NRU :: Browsing by Author "Iramiot, Jacob Stanley"

Browsing by Author "Iramiot, Jacob Stanley"

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Antibacterial Activity of Locally Prepared Herbal Cough Extracts against Klebsiella pneumoniae and Streptococcus pneumoniae
(International Journal of Biochemistry Research & Review, 2019) Atuheirwe, Maxine; Iramiot, Jacob Stanley
Cough due to Klebsiella pneumoniae and Streptococcus pneumoniae is currently managed by conventional antibiotics and herbal extracts in Uganda. However, much as these herbal extracts are extensively used, their antibacterial activity is not known. This study aimed at determining the antibacterial activity of the selected locally prepared herbal cough extracts against two bacterial strains i.e. Klebsiella pneumoniae (ATCC 700603), and Streptococcus pneumoniae (ATCC 49619). Methods: The herbal cough extracts were screened for antibacterial activity using Agar-well diffusion method for determining zone of inhibition, macro broth dilution method for Minimum Inhibitory Concentration (MIC) determination and Streak plate method for Minimum Bactericidal Concentration (MBC). Results: In vitro evaluation of antibacterial activity of the 5 brands of herbal cough extracts against K. pneumoniae and S. pneumoniae revealed that all extracts possessed significant antimicrobial effects against all microorganisms tested (p < 0.05). However, MM04 (35.6±0.0) mm and MM03 (33.6±1.5) mm had maximum zones of inhibition as compared to other herbal extracts against K. pneumoniae and S. pneumoniae respectively. Average MIC results for extracts against K. pneumoniae indicated that MM01 had the highest MIC (2.5000 mg/ml) while MM03 had the least MIC (0.0625 mg/ml). Average MIC results for extracts against S. pneumoniae showed MM01 had the highest MIC (2.0000 mg/ml) while MM03 3 had the least MIC (0.0438 mg/ml). Average MBC results for extracts against K. pneumoniae indicated that MM01 had the highest MBC (4.000 mg/ml) while MM03 had the least MBC (0.030 mg/ml). Average MBC results for extracts against S. pneumoniae showed MM01 had the highest MBC (4.000 mg/ml) while MM03 had the least MBC (0.033 mg/ml). Conclusion: The results obtained in present study were revealed that locally prepared herbal extracts had significant antibacterial activity. Hence they can be used as promising alternatives of antibiotics used against Respiratory Tract Infections due to K. pneumoniae and S. pneumoniae.
Antimicrobial resistance at the human-animal interface in the Pastoralist Communities of Kasese District, South Western Uganda
(Nature Publishing Group, 2020-09) Iramiot, Jacob Stanley; Kajumbula, Henry; Bazira, Joel; Kansiime, Catherine; Asiimwe, Benon B
Abstract Intensive usage of antimicrobials in the management of animal diseases leads to selection for resistance among microorganisms. This study aimed to assess antimicrobial use and to describe factors associated with the transmission of antimicrobial resistance between humans and animals in pastoralist communities of Kasese district. A mixed-methods approach was employed in this study. Rectal swabs were collected from the participants and cattle and transported in Carry–Blaire transport medium to the laboratory within 24 h of collection for culture and sensitivity to confirm carriage of multi-drug resistant bacteria. In-depth interviews were conducted among veterinary officers, veterinary drug vendors, human health facility in-charges in both public and private health facilities, and operators of human pharmacies and drug shops. Carriage of multi-drug resistant bacteria among humans was 88 (93%) and 76(80%) among cattle. Consumption of lakeshore water and carriage of multi-drug resistant bacteria in cattle were associated with carriage of multi-drug resistant bacteria in the human population. The prevalence of multi-drug resistance among organisms Isolated from both humans and animals was high. There is a high likelihood of transmission of multi-drug resistance between humans and animals.
Asymptomatic Bacteriuria and Candida Colonization among Pregnant Women in a District Hospital in Eastern Uganda
(Journal of Advances in Medicine and Medical Research, 2019) Bakandonda, Fredrick; Muwanguzi, Shadrack; Nakate, Prossy; Opolot, Ismail; Imongit, Sam; Nnakanwagi, Mariam Mirembe; Nteziyaremye, Julius; Nekaka, Rebecca; Iramiot, Jacob Stanley
Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and antimicrobial susceptibility patterns among pregnant women attending antenatal in a District Hospital in Eastern Uganda. Materials and Methods: A descriptive cross sectional study was conducted in which pregnant mothers who had come for routine antenatal care were counseled and their consents obtained before taking off urine samples for laboratory diagnosis. For those samples found to have pus cells, culture and sensitivity test was done to identify the organisms and determine susceptibility to particular antibiotics and antifungal agents. Results: Gram negative isolates were more sensitive to meropenem (100%), and ciprofloxacin (93.8%) but less sensitive to trimethoprim/sulphurmethoxazole (20%), Ceftazidime (7%), and Cefepime (6%). Gram positive isolates were more sensitive to vancomycin (100%), meropenem (87%) and linezolid (88.1%) but less sensitive to Cefotaxime (31%) and Trimethoprim / sulphurmethoxazole (14%). All bacteria isolated in this study were multi-drug resistant (MDR). All Candida isolates were susceptible to Econazole and Nystatin whereas all isolates were resistant to Griseofulvin. Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women in Butaleja district is high with many of the bacteria isolated exhibiting resistance to the commonly used antibiotics. Antifungal resistance was common in this study.
Bacterial colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda
(PLoS ONE, 2022) Nakawuki, Ashley Winfred; Nekaka, Rebecca; Ssenyonga, Lydia V. N.; Masifa, George; Nuwasiima, Dorreck; Nteziyaremye, Julius; Iramiot, Jacob Stanley
Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant (MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic antibiotics. This study aimed at determining the bacterial species diversity and susceptibility patterns of indwelling urinary catheters from postpartum mothers attending Mbale Regional Referral Hospital (MRRH). Methods A cross-sectional study employing quantitative and qualitative was carried out in MRRH among postpartum mothers with urinary catheters and their care-takers. The purposive non-random sampling strategy was used to collect data using an interviewer-administered questionnaire for the quantitative data collection and in-depth interviews for qualitative data collection. All the data collection tools used were developed, pretested and validated. At the point of de-catheterization, Catheter tips from enrolled participants were cut about 2-3cm below the balloon aseptically into test-tube containing peptone water, sonication technique employed, and incubation done 24hours then cultured to ensure phenotypic identification. An antibiotic sensitivity test was performed using the disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Quantitative data collected was entered in Microsoft Excel and then exported to STATA14 for statistical analysis. Thematic analysis was used to analyse and organise qualitative data by an inductive coding method using Nvivo 12 software. Results In this study, 208 postpartum mothers participated, the majority of whom were caesarean section mothers of age range 20–24 years and 17 care-takers with a median age of 32 years. The prevalence of catheter tips bacterial colonisation was 98% despite 88.5% of the participants being on broad-spectrum antibiotics. The average duration of catheterisation was 2 days. All bacteria isolates were potential uro-pathogens with a mean occurrence of 2 bacteria species in each urinary catheter tip. The rates of MDR to commonly used antibiotics were high. The urinary catheter size of greater than F14 and duration of catheterization greater than 2 days were significantly associated with the number of bacterial species isolated from each sample. The maintenance care and knowledge of care-urinary catheter care among the care-takers was found sub-optimal. Conclusion There was a high prevalence of catheter colonisation with bacterial spps diversity averaging 2 spps per sample despite use of broad spectrum antibiotics. The MDR rates were high, which calls for routine culture and sensitivity. Health workers practicing obstetric medicine need to pay attention to catheter sizes during catheterisation and its duration. Health education should be part of antenatal and postnatal care education.
Bottlenecks and opportunities towards achieving the targeted 95-95-95 HIV services in a rural district in Eastern Uganda [version 1; peer review: awaiting peer review]
(F1000Research, 2022) Namenkere, Monkya Samuel; Stella, Ayaa Mary; Linda, Sukuku; Kharono, Juliet; Mugabi, Charles; Chelangat; Chelangat, Benina; Abwola Olwedo, Mary; Nabasumba, Carol; Oboth, Paul; Osele, Julius; Nekaka, Rebecca; Iramiot, Jacob Stanley
Background: Uganda has made progress in reducing its HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the World Health Organization (WHO) target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in the Bukedea district. Methods: A mixed-methods cross-sectional study was conducted in the Bukedea district covering males and females aged 18-65 years who had consented to participate in the study. We used a purposive sampling procedure to select our study participants. Qualitative data was collected through focus group discussions, key informant interviews, and document reviews for quantitative data. Quantitative data were analyzed using STATA v 14 whereas qualitative data were analyzed using the thematic analysis approach. Results: The challenges were grouped as patient-related, medicationrelated, and facility-related. The patient-related challenges were stigma, fear of taking the medication, poor nutrition, long distances, alcoholism, busy working schedules, and domestic violence. The medication-related challenges were side effects and pill burden. The facility-related challenges were inadequate pretest counseling and stock-outs. The use of anti-retroviral drugs (ART) was common in piggery and poultry and the sources of these drugs were reported to be the people on ART and the health workers. The opportunities included home-based counseling, organizing more outreaches, counseling and health education, targeted testing, and strengthening the Village Health Teams (VHT) networks. Conclusions: The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of anti-retroviral drugs in animal husbandry was common in the Bukedea District.
Breast self-examination among female clients in a tertiary hospital in Eastern Uganda
(International Journal of Africa Nursing Sciences, 2020) Chepkwurui, Joyce; Ssenyonga, Lydia V.N.; Iramiot, Jacob Stanley
Breast self-examination is a widely accepted, inexpensive and non-complex screening method for breast cancer because it does not entail complex technical training and therefore a more practical approach in a resource limited setting. This study aimed to assess the knowledge and practice of breast self-examination among female clients at Mbale Regional Referral hospital. Methods: A cross sectional study employing qualitative and quantitative methods was carried out among 386 women selected by simple random sampling. Data was analyzed using SPSS v 16.0 and presented in tables. Univariate and bivariate analysis was done and a P-value < 0.05 was considered statistically significant while the results with a P-value≤0.2 were considered for multivariate analysis. Results: Both the knowledge and practice of breast self-examination among the participants in this study were low. Less than 50% of the participants had ever heard about breast self-examination. Only 24% of those who had ever heard about breast self-examination correctly reported that it should be done monthly. Both knowledge and practice of breast self-examination were associated with living in the urban setting, high level of education, occupation and religion. Conclusion: There was limited knowledge about breast self-examination among women in Mbale Regional Referral Hospital and this corresponds with the low practice of the same. Only a few participants reported practicing breast self-examination monthly.
Choice, Attitudes, and Perceptions of Undergraduate Nursing Students towards the Nursing Profession
(Research Square, 2022) Neumbe, Irene Mildred; Ssenyonga, Lydia; Soita, David Jonah; Iramiot, Jacob Stanley; Nekaka, Rebecca
Nursing students are the upcoming contributors to the nursing workforce and their attitudes towards the profession depict the quality of care they will offer to patients upon qualification. This study aimed to determine the reasons for choice, attitudes, and perceptions of undergraduate nursing students towards their profession. Methods: This cross-sectional study involved 165 nursing students from year one to year four registered in the two public universities in Uganda. The Attitude Scale for Nursing Profession was used to collect quantitative data. Focus Group Discussions were held to collect qualitative data about the reasons for choice and perceptions towards the nursing profession. Results: Students chose the nursing program because of its availability, poor academic performance in high school, desire to pursue a medical-related course, failure to get admitted for Medicine and Surgery, low cut-off points for the Nursing course, and interest in nursing. The majority of the students (81.8%) had positive attitudes towards the nursing profession. There was a statistically significant difference between the mean attitude scores of nursing students according to the year of study, entry scheme into the University, and source of funding for the program. Perceptions about the nursing profession were based on their personal experiences, experiences of colleagues, and observation of how nurses are treated at work. Conclusion: Although nursing students had positive attitudes towards the nursing profession, the majority of their perceptions about the profession were negative. Nursing training institutions should ensure that students receive pre-nurse counseling and introductory courses about the profession to enhance the acquisition of an accurate perception of the nursing profession.
COVID-19 Vaccination Uptake and Self-Reported Side Effects among Healthcare Workers in Mbale City Eastern Uganda
(medRxiv, 2022) Madut Akech, Gabriel; Kanyike, Andrew Marvin; Galabuzi Nassozi, Ashah; Aguti, Beatrice; Nakawuki, Ashley Winfred; Kimbugwe, Denis; Kiggundu, Josen; Maiteki, Robert; Mukyala, Dorothy; Bongomin, Felix; Obakiro, Samuel Baker; Nekaka, Rebecca; Iramiot, Jacob Stanley
Fear of anticipated side effects has hindered the COVID-19 vaccination program globally. We report the uptake and the self-reported side effects (SEs) of the COVID-19 vaccine among Healthcare workers (HCWs) in Mbale City Eastern Uganda. Methods: A cross-sectional survey of HCWs at seven different level health facilities was conducted from 6th September to 7th October 2021 using a structured self-administered questionnaire. Results: COVID-19 vaccine had been received by 119 (69%) participants of which 79 (66%) received the two recommended doses of the AstraZeneca vaccine. Getting vaccinated was associated with working in a lower health facility (aOR= 14.1, 95% CI: 4.9 – 39.6, P=0.000), perceived minor risk of contracting COVID-19 (aOR= 12.3, 95% CI: 1.0 – 44.6, p=0.047), and agreeing that COVID-19 vaccine is protective (aOR= 16.7, 95% CI: 5.6 – 50.4, p=0.000). 97 (82%) of participants experienced side effects to at least one dose of which most were mild on both the first (n=362, 51%) and second dose (n=135, 69%). The most frequently reported side effects on the first and second dose were fever (79% and 20%), injection site pain (71% and 25%), and Fatigue (69% and 20%) respectively. Conclusions: The majority of the HCWs in Mbale City had received at least one dose of the COVID-19 vaccine and experienced a side effect. The side effects were mostly mild on either dose thus the vaccines are generally safe.
Epidemiology and Antibiotic Susceptibility of Vibrio Cholerae associated with the 2017 outbreak in Kasese district, Uganda
(BMC public health, 2019) Iramiot, Jacob Stanley; Rwego, Innocent B.; Kansiime, Catherine; Asiimwe, Benon B.
Uganda is among the 51 countries where cholera outbreaks are common with epidemics occurring predominantly along the western border with Democratic Republic of Congo (DRC), Kampala city slums, Busia district which is a border town with Western Kenya, Mbale district and the Karamoja Sub-region. This report summarizes findings from the epidemiologic investigation, which aimed at identifying the mode of transmission and antibiotic susceptibility patterns of the Vibrio cholerae isolated in Kasese district, Uganda.A descriptive cross-sectional study was carried out between 2017 and 2018 to describe the epidemiology of the cholera epidemic in Kasese district, Uganda. Rectal swabs were collected from 69 suspected case-persons and cultured on Thiosulphate-Citrate-Bile-Salts Sucrose (TCBS™; SEIKEN Japan) agar and incubated at 37 °C for 18–24 h. The isolates were serotyped with polyvalent 01 antiserum and monovalent serotype Inaba and Ogawa antisera (Denka Seiken, Tokyo, Japan) to determine which serotype was responsible for the outbreak. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar.A list of discharged patients was obtained from the isolation units of Bwera hospital and Kagando hospital and the individuals were followed to the community where they live. Questionnaires were administered to a total of 75 participants who were either the cases or relatives to the case. GPS points of the homes of the cases and pictures of potential source infection were also taken and cases were mapped.A total of 222 cases were recorded in the Kasese District outbreak between the month of September 2017 and January 2018 with the case fatality rate (CFR) of 1.4%. Children below the age of 14 years contributed the biggest proportion of the cases (70%) and out of these, 33% were aged below 5 years. Culture isolated 69 V. cholerae 01 serotype Inaba from the total of 71 samples. Salmonella typhi was Isolated from the other two samples which were negative for V. cholerae. Antibiotic susceptibility using Kirby-Bauer disc diffusion method was done on isolates from 69 participants and showed 100% resistance to Ampicillin and over 50% were resistant to trimethoprim/Sulfamethoxazole whereas gentamicin showed 100% susceptibility. Environmental assessment revealed rampant cases of open defecation.Though we did not culture water to confirm contamination with Vibrio cholerae, we hypothesize that the cholera epidemic in Kasese 2017 was sparked off by consumption of contaminated water following the heavy floods that washed away latrines into water sources in Bwera, Isango and Nakiyumbu sub-counties. V. cholerae was also highly resistant to the commonly used antibiotics.
Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda
(BMC public health, 2019-10-29) Iramiot, Jacob Stanley; Rwego, Innocent B.; Kansiime, Catherine; Asiimwe, Benon B.
Uganda is among the 51 countries where cholera outbreaks are common with epidemics occurring predominantly along the western border with Democratic Republic of Congo (DRC), Kampala city slums, Busia district which is a border town with Western Kenya, Mbale district and the Karamoja Sub-region. This report summarizes findings from the epidemiologic investigation, which aimed at identifying the mode of transmission and antibiotic susceptibility patterns of the Vibrio cholerae isolated in Kasese district, Uganda.
Experiences and views of healthcare professionals on the prescription of antibiotics in Eastern Uganda: A qualitative study
(Journal of global antimicrobial resistance, 2021) Kawala Kagoya, Enid; Royen, Kathleen Van; Waako, Paul; Royen, Paul Van; Iramiot, Jacob Stanley; Obakiro, Samuel Baker; Kostyanev, Tomislav; Anthierens, Sibyl
This study aimed to explore the experiences and views of healthcare professionals on antibiotic prescription in Eastern Uganda. Methods: This was an exploratory qualitative study using semi-structured interviews. Participants included 16 healthcare professionals from Mbale and Soroti Regional Referral Hospitals. Additionally, two workshops were held (one in each hospital) with a total of 56 healthcare professionals to discuss the findings. Thematic analysis was used to analyse the data. Results: Healthcare professionals’ prescriptions are influenced by (i) healthcare workers’ perceptions and practices, (ii) patients’ perceptions and beliefs, and (iii) contextual factors. Healthcare workers’ prescriptions depend on the presence of bacterial infection and the severity of the condition, the availability and cost of medication, previous experience with antibiotic prescribing, patient character- istics, and trial and error. They also have limited knowledge and share little information on the use of antibiotics with patients. Patient factors included demand for a particular antibiotic, inability to afford expensive drugs, and limited knowledge about antibiotic use and resistance. Contextual factors that contributed to antibiotic prescribing were an overburdened healthcare system, the influence of pharmaceutical companies and pharmacies, the use of (treatment) guidelines, and difficulties with laboratory services. Conclusion: This study showed that healthcare professionals are aware of the problem of antibiotic resistance but do not feel ownership of the problem. Instead, they rather blame the overburdened system, local drug shops, pharmacies, drug representatives and patients. There is a need for a multisectoral and holistic approach toward fighting antibiotic resistance.
Impact of Differentiated Service Delivery Models on Retention and Viral Load Suppression among Art Clients in Communities in Eastern Uganda
(Research Square, 2022) Jemba, Brian; Waiswa, Sinani; Balinaine, Joseph; Lomuria, Rosaria; Nabutanyi, Gift Gloria; Ongala, Emmanuel; Opus, Benjamin; Iramiot, Jacob Stanley; Oboth, Paul; Anwola Olwedo, Mary; Nekaka, Rebecca
Although Uganda rolled out Differentiated Service Delivery models in 2017 to improve retention and achieve viral load suppression, these have remained low relative to UNAIDs targets of 95-95-95 by 2030. We determined the impact of facility and community DSD Models on viral load suppression and retention among ART clients in Katakwi district in North Eastern Uganda. Methods; A retrospective cohort study of all ART clients in the different approaches of DSD models who were active by 2017, were followed up to 2020. The primary outcomes were retention and viral load suppression of ART clients in different approaches. Eight health facilities providing ART services were purposively sampled and 771 ART clients were sampled out by simple random sampling out of 4742 total population on ART in Katakwi district. We analysed retention, viral load suppression, and their determinants by logistic regression method using STATA. Results; A total of 771 participants were sampled of whom 42.7% were male and 57.3% were females, with the mean age being 40 years. While retention rates at 95% CI of participants were 99.35% at 12 months, 94.03 at 24 months, 89.88% at 36months, and 84.57% at 48months. The viral load suppression rates were57.3% at 12 months, 70.3% at 24 months, 70.3% at 36 months, and 69% at 48 months. Retention was higher in the community-based DSD model as compared with the facility-based model. Viral load suppression was higher in the community-based DSD models in which CDDP had the highest achievement (92%) followed by CCLAD (79%) compared to the facility-based DSD models in which FBIM performance (34.3%) was far below the set standard of 95%, followed by FBG (65%) with FTDR having relatively better performance (80.9%).Being 40–59 years, receiving care from the general hospital, being married, having good current adherence, being on the first line of the current regimen, and being a female as other predictors of viral load suppression whereas being 40–59 years of age, having good current adherence, being on the current first-line regimen, and having no comorbidities were predictors of good retention. Conclusions; Both facility and community-based DSD models have led to improved retention and viral load suppression however community-based models have shown to be more effective than facility-based models through mitigation of barriers to effective HIV/AIDS care of patients on ART. Viral load suppression remained low below the UNAIDs target of 95% by 2030 albeit it improved over time.
Infectious Waste Management in the Face of COVID- 19 in a Rural Health Facility in Eastern Uganda
(Asian Journal of Medicine and Health, 2021) Okia, David; Iramiot, Jacob Stanley; Kagoya Kawala, Enid; Nekaka, Rebecca; Karungi, Veronica; Musoki, Drake; Oteko, Alfred; Nakisuyi, Janet; Aisu, Emmanuel
This study aimed to assess Infectious Waste Management in face of COVID-19, among Health care workers in Rural Health Facilities in Amuria district, Eastern Uganda. Little evidence exists of the challenges that occur while implementing Infectious waste management in the face of COVID-19 in resource-limited settings in Eastern Uganda. Our findings will close this apparent research gap and inform current district and national policies in Infectious Waste Management. Materials and Methods: We conducted cross-sectional survey in five health facilities in Amuria district, using modified CDC Infection Control Assessment Tool for health facility, and a validated structured questionnaire to assess the knowledge of health care workers present on Infectious waste management in the face of COVID-19. Observation and in-depth interviews were also conducted in addition to assess the practice and attitude of staff towards infectious waste management. Results: The five (100%) of the Health Facilities assessed in Amuria district lacked written infection prevention policies and procedures that are current, and are based on evidence-based guidelines. The facilities also had no competency-based training program that provides job-specific training on infection prevention policies and procedures to health care personnel. In terms of knowledge, Waste handlers had poor knowledge in infection control only 8.3% of the medical waste handlers could identify biohazard symbols and knew how infectious waste is segregated into the different categories at the point of generation. All (100%) of the health care workers were knowledgeable about the COVID-19 standard operating procedures. Conclusion: The doctors, nurses, clinical officers, and laboratory personnel had good knowledge of infectious waste Management and were up to date with COVID-19 standard operating procedures. The Medical Waste handlers had poor knowledge of Infectious Waste Management and COVID-19 standard operating procedures. Medical Waste handlers also had a poor attitude, towards the use of personal protective gear while on duty. All the Medical Waste handlers were willing to be trained in Infectious Waste Management. The facilities assessed had no enabling environment for infection control (no policies and in-service training in infection control for staff).We recommend Medical Waste Handlers to be trained in infection control and prevention before and after they are employed.
Knowledge of diabetic foot complication, self-care beliefs and practices among patients attending a tertiary hospital in Eastern Uganda
(International Journal of Africa Nursing Sciences, 2022) Olowo, Samuel; Iramiot, Jacob Stanley; Ssenyonga, Lydia V.
Non-communicable diseases are a stumbling block to global development. Among the diseases, diabetes mellitus in particular, features a major public health problem with increasing prevalence. Foot ulcer ranks first among the complication of diabetes mellitus preceded by cellulitis. This study aimed at determining knowledge about diabetic foot complications, foot care practices, and the beliefs of diabetic patients towards diabetes. Materials and Methods: A cross-sectional survey using a validated structured questionnaire was conducted among 199 Type 2 adult diabetic patients (≥18 years) who visited the hospital clinic and the wards during the study period. Results: More than half that is 118(59.3%) reported not to know that they may develop reduced blood flow in their feet, and 136(68.30%) reported unawareness of smoking as a contributor to reduced blood flow in their feet. Less than half which is 90(45.2%) of the patients reported to dry their feet often after washing, than half that is 96 (48.2%) always inspecting the inside of footwear before putting on, and only 54(27.1 %) of the participants reported never to walk barefooted. The patients’ beliefs on the causes of diabetes included; hereditary, bad dietary habits, inactivity, stress, being fat, punishment from God or gods, and witchcraft. Conclusion: Diabetic patients demonstrated limited knowledge of diabetic foot complications and foot care practices. The patient’s beliefs on the causes of diabetes included; hereditary, bad dietary habits, inactivity, stress, being fat, punishment from God or gods, and witchcraft.
Malaria Prevalence and Risk Factors in University Communities of Eastern Uganda: a case of Islamic University in Uganda
(Research Square, 2021) Elmi Warsame, Abdishakur; Ssenku, Jamilu Edrisa; Alemu Okurut, Shaban; Luwaga Mpagi, Joseph; Iramiot, Jacob Stanley; Kudamba, Ali; Nkambo, Mujibu; Namuli, Aidah; Nakizito, Joweria; Gidudu, George; Nabuuma, Hawa; Mukasa Kafeero, Hussein; Nachuha, Sarah; Walusansa, Abdul
Malaria remains the world’s leading vector-born cause of mortality and morbidity, and Eastern Uganda contains some of the country’s highest prevalence rates. Though academic societies, such as universities, may be prone to high malaria transmission, the extent of the burden and risk factors in university communities of Eastern Uganda are poorly understood. The aim in this study was to examine malaria prevalence, preventive strategies, and risk factors, among University communities in Eastern Uganda; to inform targeted malaria eradication efforts in academic settings. Methods: A mixed methods approach was applied. A case study of Islamic University in Uganda (IUIU), located in Eastern Uganda, was selected. A retrospective approach was used to determine malaria prevalence in IUIU from August to December 2019. Stratified random sampling was used to select IUIU community members; these were subjected to semi-structured questionnaires and Key informant Interviews (KII) to examine the preventive approaches and risk factors. An observational survey was also conducted to identify barriers to malaria prevention. Data was analyzed using descriptive statistics, graphs, Chisquare, and pictures; with STATA version-15.0. Results: The study involved 255 respondents (204, 80% students, 51, 20% staff); 130, 51% were males, 125, 49% were females. Malaria prevalence was; 12.9%, 11.7% and 12.7% for students, staff, and the general study population respectively. Lowest prevalence was registered in November (8.3% for students, 0% for staff), and the highest in December (18.4% for students, 6.7% for staff). Overall malaria prevalence in IUIU was significantly greater than Uganda’s national prevalence (χ2=182.009; p<0.0001; 95%CI). The commonest intervention was, sleeping under insecticide-treated mosquito-nets (96%), and the rarest was usage of medicinal herbs (15%). Though 41 (17.5%) of respondents who used mosquito-nets never suffered malaria, usage of mosquito-nets was not significantly associated with absence of malaria infection (p = 0.83). The same applied for other interventions except timely testing and treatment (p = 0.02). Most frequently mentioned risk factors were; improper use of mosquito nets (214, 84%), inappropriate depositing of garbage (196, 77%), and “staying out late” (133, 52%). Key barriers to malaria prevention observed were; usage of damaged bed nets (38, 19% of 198), clogged trenches with liquid wastes, and perforated wire meshes in ventilators. Conclusion: The overall prevalence of malaria in IUIU community was 12.7%; and was significantly higher than Uganda’s national prevalence (7%). Usage of insecticide-treated bed-nets was the commonest intervention, but showed no statistically significant association with malaria non-prevalence. Awareness programs should be enhanced to address inappropriate use of malaria control methods/tools, because the widespread adoption of these interventions alone did not effectively curb the burden.
Malaria preventive practices and delivery outcomes: A cross-sectional study of parturient women in a tertiary hospital in Eastern Uganda
(PloS one, 2020) Nekaka, Rebecca; Nteziyaremye, Julius; Oboth, Paul; Iramiot, Jacob Stanley; Wandabwa, Julius
Uganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda. Methods A cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics. Results Of the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24–1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04–2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant. Conclusion The effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high.
Otomycosis among Patients Presenting with Ear Discharges at a Tertiary Hospital in South Western Uganda
(International Journal of TROPICAL DISEASE & Health, 2018) Itabangi, Herbert; Katawera, Victoria; Nyaitera, Victoria; Iramiot, Jacob Stanley; Nakaye, Martha; Mwambi, Bashir; Mukasa Kiguli, James; Bazira, Joel; Byarugaba, Fredrick
To the determine prevalence, mycology profile, associated symptoms and risk factors of otomycosis among patients that present with an ear discharge. Study Design: This was a cross-sectional study in which survey data was analysed. Place and Duration of Study: Departments of Microbiology and ENT, Faculty of Medicine, Mbarara University Teaching Hospital, between 2013 and 2015. Methodology: We recruited 117 patients (52 men, 65 women of age range 1-69 years) presenting with a discharging ear. Both newly enrolled and follow-up patients were included in the study. Clinically, patients were assessed for symptoms, possible predisposing factors, and treatment history. For laboratory diagnosis, ear swabs were aseptically collected and mycology profile determined using both direct examination and culture techniques. Fungal identification was through stimulation of fruiting bodies such as conidia or chlamydospores and biochemical identification. Results: Of the 117 participants enrolled, fungal infection was detected in 24 (20.51%) with direct microscopy and confirmed in 16 (13.68%) by culture. Otomycosis was more common among the youth (54%). There were no statistically significant symptoms associated with otomycosis. However, HIV/AIDS and mastoidectomy were significant predisposing factors (38%, p = 0.001 and 25%, p = 0.002, respectively). Aspergillus species (76.47%), Candida albicans (17.65%) and Cladosporium species (5.88%) were the agents commonly associated with otomycosis in this region. Conclusion: Otomycosis can be common and is an important disease of the external ear, especially in at-risk individuals. In southwestern Uganda, the disease is common among young males and aetiology is mainly due to Aspergillus and Candida albicans but other opportunists such as Cladosporium species may also be implicated. Thus, there is a need for routine checks followed by robust diagnostic approaches as a means for evidence-based patient management.
Perceived Risk and Knowledge of COVID-2019 Community Transmission among Local Council Leaders in Rural Districts of Eastern Uganda
(Research Square, 2020) Walusansa, Abdul; Iramiot, Jacob Stanley; Kudamba, Ali; Alemu Okurut, Shaban; Mpagi, Joseph; Namuli, Aidah; Nabuuma, Hawa; Wasige, Godfrey; Kafeero, Hussein M.; Ssenku, Jamil
Corona virus disease (COVID-19) is one of the topmost global hindrances to human existence. Rural settings have been reported to be more vulnerable in some parts of the world. In Uganda, local council (LC) leaders in rural districts are among the immediate personnel mandated to support compliance with preventive guidelines, and to identify and report/deliver COVID-19 cases to health units. We examined the potential risk of COVID-19 transmission, knowledge levels, perceptions & opinions of LC leaders in selected districts in Eastern Uganda, to support the design of risk-based COVID-19 control measures in rural settings, to protect lives better. Methods: A convenience sample was taken from village council leaders in the selected districts. Pretested questionnaires and in-depth interviews were used to assess the knowledge levels, perceptions, and opinions of respondents about COVID-19. An observational survey was also conducted to examine the barriers that might deter effective control of COVID-19, with reference to health guidelines set by the Ugandan government and the World Health Organization. Data was analyzed using HyperRESEARCH 2.8 software, and STATA version-15.0. Results and discussion: Eighty percent of local council leaders reported that they were formally engaged in the fight against COVID-19 in their communities, and the common means of engagement were; dissemination of COVID-19 information by word of mouth, regulation of public events, and monitoring of visitors that come from distant places. All clients reported having received some information about this pandemic, but there was generally low knowledge on some vital aspects: 70% of the respondents did not know the meaning of COVID-19; 100% were uninformed on these common symptoms; headache, sore throat, nausea, and loss of taste & smell; 10% did not know if willingness to conform to health guidelines may affect COVID-19 prevention, and they believed that domestic animals are viable vectors. Radio was the commonest source of COVID-19 information, but it was confounded by poor quality of radio-signals. Most respondents were of the view that in the communities they lead; inaccessibility to authentic health information, financial constraints, and belief that COVID-19 is a fallacy, were some of the leading obstacles to the fight against the pandemic. Low awareness and misconceptions on COVID-19 could be explained by; technological challenges, low literacy levels, and dissemination of wrong information about this pandemic. From the observational survey, the major factors which might intensify the risk of COVID- 19 spread were: scarcity of requirements for hand hygiene, face protection, violation of health guidelines & directives, porous borders, terrain, and use of potentially polluted open water sources. Conclusion and recommendations: Rural communities in Eastern Uganda are vulnerable to the drastic spread of COVID-19, due to challenges related to: low awareness of COVID-19, reluctance in complying with preventive guidelines, finance, technology, terrain, porous borders, illiteracy and scarcity of protective wear and hygiene resources. Awareness creation, material aid, execution of preventive rules, and more research on COVID-19 are warranted.
Pneumococcal carriage and antibiotic susceptibility patterns in mother-baby pairs in a rural community in Eastern Uganda: a cross-sectional study
(F1000Research, 2020) Madut Akech, Gabriel; Naloli, Mercy; Sebwami, Paul; Kazibwe, Patrick; Atwikiriize, Maureen; Onyait, Julius; Oboth, Paul; Nteziyaremye, Julius; Nekaka, Rebecca; Iramiot, Jacob Stanley
Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five and the elderly, although any age group can be affected. This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated from mother-baby pairs in Ngora district after the rollout of the pneumococcal vaccine. We hypothesized that high carriage of Streptococcus pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contracting pneumonia. Methods: Consecutive sampling was used to select 152 mother-baby pairs from community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity testing using the Kirby-Bauer’s agar disc diffusion method. Results: This study found that there was a low prevalence of pneumococcal carriage in the mother-baby pair in Ngora district. We also observed high rates of microbial resistance to penicillin, which is the first-line drug for the management of pneumonia in Uganda. Conclusions: The relationship between pneumococcal carriage and immunization status suggests that the pneumococcal vaccine is protective against pneumococcal carriage. Resistance of S. pneumoniae to commonly used antibiotics was high.
Prevalence of antibiotic-resistant bacteria among patients in two tertiary hospitals in Eastern Uganda
(Journal of Global Antimicrobial Resistance, 2021) Obakiro, Samuel Baker; Kiyimba, Kenedy; Paasi, George; Napyo, Agnes; Anthierens, Sibyl; Waako, Paul; Royen, Paul Van; Iramiot, Jacob Stanley; Goossens, Herman; Kostyanev, Tomislav
The aim of this study was to determine the prevalence and antibiotic resistance patterns of bacterial isolates from inpatients and outpatients in Mbale and Soroti regional referral hospitals in Eastern Uganda. Methods: A retrospective analysis of culture and antibiotic sensitivity test results from the microbiology laboratories of the two tertiary hospitals was conducted for a 3-year period (January 2016–December 2018). Results: Microbiology records of 3092 patients were reviewed and analysed, with 1305 (42.1%) samples yielding clinical isolates. The most prevalent isolates were Escherichia coli (n = 442; 33.9%), Staphylococcus aureus (n = 376; 28.8%), Klebsiella pneumoniae (n = 237; 18.2%), and Streptococcus pneumoniae (n = 76; 5.8%). High rates of antimicrobial resistance were detected across both Gram-negative and Gram-positive bacteria. Escherichia coli and K. pneumoniae were resistant to several agents such as amoxicillin/ clavulanate (83.5%; 64.6%), cefotaxime (74.2%; 52.7%), ciprofloxacin (92.1%; 27.8%), gentamicin (51.8%; 76%), imipenem (3.2%; 10.5%), tetracycline (98%; 74.5%), and trimethoprim-sulfamethoxazole (74.1%; 74.3%), respectively. Staphylococcus aureus and S. pneumoniae exhibited the following resistance profile: cefoxitin (44.4%; 40.9%), chloramphenicol (69.1%; 27.6%) clindamycin (21.5%; 24.4%), gentamicin (83.2%; 66.9%), penicillin (46.5%; -) tetracycline (85.6%; 97.6%), trimethoprim-sulfamethoxazole (88%; 91.3%), and vancomycin (41.2%; -). Conclusion: We observed high resistance rates to antibiotics among the majority of microorganisms that were isolated from the samples collected from patients in Eastern Uganda. Furthermore, measures should be undertaken locally to improve microbiology diagnostics and to prevent the spread of antibiotic-resistant strains as this impedes the optimal treatment of bacterial infections and narrows the choice of effective therapeutic options.

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