Browsing by Author "Lule, Herman"

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    Determinants of contraceptive utilisation amongst teenage mothers: a case-control study in kyangwali refugee settlement (Uganda)
    (International Journal of Current Advanced Research, 2015) Lule, Herman; Echoru, Isaac; Nnabagulanyi, Mary; Mulumba, Richard
    The determinants of contraceptive utilisation amongst teenage mothers in refugee settings are poorly understood. To establish and compare determinants of contraceptive utilisation amongst refugee and host teenage mothers in Kyangwali Refugee Settlement, we conducted a case-control study to interview 132 cases and 264 controls made up of mothers aged 13-19 years during April 2014, using survey questionnaires and a focussed group discussion. Quantitative data was analysed using SPSS 16.0.Chi-square testing and Odds ratios at 95% confidence interval, and p<0.05 as significant were conducted to determine factors that significantly influenced contraceptive utilisation. Of the 396 teenage mothers, 64.6% (256) were refugees whereas 35.4% (140) were host nationals. Spousal support [X2=6.489, p=0.039; OR=2.250 (1.994-2.571) 95% CI], husband’ level of education [X2=16.189, p=0.000; OR=2.043(1.442-2.896) 95% CI] and a low birth order [X2=7.749, p=0.005; OR=1.227 (1.072-1.405) 95% CI] were significant determinants of contraceptive use. The major barriers contraception were fear of side effects 35.4% (140), refusal by the husband 30.3% (120) and lack of community based access 23.0% (91). There was no significant statistical difference in current use of contraceptives between refugee teenage mothers and host nationals [X2=0.138, p=0.710; OR=1.087(0.701-1.686) 95% CI].There is need to restructure delivery of contraceptive services in a way that enhances maximum uptake amongst teenage mothers in refugee settings, through integrated outreaches, girl-child education and male targeted messages in order to curtail the consequences of contraceptive underutilisation in this population.
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    Euthyroidectomy under local versus general anesthesia in health camp settings in Uganda: a protocol for randomized prospective equivalence single-blind controlled trial
    (Trials, 2023-05-31) Kabuye, Umaru; Fualal, Jane Odubu; Lule, Herman
    Endemic goiter is highly prevalent in Uganda at 60.2%, contributing to the high surgical burden. While compelling evidence suggest that in selected cases, thyroidectomy under local anesthesia (LA) is associated with fewer post-operative complications, low costs, and short hospital stays, local anesthesia is not considered a priority technique for thyroidectomy in resource-constrained settings such as Uganda, despite having fewer general anesthesia (GA) and critical care providers. The objective of this trial is to compare euthyroidectomy under local versus general anesthesia among patients with grade 1–2 uncomplicated euthyroid goiter in Uganda. This prospective equivalence randomized, single-blind controlled trial protocol will be conducted among eligible participants with grade 1–2 uncomplicated euthyroid goiters. The recruitment processes will start in October 2022 and end in April 2023. Consenting participants with an indication for thyroidectomy will be randomized into two arms of 29 participants in each arm during the Bulamu Health Care Organization surgical camps in Uganda. The primary outcome of this trial protocol is to compare the early post-operative complications of euthyroidectomy done under LA versus GA. The outcome variables include post-operative pain based on visual analogue scale, nausea, vomiting, hematoma formation, and transient voice changes determined at an interval of 6, 12, and 24 h and at 30 days. In addition, we shall compare the surgical site infection rates, procedure costs, hospital stay, and patients’ level of satisfaction based on a 5-point Likert scale and their willingness to undergo a similar surgery using the same anesthetic technique between the two groups. We hypothesize that euthyroidectomy under LA could potentially offer similar benefits as GA, reduce costs related to procedure, complications, and hospital stay while at the same time mitigating the unmet need for surgery attributable to shortage of general anesthesia providers and critical care facilities in low-income settings.
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    Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda
    (PeerJ, 2021) Matovu, Paul; Kirya, Musa; Galukande, Moses; Kiryabwire, Joel; Mukisa, John; Ocen, William; Wilson, Michael Lowery; Abio, Anne; Lule, Herman
    Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda. Objective: We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda. Methods: We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without. Results: Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality. Conclusion: Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.
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    New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study
    (BMC emergency medicine, 2024-07-29) Damulira, John; Muhumuza, Joshua; Kabuye, Umaru; Ssebaggala, Godfrey; Lule, Herman
    Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population.
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    Thyroidectomy underLocal versus General Anesthesia in Health Camp Settings in Uganda: a Randomized Prospective Equivalence Singleblind Controlled trial
    (BMC surgery, 2025-02-19) Kabuye, Umaru; Fualal, Jane Odubu; Lule, Herman
    Endemic goiter is highly prevalent in Uganda, placing a considerable surgical burden on the healthcare system. Across Africa, prevalence varies widely, reaching 60.2%, with visible goiter affecting 30% of Uganda’s rural population despite salt iodization programs. Despite evidence supporting thyroidectomy under local anesthesia (LA) for selected cases, its importance is underestimated moreover with limited access to general anesthesia (GA) and critical care providers in resource-constrained settings. The trial compared outcomes of thyroidectomy under LA versus GA in grade 1–2 uncomplicated euthyroid goiter patients in Uganda, with an aim to assess feasibility of LA as an alternative technique. In this prospective equivalence randomized, single-blind controlled trial, participants with grade 1–2 uncomplicated euthyroid goiters were enrolled and randomly assigned to two arms (LA and GA) during surgical camps in Uganda. The study compared early postoperative outcomes, including nausea, vomiting, hematoma formation, transient voice changes, and pain at 6, 12, and 24 h. It also assessed overall incurred material and medication costs, patient satisfaction using a 5-point Likert scale, and willingness to undergo a similar procedure with the same anesthetic technique at 30 days. Fifty-eight participants undergoing thyroidectomy received random assignment, twenty-nine for each arm. No significant differences were found between the 2 groups in demographics, symptom duration, and early post-operative complications or patients’ level of satisfaction (P > 0.05). However, the overall material and medication costs were significantly lower in the LA Group (P < 0.001). Thyroidectomy under LA can be performed in a well-selected patient population with low complication rates and comparable patient satisfaction to GA. These findings may support LA for thyroidectomy as a valuable cost-efficient alternative, especially in low-resource settings with fewer GA providers.