Browsing by Author "Kizito, Samuel"
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Item Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit(Critical care research and practice, 2016) Kwizera, Arthur; Nabukenya, Mary; Agaba, Peter; Semogerere, Lameck; Ayebale, Emmanuel; Katabira, Catherine; Kizito, Samuel; Nantume, Cecilia; Clarke, Ian; Nakibuuka, JaneIn high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference to . Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4, )), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76, )), and ARDS (OR 4.5 (95% CI: 1.07–16.7, )) had a statistically significant association with mortality. Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.Item Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda(Global Health Action, 2017) Mukunya, David; Tumwine, James K.; Nankabirwa, Victoria; Ndeezi, Grace; Odongo, Isaac; Tumuhamye, Josephine; Tongun, Justin Bruno; Kizito, Samuel; Napyo, Agnes; Achora, Vincentina; Odongkara, Beatrice; Tylleskar, ThorkildInitiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding. Methods: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software (https://opendatakit.org). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. Results: Almost half [48.2%, 95% confidence interval (CI) (44.3–52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breastfeeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73–33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41–2.88)], home delivery [AOR 1.43 95% CI (1.04–1.97)] and mother being responsible for initiating breastfeeding as compared to a health worker or relative [AOR 1.73 95% CI (1.33–2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30–0.96)] to delay initiation of breastfeeding as compared to those with no education. Conclusion: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.Item High prevalence of hypertension and cardiovascular disease risk factors among medical students at Makerere University College of Health Sciences, Kampala, Uganda(BMC research notes, 2016) Nyombi, Kenneth V.; Kizito, Samuel; Mukunya, David; Nabukalu, Angella; Bukama, Martin; Lunyera, Joseph; Asiimwe, Martha; Kimuli, Ivan; Kalyesubula, RobertCardiovascular disease has become a leading global health challenge representing the largest cause of mortality in adults worldwide. Non communicable diseases are neglected in Uganda over infectious diseases. With increased urbanization, there is likely increase in burden of these NCDs yet there is paucity of reliable data regarding the NCD burden. We assessed the prevalence of hypertension and other cardiovascular disease risk factors among medical students at Makerere University, College of Health Sciences in Kampala, Uganda. We conducted a cross-sectional study at Makerere University comprising 180 medical students. We used a standardized questionnaire and anthropometric measurements to assess their cardiovascular disease risk factors using JNC-7. Logistic regression was used to assess factors associated with elevated blood pressure.Item Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda(Journal of Public Health, 2021) Mukunya, David; Tumwine, James K.; Ndeezi, Grace; Tumuhamye, Josephine; Tongun, Justin Bruno; Kizito, Samuel; Napyo, Agnes; Achora, Vincentina; Odongkara, Beatrice; Arach, Agnes Anna; Nankabirwa, VictoriaTo assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira district, Northern Uganda. Subjects and methods In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP package. We also conducted multivariable logistic regression to assess factors associated with home births. Results A third of mothers (n = 308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a health facility was pro-rich with a concentration index of 0.10 [95% CI (0.05–0.14)]. Upon decomposing the concentration index, the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95%CI (1.8–5.3)], precipitate labor [AOR 4.18, 95% CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)]. Conclusion There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births should prioritize poorer mothers and those in rural areas.Item Key Decision Makers and Actors in Selected Newborn Care Practices: A Community-Based Survey in Northern Uganda(International Journal of Environmental Research and Public Health, 2019) Mukunya, David; Nankabirwa, Victoria; Ndeezi, Grace; Tumuhamye, Josephine; Bruno Tongun, Justin; Kizito, Samuel; Napyo, Agnes; Achora, Vincentina; Odongkara, Beatrice; Arach, gnes Anna; Tylleskar, Thorkild; Tumwine, James K.Knowledge of key decision makers and actors in newborn care is necessary to ensure that health interventions are targeted at the right people. This was a cross-sectional study carried out in Lira district, Northern Uganda. Multivariable logistic regression was used to determine factors associated with mothers being the key decision maker regarding where to give birth from and when to initiate breastfeeding. Fathers were the key decision makers on the place of birth (54.3%, n = 505) and on whether to seek care for a sick newborn child (47.7%, n = 92). Grandmothers most commonly bathed the baby immediately after birth (55.5%, n = 516), whereas mothers and health workers were common decision makers regarding breastfeeding initiation. Predictors for a mother being the key decision maker on the place of birth included: Mother having a secondary education (AOR 1.9: 95% C.I (1.0–3.6)) and mother being formally employed (AOR 2.0: 95% (1.5–2.9)). Mothers, fathers, grandmothers, health-workers, and traditional birth attendants were the most influential in the selected newborn care practices. Programs that aim to promote newborn care need to involve husbands, grandmothers, and health workers in addition to mothers.Item Mortality Among Children Under Five Years Admitted For Routine Care Of Severe Acute Malnutrition: A Prospective Cohort Study From Kampala, Uganda(BMC pediatrics, 2020) Nalwanga, Damalie; Musiime, Victor; Kizito, Samuel; Kiggundu, John Baptist; Batte, Anthony; Musoke, Philippa; Tumwine, James K.Mortality among children under 5 years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under 5 years of age admitted to the NRH for routine care of SAM.This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14.Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9–30.4%) died. In-hospital mortality was 20.7% (95% CI15.9–25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2–4.2), p = 0.014), bacteraemia (AHR 9 (95% CI 3.4–23.0), p < 0.001, and low glomerular filtration rate (eGFR), AHR 3.2; (95% CI 1.7–6.3), p = 0.001).A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.Item Ringer’s Lactate Versus Normal Saline in Urgent Cesarean Delivery in a Resource-Limited Setting: A Pragmatic Clinical Trial(A pragmatic clinical trial. Anesthesia & Analgesia, 2017) Timarwa Ayebale, Emmanuel; Kwizera, Arthur; Mijumbi, Cephas; Kizito, Samuel; Roche, Anthony M.Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer’s lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a lowresource setting. Our hypothesis was that RL would result in 30% less acidosis than NS. METHODS: This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012. Five hundred parturients were studied; 252 were randomly assigned to NS and 248 to RL groups. Preoperative and postoperative maternal venous blood gases and placental umbilical arterial cord blood gases were analyzed. The primary outcome was incidence of maternal acidosis, as defined by a postoperative drop in venous pH below 7.32 or reduction in base excess below −3 in a previously normal parturient. Maternal 24-hour postoperative morbidity, neonatal pH, and neonatal base excess were the main secondary outcomes. The study was registered in ClinicalTrials. gov as NCT01585740. RESULTS: The overall incidence of maternal acidosis was 38% in NS and 29% in RL (relative risk, 1.29; 95% confidence interval, 1.01–1.66; P = .04). Thirty-two percent of parturients in NS experienced a drop in venous pH below 7.32 postoperatively, compared with 19% in RL (relative risk, 1.65; 95% confidence interval, 1.18–2.31; P = .003). The comparative drop in base excess postoperatively below −3 between the 2 groups was not statistically significant. There were no significant differences in the incidence of maternal 24-hour postoperative morbidity events and neonatal outcomes between the 2 groups.Item Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda(BMC infectious diseases, 2017) Amanya, Geofrey; Kizito, Samuel; Nabukenya, Immaculate; Kalyango, Joan; Atuheire, Collins; Nansumba, Hellen; Akena Abwoye, Stephen; Opio, Denis Nixon; Kibuuka, Edrisa; Karamagi, CharlesHepatitis E is self-limiting, but can cause death in most at risk groups like pregnant women and those with preexisting acute liver disease. In developing countries it presents as epidemic, in 2014 Hepatitis E Virus (HEV) outbreak was reported in Napak district Uganda. The role of factors in this setting that might have propagated this HEV epidemic, including host, agent, and environmental characteristics, were still not clear. This study was therefore conducted to investigate the risk factors, person, place and time characteristics, associated with the hepatitis E virus (HEV) epidemic in Napak district. Methods: Review of line lists data for epidemiological description and matched case control study on neighborhood and age in the ratio of 1:2 were used to assess risk factors for HEV outbreak in Napak. Cluster and random sampling were used to obtain a sample size of 332, (111 cases, 221 controls). Possible interaction and confounding was assessed using conditional logistic regression. Results: Over 1359 cases and 30 deaths were reported during 2013/2014 HEV outbreak. The mean age of patients was 29 ± years, 57.9% of cases were females. Overall case Fatality Ratio was 2.2% in general population but 65.2% in pregnant women. More than 94% of the cases were reported in the sub counties of Napak, 5.7% of cases were reported in the outside neighboring districts. The epidemic peaked in January 2014 and gradually subsided by December 2014. Risk factors found to be associated with HEV included drinking untreated water (OR 6.69, 95% CI 3.15–14.16), eating roadside food (OR 6.11, 95% CI 2.85–13.09), reported not cleaning utensils (OR 3.24, 95% CI 1.55–1.76), and being a hunter (OR 1.14, 95% CI 1.03–12.66). Conclusion: The results of this study suggest that the virus is transmitted by the feco-oral route through contaminated water. They also suggest that active surveillance and appropriate measures targeting community and routine individual health actions are important to prevent transmission and decrease the deaths.Item Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda(PLoS ONE, 2017) Meyer, Amanda J.; Atuheire, Collins; Worodria, William; Kizito, Samuel; Katamba, Achilles; Sanyu, Ingvar; Andama, Alfred; Ayakaka, Irene; Cattamanchi, Adithya; Bwanga, Freddie; Huang, Laurence; Davis, J. LucianIntroduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality. Objective We carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda. Methods We collected clinical and demographic information and two sputum samples from participants. Staff recorded sputum quality and performed LED fluorescence microscopy and mycobacterial culture on each sample. If both smear examinations were negative, Xpert testing was performed. We calculated diagnostic yield, sensitivity, specificity, and other indicators for Xpert for each stratum of sputum quality in reference to a standard of mycobacterial culture. Results Patients with salivary sputum showed a trend towards a substantially higher proportion of samples that were Xpert-positive (54/286, 19%, 95% CI 15±24) compared with those with all other sputum sample types (221/1496, 15%, 95% CI 13±17). Blood-stained sputum produced the lowest sensitivity (28%; 95% CI 12±49) and salivary sputum the highest (66%; 95% CI 53±77). Specificity didn't vary meaningfully by sample types. Salivary sputum was significantly more sensitive than mucoid sputum (+13%, 95% CI +1 to +26), while bloodstained sputum was significantly less sensitive (-24%, 95% CI -42 to -5). Conclusions Our findings demonstrate the need to exercise caution in collecting sputum for Xpert and in interpreting results because sputum quality may impact test yield and sensitivity. In particular, it may be wise to pursue additional testing should blood-stained sputum test negative while salivary sputum should be readily accepted for Xpert testing given its higher sensitivity and potentially higher yield than other sample types. These findings challenge conventional recommendations against collecting salivary sputum for TB diagnosis and could inform new standards for sputum quality.Item World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda’s Referral Hospitals(Anesthesia & Analgesia, 2018) Igaga, Elizabeth N.; Sendagire, Cornelius; Kizito, Samuel; Obua, Daniel; Kwizera, ArthurA pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda’s referral hospitals. METHODS: A multicentre prospective cohort study was conducted in 5 referral hospitals in Uganda. Using a questionnaire based on the WHO SSC, patients undergoing surgical operations were systematically recruited into the study from April 2016 to July 2016. The patients were followed up daily for 30 days or until discharge for the purpose of documentation of complications. Logistic regression and linear regression were used to assess for association between compliance and perioperative surgical outcomes. RESULTS: We recruited 859 patients into the study. Overall compliance with the WHO SSC was 41.7% (95% confidence interval [CI], 39.7–43.8) ranging from 11.9% to 89.8% across the different hospitals. Overall compliance with “sign in” was 44.7% (95% CI, 43–45.6), with “time out” was 42.0% (95% CI, 39.4–44.6), and with “sign out” was 33.3% (95% CI, 30.7–35.9). There was no association between compliance and perioperative surgical outcomes: length of hospital stay, adverse events, and mortality. CONCLUSIONS: This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively.