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    Plasma levels of DDE/DDT and liver function in malaria control personnel 6 months after indoor residual spraying with DDT in Northern Uganda, 2008
    (The South African Medical Journal, 2010-02) Bimenya, G.S. ; Harabulema, M. ; Okot, J.P. ; Olwa, Francis ; Lugemwa, Myers ; Okwi, A.L.
    Objective. We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS). Method. This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrations of amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) were analysed using routine clinical chemistryautomated methods (Konelab, Vantaa, Finland). Results. All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (±26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) μg/l. Conclusion. Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available.
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    Clinical presentation and in-hospital outcome of patients with myocardial infarction admitted in Mulago hospital
    (MAKERERE UNIVERSITY, 2014-05) Achan, Josephine
    Background Myocardial infarction is one of the leading causes of mortality worldwide with decreasing incidence in developed countries and increasing incidences in developing countries, Uganda inclusive. This increasing trend has been attributed to urbanization and changing life styles in developing countries. There is high burden of risk factors like hypertension and diabetes mellitus in our setting Objectives To describe the clinical presentation and in-hospital outcome among patients admitted with myocardial infarction in Mulago hospital. Methods This was a prospective cohort study that was conducted in Mulago Hospital complex and Uganda Heart Institute. 54 subjects were recruited during the eight months study period. Data on clinical presentations, associated risk factors, laboratory and imaging findings, and complications were collected through standardized questionnaire. Blood samples were obtained for laboratory investigations. Participants were followed for minimum of two weeks and maximum of one month. Results A total of 54 patients were recruited, 29/54 (63%) had ST segment elevation myocardial infarction (STEMI) and 17/54(37%) had non-ST segment elevation myocardial infarction. Chest pain (66.7%) was the common presentation. Most patients in this study came to the hospital more than 72hours with median time of presentation to the hospital from onset of symptoms 93.5hours (SD 57.09, OR=1.002 95%CI 0.9-1.0). The mean age for the study participants was 58.7(SD=+/-10) with more males 38/54 (70.4%) than females 16/54(29.6%). Common associated symptoms were breathlessness 39/54(54.7%), palpitations 21/54(38.9%). Symptoms occurred at rest, with exercise and emotional stress. Only 7/59(13%) of the participants had low systolic and 11/54(20.4%) low diastolic blood pressure. 18/54(33.3%) had high systolic and 20/54(37%) diastolic pressure at admission. 19/54(35.2%) of participants had significant pulmonary rales at admission. 34/54(63%) had New York Heart Association class I and 40/54(74.1%) were in Killip class I. Risk factors include past medical history of hypertension 35/54 (OR=1.53, 95% CI=0.48-4.90), diabetes mellitus (OR=1.52, 95% CI=0.46-4.95), dyslipidaemia 7/54 (OR=1.73, 955CI=0.29-10.10), high LDL Cholesterol were higher risk for myocardial infarction. Low HDL (OR=1.9, 95% CI=0.55-6.58) confers higher risk for myocardial infarction compared to normal and high HDL cholesterol levels. Also similar patterns are seen in family history as positive for hypertension (59.3%) (OR=1.1, 955CI=0.35-3.88) and diabetes mellitus (37%). 50.9% of male and 92.9% of female participants had abdominal circumference greater than 102cm and 88cm respectively. Higher body mass index of 24.5-29.5(OR=2.0, 95%CI 0.3-13.1) and 29.5-39(OR=2.2, 95%CI=0.38-13.5) though the p value is not statistically significant was also a risk for myocardial infarction. Positive history of current or former h/o alcohol consumption constituted more than half of the participants (29/54). In contrast only approximately 13/54(24.1%) were current or previous smokers. Over all 10/54(24.1%) developed shock, 10/54(18.5%) had pulmonary oedema and congestive heart failure, 6/54(11.1%) developed arrhythmia, 6/54(11.1%) died in the hospital, and 2/54(3.7%) had ventricular wall aneurysm formation. 1/54(1.9%) had stroke, re infarction and thrombus formation. No patient developed pericarditis and LV dysfunction. Conclusion Majority of patients admitted with myocardial infarction had STEMI and present with chest pain. Most patients are males. Hypertension, Diabetes Mellitus and dyslipidaemia were high risk factors. There was delayed time to presentation to hospital from the time of onset of symptoms. Almost half of the patients with STEMI developed pulmonary edema, shock, congestive heart failure and arrhythmia.
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    Ectoparasites of small mammal communities in restored oil prospecting sites in Buliisa and Hoima districts
    (Makerere University, 2015) Nalikka, Betty
    A study of small mammal diversity and their ectoparasites was undertaken in seven restored oil exploration sites within the Albertine Graben between April and August 2013. Small mammals were surveyed using Sherman, Museum special and Victor rat traps. From each of the captured small mammals, ectoparasites were recovered, preserved in ethanol and later processed in the laboratory for identification. To determine whether management practices affect small mammal compositions and their ectoparasite infestations, analyses were conducted to compare the compositions and infestation levels in three area management categories; a national park, a wildlife reserve and a communal grazing area. A total of 143 small mammals belonging to ten species were captured from a total of 2273 trap nights with Mastomys natalensis being the most abundant small mammal species and being found in all the sites which were surveyed. A chi-square test showed no variation in the diversity of small mammal species across sites, X2 (54, N=29) =32.97, p=0.99. A total of 1339 ectoparasites belonging to 12 species were recovered from the captured small mammals. These belonged to four groups; mites (72.21 %), fleas (9.18 %), lice (11.87 %) and ticks (6.80 %). A Kruskal-Wallis test showed no difference in the ectoparasite diversity on small mammals in the different study sites, X2 (6, N=7) =5.07, p=0.54. The mite Echinolaelaps echidninus was the most abundant ectoparasite species representing 58.85 % of all the recovered ectoparasites. Only one small mammal species Crocidura jacksoni was found without ectoparasites. Mastomys natalensis had the highest level of ectoparasites infestation than any other small mammal species. M. natalensis and Tatera valida had a higher infestation of fleas than any of the other small mammals but the former had all three species of flea and the latter only two. A multiple regression showed a statistically significant variation in ectoparasite infestation levels on small mammal species in the different area management categories, F (1, 19) = 12.85, p < .0005, R2 =0.37. The study concluded that simplification of habitats was associated with a reduction in the diversity of small mammals as well as their ectoparasites. Measures against human and/or livestock incursion into wildlife habitats to prevent alteration of habitats were recommended.
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    Incidence and predictors of treatment failure to second line Antiretroviral treatment in a young people living with HIV clinic
    (Makerere University, 2015) MATOVU, MOSES
    Background: Second line (PI) based regimens are still very expensive in most developing nations yet will be needed soon by the high number of people on ART due to treatment failure. We asked whether socio-demographic, laboratory and treatment data can be used to estimate the incidence of treatment failure on second line based regimens and to predict treatment failure in a young people living with HIV clinic at Baylor-Uganda. Methods: A retrospective cohort study was carried out on 298 medical records of young people living with HIV receiving second line care and treatment at Baylor-Uganda between the period 2010 and 2013. Results: During the follow up time of 12 (5-49.0) months, there were 65 (21.8%) primary endpoints (treatment failure). The incidence rate was 18.2 (14.3-23.2) per 100 person years and the predictors that were associated with second line treatment failure were duration on ART medication of 1-2 years (HR=3.485, p=0.009), duration on ART of 3-4 years (HR=4.186, p=0.000), duration on ART of > 5years (HR=7.418, p=0.000), viral load > 1000 cp/ml (HR=3.933, p=0.000) and adherence levels < 95% (HR=2.775, p=0.001). Conclusion: A relatively high rate of treatment failure was reported from a clinical setup among young people living with HIV/AIDS in Kampala Uganda. Elevated viral load count, poor adherence and duration on ART were the predictors identified to second line treatment failure.
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    Factors associated with tobacco use among commercial motorcyclists in Arua Municipality, Arua district, Uganda
    (Makerere University, 2015) Apolot, Rebecca Racheal
    Introduction: Tobacco use is a public health threat that contributes to global burden of Non-Communicable Diseases (NCDs). The World Health Organization (WHO) reports that approximately one person dies every six seconds due to tobacco use, accounting for one in 10 adult deaths and up to half of current users will eventually die of a tobacco-related disease. Tobacco smoking alone among commercial motorcyclists in Arua stands at 57%. The factors associated with this prevalence in this population were not studied and this study therefore sought to explore and fill that gap. Objectives: To assess the factors associated with tobacco use among commercial motorcyclists in Arua municipality so as to generate useful information for designing tobacco use control strategies among this population. Methods: This was a cross-sectional study, conducted in Arua Municipality. Interviewer administered semi-structured questionnaires were administered to 767 commercial motorcyclists. Data was entered using Epidata 3.1 and exported to STATA 12 for analysis at univariable, bivariable and multivariable levels. Prevalence Risk Ratios (PRR) were used for statistical associations at 95% Confidence Interval (CI), p-values <0.05 were taken to be statistically significant. Results: The prevalence of tobacco use was 63.8 % (489/767), commercial motorcyclists with family history of smoking were 1.3 times likely to use any form of tobacco compared to those with no family history of smoking (PRR=1.26, 95% CI; 1.15-1.39; p<0.001). Only 5% of the commercial motorcyclists were less likely to use any form of tobacco when the cost of cigarettes was expensive compared to cheap. Commercial motorcyclists who said tobacco was readily available to them were 1.3 times likely to use tobacco compared to those who said tobacco was not readily available. Occupational factor associated with use of any form of tobacco was working for ≥ 16 hours (PRR 1.51, 95% CI 1.06-2.51, P= 0.02). Conclusion: The prevalence of tobacco use among the motorcyclist was high. Individual factors associated with use of tobacco were; family history of smoking, neutral and positive attitude on tobacco use; environmental factors were; cost of cigarettes, cigarettes readily available and weather conditions while Occupational factor was working for more than 16 hours. Increase of taxes on tobacco products and targeted health education for commercial motorcyclists would contribute to reduction of tobacco use in this population.
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    Risk factors for hypertension and frequency of target organ damage in hypertensive adults in Kampala
    (Makerere University, 2015-05) Twinobuhingiro, Aska
    Background: Hypertension is the leading risk factor for premature death and disability worldwide. Epidemiologic data on risk factors for hypertension among adults in urban Uganda is currently lacking. Objectives: 1) To determine the risk factors of hypertension in adults in Kampala; 2) To determine the prevalence of left-ventricular hypertrophy and micro-albuminuria in hypertensive adults of Kampala. Materials and methods: We recruited 315 cases and 315 controls attending a community hypertension screening program at two large churches and one mosque. Participants were interviewed, physically examined and provided a blood sample for testing; cardiac imaging and urinalysis were performed on cases to assess for target organ damage. Result: The study enrolled 315 hypertensive who were matched with equal number of none hypertensive by age group and sex. The participants had mean age of 44.3 years (range= 18 – 85). At overall model analysis, compared to those with a normal BMI, being overweight increased the odds of hypertension by 50% (OR=1.5, 95%CI: 1.18-2.05, p= 0.01) and obesity by 101% (OR =2.0, 95% CI: 1.23-3.27, p= 0.01). There was a significant increase in the odds of hypertension for: smokers vs nonsmokers (OR=1.64, 95%CI: 1.08-2.5, p=0.06), positive family history of diabetes vs none (OR=1.4, 95% CI: 0.98-1.98) and abnormal waist hip ratio vs normal (OR= 1.5, 95% CI: 0.94-2.45, p=0.09) in males. The prevalence of target organ was 32.2% for micro-albuminuria and 28% for LVH. Conclusion: In an urban population in Uganda, risk of hypertension increases with high BMI, smoking, abnormal waist-hip ratio and family history of diabetes. The high prevalence of target organ damage indicates a high burden of advanced hypertension in the community that may be undiagnosed. Public health interventions targeted at risk reduction and early diagnosis will be essential in addressing the burden of hypertension among urban dwellers
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    The prevalence and factors associated with umbilical arterial doppler abnormalities in women with pre-eclampsia at Mulago hospital
    (Makerere University, 2015-06) PETER, GIMEI
    Introduction: Umbilical artery Doppler velocimetry detects fetuses at risk of asphyxia from IUGR before changes in the CTG and biophysical score are evident. This has made it a primary fetal surveillance tool in pre-eclampsia in developed countries with resultant reduction in perinatal mortality by 29%. However, its routine use in high risk pregnancies is currently not feasible in resource limited settings. The objective was to determine the prevalence and factors associated with UA Doppler abnormalities in women with preeclampsia from 28 weeks of pregnancy so as to identify a subpopulation of these women who would require routine UA Doppler velocimetry to improve perinatal outcomes in a resource limited context. Methods: This was a cross-sectional analytical study at Mulago NRH conducted between June and September 2014. A total of 155 women with pre-eclampsia between 28 and 42 weeks of pregnancy with live singleton fetuses underwent UA Doppler sonography to determine the RI, S/D ratio, AEDV and RF patterns. The data were entered into EPIDATA 3.1 and exported to STATA version 12 for analysis. Results: The overall prevalence of UA Doppler abnormalities was 31.6%. High RI, high S/D ratio, AEDV and RF were found in 25.8%, 31.6%, 7.7% and 4.5% of the population respectively. The main factors associated with UA Doppler abnormalities were gestational age below 35 weeks (AOR=8.1, 95% CI: 2.91-22.76, P<0.001), severe pre-eclampsia with heavy proteinuria (AOR=7.3, 95% CI: 2.82-18.87, P<0.001), and multiparity (AOR=5.3, 95% CI: 1.52-18.53, P<0.001). Severe pre-eclampsia comprised 61% (n=95) of the study population. Maternal age and pre-eclampsia with light proteinuria had no association with UA Doppler abnormalities. Conclusion: UA Doppler abnormalities are very common in pre-eclampsia. Gestational age below 35 weeks and heavy proteinuria were the main associated factors of these abnormalities
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    Awareness and practices of preconception care among women attending antenatal care at Rushere community hospital, kiruhura district
    ( 2015-08) Tweheyo, Samuel
    Background: Preconception care (PCC) has been shown to be effective in improving the health of mothers and pregnancy outcomes in developed countries. The aim of this study was therefore to describe the awareness and practices of preconception care among women attending ANC in Kiruhura district. Methods: The study was a cross-sectional descriptive study that used both quantitative and qualitative methods. Sample size was 376 women and study area was Rushere community hospital. Results: Three hundred seventy six pregnant women were interviewed. The mean/median age of respondents was 26 years (range 16–45 years). A total of 106(28.2%) respondents were prime gravid; 164(43.6%) multipara, and 106(28.2%) grandmultipara. 59(15.7%) respondents had no formal education while 225(59.8%) had primary school education, 75(20%) had secondary school education and only 17(4.9%) had tertiary education. Awareness A total of 144(38.3%) respondents had heard of preconception care and were referred to as the ‘aware group’. Out of these, 52(36.11%) could correctly define it. The respondents’ awareness of preconception care and their ability to define the subject correctly increased significantly with their educational status. Practice A total of 84 (22.34%) practiced some form of preconception care. Only 70(83.3%) of those who practiced PCC consulted health staff and of these, 22(31.42%) consulted general practitioners and clinical officers, while 48(68.6%) consulted nurses while the other 14(16.67%) respondents consulted traditional birth attendants and their parents. Conclusion: Generally women were not aware of preconception care, especially the forms of medical assessment and screening procedures that are done although there was some awareness in the simple definition and counseling about healthy life style. This study therefore has pointed out that Rushere hospital staff need to think of innovative ways to improve levels of PCC awareness and practice among the general population that it serves.
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    Factors associated with empathy among midwives working in obstetrics and gynecology department of Mulago hospital Uganda
    (Makerere University, 2015-08) TENGERA, OLIVE
    Introduction: Empathy is an essential component of a caring relationship and especially critical to the provision of quality midwifery care. It enables health care professionals to identify and understand patient‘s experiences, concerns and perspectives. Empathy is also fundamental to the health care provider-patient relationship. There is limited evidence about midwives empathy level and associated factors. Objective: The major purpose of the study was to assess factors associated with empathy among midwives working in Obstetrics and Gynecology (OBGY) Department of Mulago Hospital, Kampala Uganda. Methodology: A cross sectional study was carried out among 185 midwives. The Jefferson Scale of Empathy–Health Professional (JSE-HP), a valid and a reliable self-report scale was used. Descriptive statistical analysis, cross tabulation and logistic regression were used in the analysis. The resulting mean empathy scores were analyzed alongside personal and work related factors. Results: The study found that the level of empathy among midwives is slightly above average. Only 53 percent of the participants scored above the mean empathy score. Personal factors including the place of work (labour suite or clinic/wards/theatre) where the midwife worked were significantly associated with empathy scores (X2=11.260, P=0.046). Similarly and the years of experience in the current OBGY unit was associated with empathy scores (P=0.050, OR 2.131, CI0.980-4.632). Heavy workload was identified as work related factor, significantly associated with empathy score of midwives (P=0.037). Other work related factors identified to influence empathy among midwives were motivation (P=0.08), and work environment (P=0.07). Conclusion: The unit where a midwife worked, years of experience working in OBGY unit and workload were significantly associated with midwives‘ empathy. Working environment needs to be improved in order to enhance the midwives‘ empathy.
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    Prevalence and risk factors of echinococcus granulosus infection in dogs in Moroto and Bukedea districts in Uganda
    (Springer Netherlands, 2016) Oba, Peter ; Ejobi, Francis ; Omadang, Leonard ; Chamai, Martin ; Okwi, Andrew Livex ; Othieno, Emmanuel ; Inangolet, Francis Olaki ; Ocaido, Michael
    A cross sectional study was conducted in Moroto and Bukedea districts of Uganda from May to September 2013 to determine the prevalence and risk factors of Echinococcus granulosus infection in dogs. Fresh dog faecal samples were collected, preserved in 70 % ethanol, and later screened for presence of taeniid eggs using zinc chloride floatation method. Positive samples were confirmed by a copro-PCR (polymerase chain reaction) for E. granulosus using NADH dehydrogenase sub-unit 1 gene (NADH1) as a target molecular marker. Structured questionnaires and focus group discussions were used to collect quantitative and qualitative data for risk factor identification. Study sub-counties were selected by simple random sampling. Overall apparent prevalence of taeniid infection in dogs of 14.9 % (39/261, confidence interval 10.6–19.2) in both districts was recorded using the faecal floatation test. The sensitivity of the faecal floatation test was found to be 78 % (25/32), while the specificity was 93%(215/229). Copro-PCR results revealed a true prevalence of 14.4% (9.91–19.0, 95 % CI) in dogs in Moroto district and 7.4 % (2.14–12.60, 95 % CI) in Bukedea district. The overall true prevalence of cystic echinococcosis (CE) was 12.2 % (8.70–15.76, 95 % CI) in both districts. The major risk factors identified using logistic regression were uncontrolled access of dogs to animal slaughter facilities, higher cattle herd sizes and lack of knowledge about the disease. It was recommended that restricting dog access to infected tissues and public health education about epidemiology of CE should be done.
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    Outcome at two weeks in patients with Traumatic brain injury following road traffic accidents in an urban tertiary hospital in Uganda
    (Congent Medicine, 2017) Erem, Geoffrey ; Bugeza, Sameul ; Kiguli, Elsie Malwadde
    : Road traffic accidents (RTAs) are a major global public health problem and are now a recognized neglected pandemic. Head injuries cause immediate death in 25% of acute trauma. We conducted this study to determine the immediate outcomes in adult with head injury following RTA. A prospective study was conducted among 178 adult patients and followed up for two weeks to determine immediate outcomes. Multivariate logistic regression analysis was used to determine predictor variables of immediate outcome. Majority had moderate disability (38.2%), then severe disability (25.8%) and good recovery (24.7%) at two weeks. Persistent vegetative state and death occurred in 2 and 9% of patients respectively. Sixty-three percent of patients had favourable outcome. Convulsions, intracerebral haemorrhage had significant p-values at bivariate analysis (0.019, 0.008 respectively) at GCS. Vomiting, convulsions, extra cerebral haemorrhage and intracerebral haemorrhage had significant association p values (0.000, 0.001, 0.000 and 0.000 respectively) at two weeks by GOS. Level of consciousness (p-value = 0.000), intracerebral haemorrhage (p = 0.003), skull fractures (p = 0.001) and surgery (p = 0.016) were statistically significant at multivariate analysis. GCS and GOS were important in assessment of immediate outcomes at 2 weeks but GOS was a more reliable assessment tool.
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    Effects of the informed health choices podcast on the ability of parents of primary school children in Uganda to assess claims about treatment effects : A randomised controlled trial
    (The Lancent, 2017) Semakula, Daniel ; Nsangi, Allen ; Oxman, Andrew D. ; Oxman, Matt ; Austvoll-Dahlgren, Astrid ; Rosenbaum, Sarah ; Morelli, Angela ; Glenton, Claire ; Lewin, Simon ; Kaseje, Margaret ; Chalmers, Iain ; Fretheim, Atle ; Doris Tove Kristoffersen, Doris Tove ; Sewankambo, Nelson K
    Background: As part of the Informed Health Choices project, we developed a podcast called "The Health Choices Programme" to help improve the ability of people to assess claims about the benefits and harms of treatments. We aimed to evaluate the effects of the podcast on the ability of parents of primary school children in Uganda to assess claims about the effects of treatments. Methods: We did this randomised controlled trial in central Uganda. We recruited parents of children aged 10–12 years who were in their fifth year of school at 35 schools that were participating in a linked trial of the Informed Health Choices primary school resources. The parents were randomly allocated (1:1), via a web-based random number generator with block sizes of four and six, to listen to either the Informed Health Choices podcast (intervention group) or typical public service announcements about health issues (control group). Randomisation was stratified by parents’ highest level of formal education attained (primary school, secondary school, or tertiary education) and the allocation of their children’s school in the trial of the primary school resources (intervention vs control). The primary outcome, measured after listening to the entire podcast, was the mean score and the proportion of parents with passing scores on a test with two multiple-choice questions for each of nine key concepts essential to assessing claims about treatments (18 questions in total). We did intention-to-treat analyses. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201606001676150. Findings: We recruited parents between July 21, 2016, and Oct 7, 2016. We randomly assigned 675 parents to the podcast group (n=334) or the public service announcement group (n=341); 561 (83%) participants completed follow-up. The mean score for parents in the podcast group was 67•8% (SD 19•6) compared with 52•4% (17•6) in the control group (adjusted mean difference 15•5%, 95% CI 12•5–18•6; p<0•0001). In the podcast group, 203 (71%) of 288 parents had a predetermined passing score (≥11 of 18 correct answers) compared with 103 (38%) of 273 parents in the control group (adjusted difference 34%, 95% CI 26–41; p<0•0001). No adverse events were reported. Interpretation: Listening to the Informed Health Choices podcast led to a large improvement in the ability of parents to assess claims about the effects of treatments. Future studies should assess the long-term effects of use of the podcast, the effects on actual health choices and outcomes, and how transferable our findings are to other countries.
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    Knowledge, attitude and usage of medical animations as a complementary learning resource by undergraduates at Makerere University College of Health Sciences
    (Makerere University, 2017) Nansinguza, Jacob
    Background: A medical animation is a short educational film, usually based around medical topic rendered using three-dimensional computer graphics. It evolved from the field of realistic medical illustrations such as those created by Andrea Vesalius and became viable for medical use in the 1960s. Its main uses in learning are supporting the visualization and mental representation process. Objective The objective of this study was to assess knowledge, attitude and usage of medical animations as a complementary learning resource by undergraduates at MakCHS. Methods: This was a cross sectional descriptive study that employed mixed methods for data collection. It was carried out among first and second year undergraduate students within Makerere University in the 2016/17 academic year, between May and October 2016. A survey consisting of semi structured, self-administered questionnaires collected quantitative data from 229 students and, 23 individuals participated in the four focus group discussions. Quantitative data was entered using Epi-data 3.02 and exported to STATA 12 for analysis. Frequencies and proportions were obtained to describe the data. Logistic regression analysis was done to establish association between independent and dependent variables at 95% confidence interval and 0.05 level of significance. Qualitative data was collected through focus group discussions, transcribed and later coded into common subthemes and subsequently, into themes. It was analyzed under interpretivism approach. Results: Majority of the participants (58.1%) were males, 42.8% were aged 21-23 with a mean age of 22.7 (SD 3.8) years. More than half of the participants 53.3% were studying MBChB. Majority of the participants (79.5%) had ever heard about medical animations while, only 56.8% of the participants were knowledgeable. A significant number 91.3% of participants had a positive attitude towards medical animations. The main independent variables for use of medical animations were knowledge (Adj OR=0.33 ; 95% CI=0.18-0.62) and attitude (Adj OR=0.19; 95% CI=0.06-0.58). Whereas the major source of information about medical animations was lecturers, colleagues from other universities were the main source of medical animations. Conclusion: This study reveals that half of the participants are knowledgeable about medical animations. A significant number of participants have a positive attitude towards medical animations and have ever used them in their complementary learning. Main independent variables for use of medical animations are knowledge and attitude. Almost all participants 223/229 recommend usage of the resource.
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    Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects : A cluster-randomised controlled trial
    ( 2017) Nsangi, Allen ; Semakula, Daniel ; Oxman, Andrew D. ; Oxman, Matt ; Austvoll-Dahlgren, Astrid ; Rosenbaum, Sarah ; Morelli, Angela ; Glenton, Claire ; Lewin, Simon ; Kaseje, Margaret ; Chalmers, Iain ; Fretheim, Atle ; Kristoffersen, Doris Tove ; Sewankambo, Nelson K
    Background: Claims about what improves or harms our health are ubiquitous. People need to be able to assess the reliability of these claims. We aimed to evaluate an intervention designed to teach primary school children to assess claims about the effects of treatments (ie, any action intended to maintain or improve health). Methods: In this cluster-randomised controlled trial, we included primary schools in the central region of Uganda that taught year-5 children (aged 10–12 years). We excluded international schools, special needs schools for children with auditory and visual impairments, schools that had participated in user-testing and piloting of the resources, infant and nursery schools, adult education schools, and schools that were difficult for us to access in terms of travel time. We randomly allocated a representative sample of eligible schools to either an intervention or control group. Intervention schools received the Informed Health Choices primary school resources (textbooks, exercise books, and a teachers’ guide). Teachers attended a 2-day introductory workshop and gave nine 80 min lessons during one school term. The lessons addressed 12 concepts essential to assessing claims about treatment effects and making informed health choices. We did not intervene in the control schools. The primary outcome, measured at the end of the school term, was the mean score on a test with two multiple-choice questions for each of the 12 concepts and the proportion of children with passing scores on the same test. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201606001679337. Findings: Between April 11, 2016, and June 8, 2016, 2960 schools were assessed for eligibility; 2029 were eligible, and a random sample of 170 were invited to recruitment meetings. After recruitment meetings, 120 eligible schools consented and were randomly assigned to either the intervention group (n=60, 76 teachers and 6383 children) or control group (n=60, 67 teachers and 4430 children). The mean score in the multiple-choice test for the intervention schools was 62•4% (SD 18•8) compared with 43•1% (15•2) for the control schools (adjusted mean difference 20•0%, 95% CI 17•3–22•7; p<0•00001). In the intervention schools, 3967 (69%) of 5753 children achieved a predetermined passing score (≥13 of 24 correct answers) compared with 1186 (27%) of 4430 children in the control schools (adjusted difference 50%, 95% CI 44–55). The intervention was effective for children with different levels of reading skills, but was more effective for children with better reading skills. Interpretation: The use of the Informed Health Choices primary school learning resources, after an introductory workshop for the teachers, led to a large improvement in the ability of children to assess claims about the effects of treatments. The results show that it is possible to teach primary school children to think critically in schools with large student to teacher ratios and few resources. Future studies should address how to scale up use of the resources, long-term effects, including effects on actual health choices, transferability to other countries, and how to build on this programme with additional primary and secondary school learning resources.
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    Consumer health information literacy promotion program in public and community libraries in Africa : experience from Kenya, Nigeria, Uganda, and Zimbabwe
    (Taylor & Francis Group, 2017) Ajuwon, Grace A. ; Kamau, Nancy ; Kinengyere, Alison ; Masimba, Muziringa
    The aim of this project was to enhance the capacity of public and community librarians in four African countries (Kenya, Nigeria, Uganda, and Zimbabwe) in meeting the consumer health information (CHI) needs of their patrons. A total of 65 librarians from 34 public and community libraries were trained on how to access and use consumer health information resources by health sciences librarians in the selected countries. A needs assessment preceded the training that focused on health literacy, health information literacy, sources of health information, online information searching tools and search techniques, and how to search CHI resources, including Kidshealth.org, Womenshealth.gov, MedlinePlus, and CancerNet, among others. Each team of participating libraries received a seed grant to design and implement a consumer health activity. The trained public and community librarians in both Nigeria and Uganda conducted training on use of CHI resources to different categories of patrons. In Nigeria, high school students were trained on how to use their mobile phone to access CHI resources. Adolescents and other categories of library patrons were trained on information and communication technology (ICT) skills and accessing CHI resources in Uganda. In Kenya, the public librarian created a Consumer Health Information Corner and purchased CHI books for patrons to consult, while in Zimbabwe, the public library partnered with other non-governmental organizations to provide consumer health information materials to the library for patron use. It is possible for academic health sciences librarians to partner with public and community librarians in Africa to carry out a successful CHI project.
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    Knowledge Attitude and Practice of Medical Photography among Postgraduate Students at Makerere University College of Health Sciences
    (Makerere University, 2017) Bamusonighe, Apollo Peter
    BACKGROUND Medical Photography is concerned with taking images that are beneficial to medical practice. As a specialized area of photography, it entails the documentation of clinical presentation of patients, medical and surgical procedures, medical devices and specimens. This requires specialised training and skills to accomplish the desired outcome. However, due to the increased availability of easy-to-use point and shoot cameras among the population, it is possible to take medical photographs by persons not trained as medical photographers. There was a need therefore, to assess the knowledge, attitude and practice of medical photography among postgraduate at Makerere University College of Health Sciences. METHODOLOGY This was a cross-sectional, descriptive study conducted at the Makerere University College of Health Sciences. Primary data was collected from 141 participants using a self-administered questionnaire adapted from a tool formulated by WHO. Secondary data was obtained from analysing 144 medical photographstaken by post graduates using the tool developed by Tango tools.These photographs were analysed for impact and interest, viewpoint, colour management, composition, technique, manipulation and presentation. RESULTS The majority of the participants were aged 30 and below 48.2%, male 66% and offered general surgery 26.2% as a study program. Only 39% of the participants were knowledgeable about medical photography. However, 81.6% had heard about medical photography and 56.7% knew people who practiced medical photography.The majority of participants 78% had a positive attitude towards medical photographs while69.5% felt that they could take quality medical photographs.Only 13.5% of the participants took their own medical photographs and 81.6% reported mobile phone as the most frequently used equipment.Theavailability of quality medical photographs was a challenge among81.6%of the participants. The photographs analysed revealed that 77.8% were snapshots and photograph quality was affected by framing decisions and post shoot manipulation. x CONCLUSION The majority of participants were exposed to medical photography directly through active involvement or indirectly through passive observation.Participants perceived medical photographsto beimportant but were not readily available. Choice of equipment and its use affected the medical photography process.
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    Where is students' research in evidence-informed decision-making in health? Assessing productivity and use of postgraduate students' research in low- and middle-income countries : a systematic review
    (BioMed Central, 2017) Obuku, E. ; Lavis, J. ; Kinengyere, A. ; Mafigiri, D. ; Sengooba, F. ; Karamagi, C. ; Sewankambo, N.
    Background: Investing in research that is not accessible or used is a waste of resources and an injustice to human subject participants. Post-graduate students’ research in institutions of higher learning involves considerable time, effort and money, warranting evaluation of the return on investment. Although individual studies addressing research productivity of post-graduate students are available, a synthesis of these results in low-income settings has not been undertaken. Our first aim is to identify the types of approaches that increase productivity and those that increase the application of medical post-graduate students’ research and to assess their effectiveness. Our second aim is to assess the determinants of post-graduate students’ research productivity. Methods: We propose a two-stage systematic review. We will electronically search for published and grey literature in PubMed/MEDLINE and the ERIC databases, as well as contact authors, research administration units of universities, and other key informants as appropriate. In stage one, we will map the nature of the evidence available using a knowledge translation framework adapted from existing literature. We will perform duplicate screening and selection of articles, data abstraction, and risk of bias assessments for included primary studies as described in the Cochrane handbook for systematic reviews. Our primary outcome is publication output as a measure of research productivity, whilst we defined research use as citations in peer-reviewed journals or policy-related documents as our secondary outcome. In stage two, we will perform a structured narrative synthesis of the findings and advance to quantitative meta-analysis if the number of studies are adequate and their heterogeneity is low. Adapting the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach, we will assess the overall quality of evidence for effects, and report our results in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Discussion: We will share our findings with universities, other training institutions, civil society, funders as well as government departments in charge of education and health particularly in low- and middle-income countries.
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    Clinical and cranial computed tomography scan findings in adults following road traffic accidents in Kampala, Uganda.
    (African Health Sciences, 2017) Erem, Geoffrey ; Bugeza, Samuel ; Kiguli, Elsie Malwadde
    Background: Globally, road traffic accidents are a major cause of death and disability. The developing countries bear a disproportionately large share of the RTAs which account for about 85% of the deaths. Most of these RTAs result in head injury, which globally, most scholars and medical practitioners consider a significant economic, social and medical problem. In Mulago National referral hospital, RTA is the leading cause of surgical admission. Objective: To describe the cranial computed tomography (CT) scan findings in adults following RTA in Mulago hospital. Methods: Using CT, detailed analysis of 178 adult patients with head injury following RTA was performed. Data was analyzed using SPSS version 16 and presented in tables and graphs. Data recorded included socio-demographic characteristics, clinical and CT variables. Results: Seventy seven percent of the respondents were between 18- 39 years. 52.6% of patients had open head injury. Headache was the most common clinical variable followed by dizziness and aphasia. The most common CT characteristic was extracerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral haemorrhage was commonest in the frontal lobe followed by parietal lobe. Conclusion: Public health interventions like advocacy and education of the population on safe and responsible road usage should be emphasized to reduce on RTAs
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    Can an educational podcast improve the ability of parents of primary school children to assess the reliability of claims made about the benefits and harms of treatments : study protocol for a randomised controlled trial
    (BioMed Central, 2017) Semakula, Daniel ; Nsangi, Allen ; Oxman, Matt ; Austvoll-Dahlgren, Astrid ; Sarah Rosenbaum, Sarah ; Margaret Kaseje, Margaret ; Nyirazinyoye, Laeticia ; Fretheim, Atle ; Chalmers, Iain ; Oxman, Andrew ; Sewankambo, Nelson K.
    Background: Claims made about the effects of treatments are very common in the media and in the population more generally. The ability of individuals to understand and assess such claims can affect their decisions and health outcomes. Many people in both low- and high-income countries have inadequate aptitude to assess information about the effects of treatments. As part of the Informed Healthcare Choices project, we have prepared a series of podcast episodes to help improve people’s ability to assess claims made about treatment effects. We will evaluate the effect of the Informed Healthcare Choices podcast on people’s ability to assess claims made about the benefits and harms of treatments. Our study population will be parents of primary school children in schools with limited educational and financial resources in Uganda. Methods: This will be a two-arm, parallel-group, individual-randomised trial. We will randomly allocate consenting participants who meet the inclusion criteria for the trial to either listen to nine episodes of the Informed Healthcare Choices podcast (intervention) or to listen to nine typical public service announcements about health issues (control). Each podcast includes a story about a treatment claim, a message about one key concept that we believe is important for people to be able to understand to assess treatment claims, an explanation of how that concept applies to the claim, and a second example illustrating the concept. We designed the Claim Evaluation Tools to measure people’s ability to apply key concepts related to assessing claims made about the effects of treatments and making informed health care choices. The Claim Evaluation Tools that we will use include multiple-choice questions addressing each of the nine concepts covered by the podcast. Using the Claim Evaluation Tools, we will measure two primary outcomes: (1) the proportion that ‘pass’, based on an absolute standard and (2) the average score Discussion: As far as we are aware this is the first randomised trial to assess the use of mass media to promote understanding of the key concepts needed to judge claims made about the effects of treatments.
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    The horizon of information sharing at Makerere University : multimedia, audiovisual and the linked open data
    (Science Publishing Group, 2017) Mulumba, Onan ; Kinengyere, Alison Annet ; Akullo, Winny Nekesa
    Makerere University has, in the recent past, climbed up the academic and research ranks, globally, and this has been supported by excellent information services, covering all available information resource formats and targeting users in the university community with varying information needs and information seeking behaviour. The metadata of such useful information resources is Machine-Readable. The major objective of this paper was to explore the level of data sharing at Makerere university library, focusing on audiovisual and multimedia collection. A semi-structured questionnaire (online and print) was administered to Library staff at Makerere University. The data were qualitatively and quantitatively analysed using simple percentages and recorded in tables and graphs. Of the 22 target respondents, a response rate of 81.8% (18) was realized. The results of the paper revealed that the majority of the librarians were not aware of the functionality of the LOD concept and the semantic web. Majority (88.9%) of the librarians were involved in data processing and entry for the general library collection, 18.8% of them are involved in data processing and entry for audiovisual and multimedia collection. It was further revealed that the data at Makerere university library is not linked to open data cloud and therefore not discoverable through the semantic web. The most prominent benefit of LOD cited by librarians was the opportunity to eliminate or reduce recreating existing descriptors already elaborated by other experts. The major challenges to linking data to open data cloud at Makerere university library were lack of skilled staff and lack of awareness about the concept of LOD.