School of Medicine (Sch. of Med.) Collections
http://hdl.handle.net/10570/183
2024-03-28T19:58:16ZThe abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
http://hdl.handle.net/10570/1277
The abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
Kwitonda, Pascal
INTRODUCTION:
Burkitt lymohoma is a B-cell lymphoma presenting in three main clinical variants: the endemic, the sporadic and the immunodeficiency-associated variants.
In Uganda, Burkitt’s lymphoma represents 50-70% of childhood cancers presenting mainly as facial tumour. Diagnosis depends on tissue examination. Imaging provides very useful diagnostic and staging information. Characteristically abdominal BL sonographically presents as well defined solid hypoechoic mass with mass effect; they lack calcifications and are a vascular on colour Doppler study. Ultrasound therefore plays an important auxiliary role in early detection and diagnosis of this potentially curable tumour and can be used to predict the prognosis.
OBJECTIVES:
The major objective of the study was to describe the sonographic features of BL and to relate them with the clinical features and laboratory findings in order to determine the prognostic benefit of abdominal ultrasound in patients with BL at the UCI-Mulago hospital.
METHODOLOGY:
This case series was conducted In UCI and Department of Radiology-Mulago hospital from march 2009 to September 2009. Sixty (60) patients with confirmed BL had abdominal ultrasonography done before initiation of chemotherapy and at one month after initiation of chemotherapy.
RESULTS:
Sixty (60) patients participated in the study. The age range was 3-18 years with a mean of 7.2 and standard deviation of 2.98. The peak incidence was between 5-9 years. There were 43 (71.7%) males and 17(28.3%) females. Facial bone tumours remained the commonest clinical finding however, the commonest single presenting compalit was palpable abdominal mass with pain in 31(51.7%) patients. Abdominal ultrasound showed that 40 (66.7%) of all patients had intra abdominal masses. Forty four (73.3%) patients had the tumours involving other parts of the body. Mpst patients presented with stage D disease and therefore had poor prognosis.
The commonest ultrasound findings were multiple lobulated heterogeneous hypoechoic abdominal masses in 40 (66.7%) patients. Of these masses 20(33.3%) were in the kidneys. Follow-up abdominal ultrasound showed that 32(80%) patients had tumour regression after one month of induction.
CONCLUSION:
• Abdominal ultrasound was able to demonstrate greater disease extent than clinical evaluation, thus highlighting the value of imaging in tumour staging and follow-up of patients.
• This study showed more cases of abdominal BL involvement than previously seen in our patients, possibly due to better imaging facilities now.
• Burkitt’s lymphoma should be strongly suspected in a child presenting with large lobulated hypoechoic intra-abdominal mass and histological diagnosis must be established as soon as possible.
• Serum LDH levels were very high in patients with large and multiple tumour sites involvement but decreased as the tumour mass regressed.
RECOMMENDATIONS:
• Follow up abdominal ultrasound should be done after one month of treatment in order to assess early response to chemotherapy.
• A bigger study should be done to comprehensively assess the role of ultrasound and serum LDH levels in follow up and determination of prognosis in BL patients.
A dissertation submitted in partial fulfillment of the requirements for the award of a Master of Medicine in Radiology of Makerere University.
2009-10-01T00:00:00ZAcceptability and perceptions of contraceptives among young HIV positive women in KCCA Art Clinics
http://hdl.handle.net/10570/7611
Acceptability and perceptions of contraceptives among young HIV positive women in KCCA Art Clinics
Muzeyi, Wani
Introduction
There are about 7000 new HIV infections among young women in Sub Saharan Africa. Forty- three percent of pregnancies among young HIV positive women in Uganda are either unwanted or mistimed and this accounts for 21.3% of neonatal HIV infections. The prevention of unwanted pregnancy among young HIV positive women through the use of effective modern contraceptives is a key component of the WHO’s four-pronged HIV prevention and control strategy.
Study objective.
To determine the acceptability of contraceptives, its associated factors and perceptions of contraceptives among young HIV positive women in KCCA ART Clinics.
Methods
We conducted a convergent parallel mixed-methods study from February to May 2019 among 450 participants in three Public Kampala city HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III). For quantitative data, participants were systematically recruited into the study and were interviewed using a structured questionnaire. Data was analysed using STATA 13. Acceptability of contraceptives was measured by the proportion of participants that reported contraceptives to be very acceptable or acceptable. Prevalence ratios were determined using modified Poisson regression reporting clustered robust standard errors with a 95% confidence interval (CI) and P values. For qualitative data, six to eight participants were purposively selected from each facility for in-depth interviews. A total of 20 in-depth interviews were conducted from the three facilities. Thematic analysis was used to describe the data.
Results
The acceptability of contraceptives among young HIV positive women was low at 40.4 %( 95% CI: 26.0-54.9). Age greater than19 years (PR; 6.88, 95%CI; 1.09-46.91, P =0.04), having a friend who uses contraceptive (PR; 1.89, 95CI; 1.12-3.19; P=0.018) and being divorced/separated (PR; 1.31, 95%CI; 1.03-1.67, P=0,027) were found to be significantly associated with acceptability of contraceptives. Regarding perceptions themes that emerged misconceptions on contraceptive use, lived experiences and perceived negative interaction between ARVs and contraceptive.
Conclusion
Acceptability of contraceptives among young HIV positive in KCCA ART clinics was low and this could have been due to perceptions young women have about contraceptive usage. Young HIV positive women should be given more information on the safety of contraceptives use.
2019-09-01T00:00:00ZAcceptability of cervical cancer screening using visual inspection with acetic acid and lugol's iodine among women attending the family planning clinic in mulago hospital.
http://hdl.handle.net/10570/601
Acceptability of cervical cancer screening using visual inspection with acetic acid and lugol's iodine among women attending the family planning clinic in mulago hospital.
Busingye, Priscilla
BACKGROUND:
Cervical cancer is the commonest malignancy among women in Uganda. Over 80% of patients diagnosed with cervical cancer in Mulago hospital present with advanced disease. Cytology based screening services are not feasible for low resource settings like Uganda. It is proposed that visual inspection with acetic acid and Lugol’s iodine is an alternative method to cytology. There are already programs going on with VIA/VILI but since they are new methods we need to know the acceptability of cervical cancer screening using these methods in Ugandan women.
OBJECTIVES:
The main objective of the study was to determine acceptability of cervical cancer screening using VIA/VILI among women attending the family planning clinics at mulago hospital.
METHODS:
It was a cross-sectional study with both quantitative and qualitative approaches. A total of 384 participants were recruited in the study
RESULTS:
Participants who accepted cervical cancer screening using VIA/VILI were 229. Of these, 209 that is, 91.3% were willing to recommend others for the same service while 223 participants that is 98.7% would return for the same screening if the need arose. 155 participants out of 384 did not accept screening. The reasons for refusal included; fear of undressing, fear of the speculum and fear of results. Findings were similar in the FGD.
CONCLUSIONS:
Acceptability of cervical cancer screening using VIA/VILI was found to be very high among women attending family planning in Mulago hospital. Some women refuse screening because of fear of instruments, undressing and fear of knowing that they might have cancer.
A Dissertation submitted in partial fulfillment of the requirements for the award of the academic degree of masters of medicine in Obstetrics and Gynaecology of makerere university.
2008-05-01T00:00:00ZAcceptability of TeleMental Health and its influencing factors among adolescent patients, caretakers, and mental health professionals at Butabika Hospital
http://hdl.handle.net/10570/12680
Acceptability of TeleMental Health and its influencing factors among adolescent patients, caretakers, and mental health professionals at Butabika Hospital
Segawa, Enock Suubi
Background: Mental disorders are a significant cause of disability worldwide, Uganda inclusive. In 2019, they accounted for 4.92% and 3.94% of the disease burden in the world and Uganda, respectively. Adolescents are at a relatively higher risk of these disorders due to developmental biological and psychological vulnerabilities to environmental stressors. Telemental health (TMH) can be used to increase access to mental health services for adolescents. However, its effectiveness will depend on its acceptability by adolescent patients, their caretakers, and mental health professionals (MHPs).
Main objective: To assess the acceptability of TMH for adolescent patients at Butabika Hospital among adolescent patients, their caretakers, and MHPs, and determine the associated factors among the patients and their caretakers.
Methods: A concurrent mixed-methods design was used. The quantitative research component was a cross-sectional design among 63 patients and 188 caretakers. Quota sampling was used. Data were collected using a researcher-administered questionnaire. It was managed in EpiData Manager and analysed using Stata software. The qualitative research component was with four mental health professionals, six patients, and eight caretakers. An exploratory descriptive qualitative approach was used. Data were collected through in-depth and key-informant interviews. It was managed in OpenCode and analysed by thematic analysis. Results from the qualitative were triangulated with those from the quantitative research component at the interpretation phase.
Results: Most patients were female (61.9%), did not own phones (59.7%), and had no experience with any TMH service (77.4%), while most caretakers were female (72.3%), owned phones (97.9%), and had no experience with any TMH service (81.4%).
The prevalence of high acceptability among patients was 77.8% (95% CI: 67.2% - 88.3%), and among caretakers was 93.1% (95% CI: 89.4% - 96.7%). None of the candidate factors was associated with high acceptability among patients, while caretaker acceptability was associated with phone ownership (aPR 0.940, 95% CI: 0.900 - 0.982). There were no confounding or interaction effects in the data. Most participants favoured using or providing the TMH service at Butabika Hospital. Furthermore, while using or providing the service was ethical, it presented difficulties in the case of providing it to minors who were non-emancipated patients. The mental health professionals also anticipated minimal opportunity costs, except if they had to provide it outside working hours. Finally, most participants believed that physical limits hampered the efficiency of the service.
Conclusion: Most patients and caretakers expressed high acceptability of the TMH service for adolescent patients at Butabika Hospital. Among caretakers, not owning a phone was associated with a high acceptability of TMH. However, the study was underpowered to detect associations between any candidate predictor and high acceptability. Most participants had favourable opinions about the service. However, they also expressed concerns about its limitations. The management of Butabika Hospital could consider conducting formative research about the TMH service. All TMH providers should endeavour to innovate within prevailing constraints to mitigate the limitations of TMH. Finally, future researchers should use large homogeneous samples from study populations to ensure adequate study power.
A research dissertation submitted to Makerere University in partial fulfilment of the requirements for the award of a degree in Masters of Science in Clinical Epidemiology and Biostatistics of Makerere University.
2023-11-01T00:00:00Z