NRU :: Browsing by Author "Buwembo, William"

Browsing by Author "Buwembo, William"

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Accreditation in a Sub Saharan Medical School: a case study at Makerere University
(BMC medical education, 2013) Galukande, Moses; Opio, Kenneth; Nakasujja, Noeline; Buwembo, William; Kijjambu, Stephen C.; Dharamsi, Shafik; Luboga, Sam; Sewankambo, Nelson K.; Woollard, Robert
Of more than the 2,323 recognized and operating medical schools in 177 countries (world wide) not all are subjected to external evaluation and accreditation procedures. Quality Assurance in medical education is part of a medical school’s ethical responsibility and social accountability. Pushing this agenda in the midst of resource limitation, numerous competing interests and an already overwhelmed workforce were some of the challenges faced but it is a critical element of our medical profession’s social contract. This analysis paper highlights the process of standard defining for Medical Education in a typically low resourced sub Saharan medial school environment. Methods: The World Federation for Medical Education template was used as an operating point to define standards. A wide range of stakeholders participated and meaningfully contributed in several consensus meetings. Effective participatory techniques were used for the information gathering process and analysis. Results: Standards with a clear intent to enhance education were set through consensus. A cyclic process of continually measuring, judging and improving all standards was agreed and defined. Examples of the domains tackled are stated. Conclusion: Our efforts are good for our patients, our communities and for the future of health care in Uganda and the East African region.
Assessment of Factors Associated with Dental Caries in Rural Communities in Rakai District, Uganda
(Clinical Oral Investigations, 2011) Rwenyonyi, Charles Mugisha; Muwazi, Louis Mugambe; Buwembo, William
To assess factors associated with dental caries in rural communities in Rakai District, Uganda. This was a cross-sectional survey in 18–62 year olds, randomly selected from three sub-counties: Kyalurangira (n = 121), Kabira (n = 133), and Kacheera (n = 67). The participants were clinically examined for caries using Decayed Missing Filled Teeth (DMFT) index and were administered to a structured questionnaire. In the whole material, caries prevalence (DMFT score > 0) was 57.3% and the mean DMFT score was 2.3. The M-component contributed 61% of the DMFT scores. Using bivariate analyses, age, consumption of sugared snacks and tobacco smoking were directly and significantly associated with development of dental caries. Tooth cleaning and previous dental visits were indirectly and significantly associated with dental caries. In binary logistic regression analyses, the participants who were older were four times and those who consumed sugared snacks were 11 times more likely to develop dental caries as compared to their counterparts. The participants who cleaned their teeth or who had visited the dentists were less likely to develop dental caries as compared to their counterparts. The odds ratios were 0.6 and 0.5, respectively. Based on stepwise multiple linear regression analyses, age, previous dental treatment, consumption of sugared snacks, tooth cleaning and tobacco smoking explained a total of 46% of the variations in DMFT scores. Caries prevalence and severity were relatively low in this population. Although a number of independent variables were significantly associated with caries they gave a modest overall multivariate model.
A comparison of oral bacteriome isolated from periodontal pockets of participants with or without diabetes mellitus in Uganda: a case control study
(BioMed Central Ltd, 2024-05) Kiryowa, Haruna Muhmood; Buwembo, William; Munabi, Ian Guyton; Mwaka, Erisa Sabakaki; Rwenyonyi, Charles Mugisha; Kaddumukasa, Mark; Kiguli, Sarah
Abstract Objective Diabetes mellitus predisposes patients to increased incidence and severe forms of periodontal disease. Currently, information on the bacterial diversity of patients with diabetes mellitus and periodontitis in Uganda is scanty. This study set out to describe the bacteria associated with periodontitis in patients with diabetes mellitus in Uganda, as part of a larger study describing the association between periodontal disease and diabetes mellitus. Results This was a case control involving 45 samples of gingival crevicular fluid collected from participants with periodontitis, the cases being 26 participants with diabetes mellitus and controls 19 participants without diabetes mellitus. Sequencing using the 16s Oxford nanopore long read protocol was followed by a bioinformatics analysis pipeline for alpha and beta diversity indices in the two groups. Multivariate tests were done to determine the differences in the bacterial composition in the two groups. Of the 739 Operational Taxonomic Units and 500 phyla identified, 37.9% (280/739) were from participants with diabetes mellitus. Analysis of beta diversity revealed a dissimilarity between the two study groups (CAP score=0) with a significant association noted between periodontitis and the subgingival bacteria (P=0.001). Diabetes mellitus reduced the quantity and altered the composition of the subgingival microbiome in the study participants. Keywords Diabetes mellitus, Microbiome, OTUs, Periodontal pockets and periodontitis
Informed consent in clinical practice: patients’ experiences and perspectives following surgery
(BMC research notes, 2015) Ochieng, Joseph; Buwembo, William; Munabi, Ian; Ibingira, Charles; Kiryowa, Haruna; Nzarubara, Gabriel; Mwaka, Erisa
Informed consent during medical practice is an essential component of comprehensive medical care and is a requirement that should be sought all the time the doctor interacts with the patients, though very challenging when it comes to implementation. Since the magnitude and frequency of surgery related risk are higher in a resource limited setting, informed consent for surgery in such settings should be more comprehensive. This study set out to evaluate patients’ experiences and perspectives of informed consent for surgery. Methods: This was a survey of post-operative patients at three university teaching hospitals in Uganda. The participants were interviewed using guided, semi-structured questionnaires. Patients from different surgical disciplines participated in the study.
Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting
(BMC research notes, 2015) Ochieng, Joseph; Ibingira, Charles; Buwembo, William; Munabi, Ian; Kiryowa, Haruna; Kitara, David; Bukuluki, Paul; Nzarubara, Gabriel; Mwaka, Erisa
Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting.
Moyer’s method of mixed dentition analysis: a meta-analysis
(African Health Sciences, 2004) Buwembo, William; Luboga, Sam
Mixed dentition analysis forms an essential part of an orthodontic assessment. Moyer’s method which is commonly used for this analysis is based on data derived from a Caucasian population. The applicability of tables derived from the data Moyer used to other ethnic groups has been doubted. However no meta-analyses have been done to statistically prove this. Objective: To assess the applicability of Moyer’s method in different ethnic groups. Study design: A meta-analysis of studies done on other populations using Moyer’s method. Method: The seven articles included in this study were identified by a literature search of Medline (1966-June 2003) using predetermined key words, inclusion and exclusion criteria. 195 articles were reviewed and meta-analyzed. Results: Overall the correlation coefficients were found to be borderline in variation with a p-value of 0.05. Separation of the articles into Caucasian and Asian groups also gave borderline p-values of 0.05. Conclusion Variation in the correlation coefficients of different populations using Moyer’s method may fall either side. This implies that Moyer’s method of prediction may have population variations. For one to be sure of the accuracy while using Moyer’s method it may be safer to develop prediction tables for specific populations. Thus Moyer’s method cannot universally be applied without question.
Musculoskeletal disorder risk factors among nursing professionals in low resource settings: a cross-sectional study in Uganda
(BioMedical Central, 2014) Kitara, David L.; Munabi, Ian G.; Buwembo, William; Ochieng, Joseph
Abstract Background: Musculoskeletal disorders (MSD) constitute one of the main occupational hazards among health care workers. However, few epidemiological studies on work related MSD among nursing professionals have been carried out in Africa. The purpose of this study was to assess the work related musculoskeletal disorders and associated risk factors among nursing professionals in Uganda. Methods: This was a cross-sectional study of MSD among 880 nursing professionals from five selected hospitals in Uganda. Data was collected using a questionnaire adapted from the Dutch Musculoskeletal and Nordic Musculoskeletal questionnaires. Descriptive (mean, standard deviation and percentages) and inferential (Chi square test and logistic regression analysis) statistics were used to analyse data. Alpha level was set at p < 0.05. Results: A total of 741 completed questionnaires were analysed (response rate 85.4%). The average age of the respondents was 35.4 (SD 10.7) years and a majority were female (85.7%). The average working hours per week was 43.7 (SD 18.9 hours). The 12-month period-prevalence of MSD at anybody site was 80.8%. The most common site of MSD was the lower back (61.9%). Significant risk factors for reported MSD included often working in a slightly bent posture (adjOR 2.25, 95% CI 1.20-4.26), often working in a slightly twisted posture for long (adjOR 1.97, 95% CI 1.03-3.77), mental exhaustion (adjOR 2.05, 95% CI 1.17-3.5), being absent from the work station for more than 6 months due to illness or an accident (adjO|R, 4.35, 95% CI 1.44-13.08) and feeling rested after a break (adjOR 2.09, 95% CI 1.16-3.76). Conclusions: Musculoskeletal disorders affect more than 80% of nursing professionals in Uganda with the most commonly, affected site being the lower back. Significant risk factors for MSD include; being absent from the work station for more than 6 months due to illness or an accident, working in awkward postures, pushing/pulling of heavy loads and mental exhaustion. There is a need for greater advocacy, better working conditions and adoption of strategies to reduce occupational injuries.
Musculoskeletal disorders among nursing staff: a comparison of five hospitals in Uganda
(The Pan African Medical Journal, 2014) Munabi, Ian G.; Buwembo, William; Kitara, David L.; Ochieng, Joseph; Nabirye, Rose C.; Mwaka, Erisa S.
Introduction: Low and middle income countries have severe nursing staff shortages which is associated with risk of poor quality of patient care and increased patient exposure to adverse events. This is accompanied with increased risk of musculoskeletal disorders to the nursing staff. This paper sets out to identify and compare factors associated with musculoskeletal disorders among nursing staff in 5 different hospitals in Uganda. Methods: This was a cross sectional study on nurses from 5 different hospitals in Uganda. The study used a 12 month recall of reported Musculoskeletal disorders (MSD) among nurses. Ethical approval was obtained. Logistic regression analysis and ANOVA were used. The level of significance was set at 0.05 for all statistical tests. Results: There were 755 respondents of whom 433 (58.4%) were nurses. The prevalence of MSD at anybody site was 80.8%. There were significant differences in reported MSD among nursing staff across different hospital settings which were worse in the public hospitals as compared to the private and private not for profit hospitals (p <0.001). Age (adjusted OR 1.03, 95% CI 1.01- 1.06), self reported poor general health status (adj OR 4.5, 95% CI 2.8-7.24) and stress as suggested by waking up tired in the morning (adj OR 3.4, 95% CI 2.17-5.32) were significant associated factors for MSD in this population. Conclusion: Reported MSD among nursing staff across 5 different hospitals is worse in public as compared to private hospitals. Age, self reported poor general health status and stress were important factors for MSD in this population.
Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils
(BMC Research Notes, 2014) Mwaka, Erisa S.; Munabi, Ian G.; Buwembo, William; Kukkiriza, John; Ochieng, Joseph
Though seen as a convenient method of carrying books and other scholastic materials including food items, schoolbags are believed to contribute to back and other musculoskeletal problems in school going children. This study set out to determine the prevalence of low back and other musculoskeletal pains and describe their relationship with schoolbag use in pupils. Results: This was a cross-sectional descriptive study involving 532 pupils from six primary schools with a mean age of 13.6 years. Analyses included the chi- square test, independent t tests, regression analysis and test for trend across ordered groups. Backpacks were the most common type of schoolbag and younger children carried disproportionately heavier bags. Urban pupils were younger, carried significantly heavier bags, and less likely to complain about schoolbag weight than the rural pupils, About 30.8% of the pupils carried schoolbags which were more than 10% of their body weight. About 88.2% of pupils reported having body pain especially in the neck, shoulders and upper back. About 35.4% of the children reported that carrying the schoolbag was the cause of their musculoskeletal pain. The prevalence of lower back pain was 37.8%. There was significant association between low back pain and; method of bag carriage (p < 0.0001), long duration of walking (odds ratio 2.67, 95% CI 1.38- 5.16) and the time spent sitting after school (p = 0.02). Only 19% had lockers at school. Conclusion: Urban pupils were younger, carried significantly heavier bags, and less likely to complain about schoolbag weight than the rural pupils. The majority of pupils complained of musculoskeletal pain of which 35.4% was attributed to the schoolbags. The prevalence of lower back pain was 37.8%. Schools need to provide lockers and functional libraries in order to avoid excessive loading and repetitive strain injuries.
Outcomes of Periodontal Treatment in Diabetes Mellitus Patients at Kiruddu Referral Hospital in Uganda. A Prospective Cohort Study
(Research Square, 2021) Kiryowa, Haruna; Mwaka, Erisa; Buwembo, William; Munabi, Ian; Rwenyonyi, Charles; Kaddumukasa, Mark
Periodontitis is a common complication of diabetes mellitus associated with poor glycemic control. The relationship between periodontal disease and glycemic control in patients with diabetes mellitus remains unclear. This study set out to determine the outcomes of periodontal treatment in diabetic patients in Uganda.Using a cohort study design, 41 adult diabetic patients with periodontal disease were enrolled and followed up for 3 months. Fasting blood sugar, glycated hemoglobin levels, pocketprobing depth, bleeding and clinical attachment loss at baseline and 3 months after periodontal treatment were determined. Gingival crevicular fluid was assessed to detect presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Bacteroides forsythus and Fusobacterium nucleatum. Data were analyzed using R version 4.10. Mean differences were calculated to determine effect of treatment and multiple logistic regressions was used to determine association between Hba1c and the different variables.Of the41 participants, 61% were females while 39% were males. The average age was 49.2 years (S.D = 11.2)while the mean BM1 was 27.8 (S.D = 4.8). Overall, there was a reduction in the average number of teeth with bleeding sites, those with pockets and the frequencies of selected bacteria except Fusobacterium nucleatum at 3 months after periodontal treatment. Following periodontal treatment, 39% of the participants had an improvement in their glycemic control (mean HbA1c reduction of 1.86) with age < 47.1 years, diabetic duration less than 1.6 years, BM1< 27.7 and HBA1c >8.9 at baseline being positively associated with this improvement. Treating periodontal disease in diabetic patients especially those with HBA1c <9.0 can improve glycemic control. However, larger studies need to be conducted to ascertain why some patients fail to attain an improved metabolic control following this intervention.
Prediction of Width of Un-Erupted Incisors, Canines and Premolars in a Ugandan Population:A Cross Sectional Study
(BMC oral health, 2012) Buwembo, William; Kutesa, Annet; Muwazi, Louis; Rwenyonyi, Charles Mugisha
Accurate prediction of the space forms an important part of an orthodontic assessment in the mixed dentition. However the most commonly used methods of space analysis are based on data developed on Caucasian populations. In order to provide more accurate local data we set out to develop a formula for predicting the widths of un-erupted canines and premolars for a Ugandan population and to compare the predicted widths of the teeth from this formula with those obtained from Moyers’ tables, and Tanaka and Johnston’s equations.Dental casts were prepared using mandibular and maxillary arch impressions of 220 children (85 boys/135 girls) aged 12–17 years recruited from schools in Kampala, Uganda. The mesio-distal width of the mandibular incisors, mandibular and maxillary canines and premolars were measured with a pair of digital calipers. Based on regression analysis, predictive equations were derived and the findings were compared with those presented in Moyers’ probability tables, and Tanaka and Johnston’s equations. There were no statistically significant differences between the tooth widths predicted by our equations and those from Moyers’ probability tables at the 65th and 75th percentile probabilities for the girls and at 75th level in boys in the mandibular arch. While in the maxillary arch no statistically significant differences at the 75th and 95th levels were noted in girls. There were statistically significant differences between predicted tooth sizes using equations from the present study and those predicted from the Tanaka and Johnston regression equations.In this Ugandan population, Moyers’ probability tables could be used to predict tooth widths at specific percentile probabilities, but generally, Tanaka and Johnston technique tends to overestimate the tooth widths.
A qualitative analysis of health professionals’ job descriptions for surgical service delivery in Uganda
(Human resources for health, 2014) Buwembo, William; Munabi, Ian G.; Galukande, Moses; Kituuka, Olivia; Luboga, Samuel A.
The ever increasing demand for surgical services in sub-Saharan Africa is creating a need to increase the number of health workers able to provide surgical care. This calls for the optimisation of all available human resources to provide universal access to essential and emergency surgical services. One way of optimising already scarce human resources for health is by clarifying job descriptions to guide the scope of practice, measuring rewards/benefits for the health workers providing surgical care, and informing education and training for health professionals. This study set out to determine the scope of the mandate to perform surgical procedures in current job descriptions of surgical care health professionals in Uganda. Methods: A document review was conducted of job descriptions for the health professionals responsible for surgical service delivery in the Ugandan Health care system. The job descriptions were extracted and subjected to a qualitative content data analysis approach using a text based RQDA package of the open source R statistical computing software. Results: It was observed that there was no explicit mention of assignment of delivery of surgical services to a particular cadre. Instead the bulk of direct patient related care, including surgical attention, was assigned to the lower cadres, in particular the medical officer. Senior cadres were assigned to perform predominantly advisory and managerial roles in the health care system. In addition, a no cost opportunity to task shift surgical service delivery to the senior clinical officers was identified.
Root and Canal Morphology of Maxillary First Premolar Teeth in a Ugandan Population
(Open J Stomatol, 2011) Rwenyonyi, Charles Mugisha; Kutesa, Annet; Muwazi, Louis; Buwembo, William
To determine the variations in the root and canal morphology of the maxillary first premolar teeth in a Ugandan population. Extracted maxillary first premolar teeth (n = 202) were evaluated in this study. The specimens had their pulp chambers de-roofed. They were decalcified in nitric acid and made transparent with methyl salicylate. Indian ink was injected into the root canals to display their configuration. Results : One hundred and forty eight (73.3%) of the specimens had two roots, of which 16.9% (n =25) had fused roots. About 26.7% (n = 54) of the specimens were single rooted. Eleven (20.4%) of the single rooted specimens had one canal of either Vertucci type I, III, V or VII configuration while 79.6% (n = 43) of the specimens had two canals of either Vertucci type II, IV or VI configuration. The two-rooted specimens exhibited Vertucci type IV and VIII canal configuration: 96.6% and 3.4%, respectively. The single rooted teeth had a higher prevalence of lateral canals, canal intercommunications and multiple apical foramina as compared to the two-rooted specimens. Conclusion : The maxillary first premolar teeth in this Ugandan population showed a higher prevalence of two-root morphology with majority of the roots having Vertucci type IV canal configuration. There was no three-root anomaly recorded in the present material.
Weight, Height and Eruption Times of Permanent Teeth of Children Aged 4–15 Years in Kampala, Uganda
(BMC oral health, 2013) Kutesa, Annet; Nkamba, Eriab Moses; Muwazi, Louis; Buwembo, William; Rwenyonyi, Charles Mugisha
Tooth eruption is a continuous biological process by which developing teeth emerge through the jaws and the overlying mucosa to enter into the oral cavity. Tooth eruption time and sequence are important factors in dental treatment planning, particularly in orthodontics, but also in forensic dentistry to estimate age of a child. Tooth eruption time is influenced by many factors. In this study we set out to determine the timing of eruption of permanent teeth and assess its association with the height and weight of school children aged 4–15 years in Kampala, Uganda.This was a cross sectional study comprising of 1041 healthy Ugandan children: boys/girls (520/521) who were consecutively selected from two primary schools in Kampala. The children were clinically assessed for tooth emergency through the oral mucosa as well as measuring their weight and height. The mean and standard deviation of tooth eruption time was estimated for boys and girls. Bivariate analysis was used to assess any significant association between tooth eruption time and demographic variables. Pearson and partial correlation analyses were used to assess any significant association between the tooth eruption time and anthropometric measurements of the children.Generally, the mean eruption times for girls were lower compared to boys except for three teeth (#25, #32 and #42) which erupted earlier in boys. The average difference in mean eruption times of all teeth between boys and girls was found to be 0.8 (range, 0–1.5) years. In partial correlation analysis, mean tooth eruption times were positively, but not significantly associated with height while controlling for weight except for the mandibular left central incisor (#31). On the other hand, in partial correlation analysis, mean tooth eruption times were positively associated with weight while controlling for height except for tooth #11, #16, #26 and #41. The weight of the child was significantly correlated with mean eruption times in 50% of the teeth.In the present study, the mean tooth eruption times for girls were lower compared to boys except for three teeth (#25, #32 and #42). The height of the child did not show any significant influence on the tooth eruption times while the influence of weight on tooth eruption times was non-conclusive.

Browsing by Author "Buwembo, William"

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