive blood transfusion for anemic patients (aOR=7.1, (95%CI: 1.4–36). Healthcare workers reported that failure to reach intended referral sites due to transport costs, stockouts of antimalarials and blood products at health facilities, and absence of integrated community case management of childhood illnesses (iCCM) were likely contributors to deaths among children with severe malaria. Conclusion: Incomplete or insufficient treatment due to lack of patient resources and drug stockouts contributed to malaria mortality amongchildren ≤12 years in Ivukula Subcounty in Uganda. We recommend accurate quantification of antimalarials for health facilities, offering transport support to severe patients referred to higher-level facilities, and increasing access to blood products. Activation of iCCM could facilitate public health efforts against severe malaria in the district.
Background. Preeclampsia is a priority obstetric emergency requiring urgent diagnosis and treatment to avert poor pregnancy outcomes. Nonproteinuric preeclampsia poses even greater diagnostic challenges due to contested diagnostic criteria by the clinical practice guidelines and variable clinical presentation. Previously, preeclampsia was only diagnosed if high blood pressure and proteinuria were present. This study determined the prevalence of nonproteinuric preeclampsia and associated factors among women admitted with hypertensive disorders of pregnancy at a referral hospital in southwestern Uganda. Methods. Women with hypertensive disorders of pregnancy were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital between November 2019 and May 2020. We interviewed all pregnant women ≥20 gestation weeks presenting with hypertension and obtained their sociodemographic, medical, and obstetric characteristics. We excluded women with chronic hypertension. We measured bedside dipstick proteinuria in clean-catch urine. Preeclampsia was defined as hypertension plus any feature of severity including <100,000 platelets/ul, creatinine >1.1 g/dl, and liver transaminases ≥twice upper normal limit with or without proteinuria. We defined nonproteinuric preeclampsia in participants with <+2 urine dipstick cut-off and determined the factors associated with nonproteinuric preeclampsia using logistic regression. Results. We enrolled 134 participants. The mean age was 26.9 (SD ± 7.1) years and 51.5% were primigravid. The prevalence of nonproteinuric preeclampsia was 24.6% (95% CI: 17.9–32.7). Primigravidity (aOR 2.70 95% CI: 1.09–6.72, = 0.032) was the factor independently associated with nonproteinuric preeclampsia. Conclusion. Nonproteinuric preeclampsia was common, especially among primigravidae. We recommend increased surveillance for nonproteinuric preeclampsia, especially among first-time pregnant women, who may not be detected by the traditional criteria. Obstetrics care providers should emphasize laboratory testing beyond proteinuria, among all women with hypertensive disorders of pregnancy to optimally diagnose and manage nonproteinuric preeclampsia.
Introduction: in 2018, Uganda experienced recurrent outbreaks of anthrax in both humans and livestock. We aimed to determine risk factors for human anthrax outbreak among residents of Kazo County, Kiruhura District, southwestern Uganda.
Abstract Background: In 2022, a Sudan virus disease (SVD) outbreak occurred in Uganda, resulting in 142 confirmed cases, most in Mubende and Kassanda districts. We determined risk factors for Sudan virus (SUDV) infection among household members (HHM) of cases. Methods: We conducted a case-control and retrospective cohort study in January 2023. Cases were RT-PCR-confirmed SUDV infection in residents of Mubende or Kassanda districts during the outbreak. Case-households housed a symptomatic, primary case-patient for ≥24 hours and had ≥1 secondary case-patient with onset <2 weeks after their last exposure to the primary case-patient. Control households housed a case-patient and other HHM but no secondary cases. A risk factor questionnaire was administered to the primary case-patient or another adult who lived at home while the primary case-patient was ill. We conducted a retrospective cohort study among case-household members and categorized their interactions with primary case-patients during their illnesses as none, minimal, indirect, and direct contact. We conducted logistic regression to explore associations between exposures and case-household status, and Poisson regression to identify risk factors for SUDV infection among HHM. Results: Case- and control-households had similar median sizes. Among 19 case-households and 51 control households, primary case-patient death (adjusted odds ratio [OR adj ]=7.6, 95% CI 1.4-41) and ≥2 household bedrooms (OR adj =0.19, 95% CI 0.056-0.71) were associated with case-household status. In the cohort of 76 case-HHM, 44 (58%) were tested for SUDV <2 weeks from their last contact with the primary case-patient; 29 (38%) were positive. Being aged ≥18 years (adjusted risk ratio [aRR adj ]=1.9, 95%CI: 1.01-3.7) and having direct or indirect contact with the primary case-patient (aRR adj =3.2, 95%CI: 1.1-9.7) compared to minimal or no contact increased risk of SVD. Access to a handwashing facility decreased risk (aRR adj =0.52, 95%CI: 0.31-0.88). Conclusion: Direct contact, particularly providing nursing care for and sharing sleeping space with SVD patients, increased infection risk among HHM. Risk assessments during contact tracing may provide evidence to justify closer monitoring of some HHM. Health messaging should highlight the risk of sharing sleeping spaces and providing nursing care for persons with Ebola disease symptoms and emphasize hand hygiene to aid early case identification and reduce transmission.
Abstract Background Studies investigating the prevalence of hypertension and its correlation with anthropometric indices among adolescents are still scarce compared to those conducted in adults of greater than 40 years. So far, no other study estimating the prevalence and correlates of hypertension among adolescents in Uganda has been found. Objective The purpose of this study, therefore, was to asses the prevalence of hypertension and its correlation with anthropometric indices among adolescents in Mbarara Municipality, southwestern Uganda. Methods A cross-sectional study was carried out among 616 secondary school adolescents aged 12–19 years in Mbarara Municipality, Uganda. Blood pressure and anthropometric indices were determined by standard methods. In the statistical analysis, linear regression analysis was done to assess the relationship between blood pressure and anthropometric indices. Results Overall prevalence of hypertension among adolescents was at 3.1% ( n = 19) while prehypertension was 7.1% ( n = 44). There was a statistically significant correlation between blood pressure, neck circumference, waist to hip ratio and body mass index at bivariate analysis. In multivariate analysis for anthropometric indices and sex, only neck circumference remained significantly correlated with blood pressure ( p < 0.05). Conclusion The prevalence of hypertension among adolescents in the study setting was low. An increase in neck circumference results in an increase in blood pressure among adolescents.
Introduction: Handwashing is a low-cost, high-impact strategy for limiting the transmission of COVID-19. We assessed the level of compliance to handwashing and associated factors, among Ugandan residents, in the first two months of the outbreak in Uganda, to inform prevention measures.
Abstract Background Safeguarding the psychological well-being of healthcare workers (HCWs) is crucial to ensuring sustainability and quality of healthcare services. During the COVID-19 pandemic, HCWs may be subject to excessive mental stress. We assessed the risk perception and immediate psychological state of HCWs early in the pandemic in referral hospitals involved in the management of COVID-19 patients in Uganda. Methods We conducted a cross-sectional survey in five referral hospitals from April 20–May 22, 2020. During this time, we distributed paper-based, self-administered questionnaires to all consenting HCWs on day shifts. The questionnaire included questions on socio-demographics, occupational behaviors, potential perceived risks, and psychological distress. We assessed risk perception towards COVID-19 using 27 concern statements with a four-point Likert scale. We defined psychological distress as a total score > 12 from the 12-item Goldberg’s General Health Questionnaire (GHQ-12). We used modified Poisson regression to identify factors associated with psychological distress. Results Among 335 HCWs who received questionnaires, 328 (98%) responded. Respondents’ mean age was 36 (range 18–59) years; 172 (52%) were male. The median duration of professional experience was eight (range 1–35) years; 208 (63%) worked more than 40 h per week; 116 (35%) were nurses, 52 (14%) doctors, 30 (9%) clinical officers, and 86 (26%) support staff. One hundred and forty-four (44%) had a GHQ-12 score > 12. The most common concerns reported included fear of infection at the workplace (81%), stigma from colleagues (79%), lack of workplace support (63%), and inadequate availability of personal protective equipment (PPE) (56%). In multivariable analysis, moderate (adjusted prevalence ratio, [aPR] = 2.2, 95% confidence interval [CI] 1.2–4.0) and high (aPR = 3.8, 95% CI 2.0–7.0) risk perception towards COVID-19 (compared with low-risk perception) were associated with psychological distress. Conclusions Forty-four percent of HCWs surveyed in hospitals treating COVID-19 patients during the early COVID-19 epidemic in Uganda reported psychological distress related to fear of infection, stigma, and inadequate PPE. Higher perceived personal risk towards COVID-19 was associated with increased psychological distress. To optimize patient care during the pandemic and future outbreaks, workplace management may consider identifying and addressing HCW concerns, ensuring sufficient PPE and training, and reducing infection-associated stigma.
