Browsing by Author "Kijjambu, Stephen C."

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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.
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    Aetiology and Presentation of Intestinal Obstruction among Patients Presenting to a Tertiary Hospital in Uganda
    (Int J Crit Care Emerg Med, 2016) Nakanwagi, Arlene Muzira; Kijjambu, Stephen C.; Ongom, Peter; Luggya, Tonny Stone
    Intestinal Obstruction is the impairment of normal flow of intestinal contents from mouth to anal canal with aetiology that varies depending on various factors. Understanding aetiology of a country’s surgical services has proven to aid better planning for its emergency surgical conditions. Mulago, which is Uganda’s National Referral Hospital, is resource constrained with a surgical burden of 33% due to acute abdomen with Intestinal Obstruction. This study aimed to determine the current presentation pattern and etiological factors of Intestinal Obstruction at Mulago. Ethical approval was got, from Makerere University School of Medicine IRB, to carry out a prospective observational study among surgical patients admitted to Mulago Hospital’s surgical wards and units. All patients admitted to the hospital for the study period that fitted the inclusion criteria, with suspected partial or complete Intestinal Obstruction or those with confirmed diagnosis intraoperatively were consented and enrolled. Results: We recruited 110 with 79 (71.8%) males and 31 (28.2%) females. Paediatric patients of 0-12 years were 45 (41.0%) and 65 (59%) were adults above 13 years. We had 50% that presented after 72 hrs of symptoms, 24.6% of these were initially managed in a health centre and only 7.3% of the participants presented within 24 hours. The commonest symptoms that presented were colicky abdominal pain, vomiting, abdominal distension and relative constipation. Hernias were the commonest cause of Intestinal Obstruction in adults followed by gut volvulus then adhesions and tumours while in the paediatric group had intussusceptions as the most common aetiological factor followed by Anorectal malformations and then congenital atresia plus stenosis as third commonest cause of in children respectively. Hernias followed by intestinal volvulus were the commonest adult aetiology while intussusceptions followed by Anal Rectal Malformations were the commonest paediatric aetiology of intestinal obstruction. In Mulago hospital with colicky abdominal pain, abdominal distension and vomiting as the commonest presenting symptoms with males the predominantly affected sex.
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    Outcomes of Management of Intestinal Obstruction at an Urban Tertiary Hospital in Sub Saharan Africa: a cross‑sectional study
    (BMC surgery, 2021-11-30) Nakanwagi, Arlene Muzira; Kijjambu, Stephen C.; Ongom, Peter; Luggya, Tonny Stone
    Intestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital. This was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association. We enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality. This study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.