Browsing by Author "Ogwang, Martin"
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Item Access to Pediatric Surgery Delivered by General Surgeons and Anesthesia Providers in Uganda: Results from 2 Rural Regional Hospitals(Surgery, 2021) Grabski, David F.; Ajiko, Margaret; Kayima, Peter; Ruzgar, Nensi; Nyeko, David; Fitzgerald, Tamara N.; Langer, Monica; Cheung, Maija; Cigliano, Bruno; D’Agostino, Sergio; Baird, Robert; Duffy, Damian; Tumukunde, Janat; Nabukenya, Mary; Phyllis Kisa, Phyllis; Ogwang, Martin; Sekabira, John; Kakembo, Nasser; Ozgediz, DorukSignificant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children’s surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity.Two years of a prospective clinical database of children’s surgery admissions at 2 regional referral hospitals in Uganda were reviewed. Primary outcomes included case volume and clinical outcomes of children at each hospital. Additionally, the disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Using a value of statistical life calculation, we also estimated the economic benefit of the pediatric surgical care currently being delivered. From 2016 to 2019, more than 300 surgical procedures were performed at each hospital per year. The majority of cases were standard general surgery cases including hernia repairs and intussusception as well as procedures for surgical infections and trauma. In-hospital mortality was 2.4% in Soroti and 1% in Lacor. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted life-years averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society.This investigation demonstrates that lifesaving pediatric procedures are safely performed by general surgeons in Uganda. General surgeons who perform pediatric surgery significantly increase surgical access to rural regions of the country and add a large economic benefit to Ugandan society. Overall, the results of the study support increasing pediatric surgical capacity in rural areas of low- and middle-income countries through support and training of general surgeons and anesthesia providers.Item The Alteration of Lipid Metabolism in Burkitt Lymphoma Identifies a Novel Marker: Adipophilin(PLoS ONE, 2012) Ambrosio, Maria R.; Piccaluga, Pier P.; Ponzoni, Maurilio; Rocca, Bruno J.; Malagnino, Valeria; Onorati, Monica; Falco, Giulia De; Calbi, Valeria; Ogwang, Martin; Naresh, Kikkeri N.; Pileri, Stefano A.; Doglioni, Claudio; Leoncini, Lorenzo; Lazzi, StefanoRecent evidence suggests that lipid pathway is altered in many human tumours. In Burkitt lymphoma this is reflected by the presence of lipid droplets which are visible in the cytoplasm of neoplastic cells in cytological preparations. These vacuoles are not identifiable in biopsy section as lipids are ‘‘lost’’ during tissue processing. Methods and Results: In this study we investigated the expression of genes involved in lipid metabolism, at both RNA and protein level in Burkitt lymphoma and in other B-cell aggressive lymphoma cases. Gene expression profile indicated a significant over-expression of the adipophilin gene and marked up-regulation of other genes involved in lipid metabolism in Burkitt lymphoma. These findings were confirmed by immunohistochemistry on a series od additional histological samples: 45 out of 47 BL cases showed strong adipophilin expression, while only 3 cases of the 33 of the not-Burkitt lymphoma category showed weak adipophilin expression (p,0.05). Conclusions: Our preliminary results suggest that lipid metabolism is altered in BL, and this leads to the accumulation of lipid vacuoles. These vacuoles may be specifically recognized by a monoclonal antibody against adipophilin, which may therefore be a useful marker for Burkitt lymphoma because of its peculiar expression pattern. Moreover this peptide might represent an interesting candidate for interventional strategies.Item Communities and service providers address access to perinatal care in post conflict Northern Uganda: socializing evidence for participatory action(Fam Med Com Health, 2021) Belaid, Loubna; Atim, Pamela; Atim, Eunice; Ochola, Emmanuel; Ogwang, Martin; Bayo, Pontius; Oola, Janet; Wonyima Okello, Isaac; Sarmiento, Ivan; Rojas-Rozo, Laura; Zinszer, Kate; Zarowsky, Christina; Andersson, NeilDescribe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda. Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes. Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall. They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign. Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.Item Diagnosis of Burkitt lymphoma using an algorithmic approach – applicable in both resource-poor and resource-rich countries(British journal of haematology, 2011) Naresh, Kikkeri N.; Ibrahim, Hazem A. H.; Lazzi, Stefano; Rince, Patricia; Onorati, Monica; Ambrosio, Maria R.; Bilhou-Nabera, Chryste`le; Amen, Furrat; Reid, Alistair; Mawanda, Michael; Calbi, Valeria; Ogwang, Martin; Rogena, Emily; Byakika, Bessie; Sayed, Shahin; Moshi, Emma; Mwakigonja, Amos; Raphael, Martine; Magrath, Ian; Leoncini, LorenzoDistinguishing Burkitt lymphoma (BL) from B cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma (DLBCL) and BL (DLBCL/BL), and DLBCL is challenging. We propose an immunohistochemistry and fluorescent in situ hybridization (FISH) based scoring system that is employed in three phases – Phase 1 (morphology with CD10 and BCL2 immunostains), Phase 2 (CD38, CD44 and Ki-67 immunostains) and Phase 3 (FISH on paraffin sections for MYC, BCL2, BCL6 and immunoglobulin family genes). The system was evaluated on 252 aggressive B-cell lymphomas from Europe and from sub-Saharan Africa. Using the algorithm, we determined a specific diagnosis of BL or not-BL in 82%, 92% and 95% cases at Phases 1, 2 and 3, respectively. In 3Æ4% cases, the algorithm was not completely applicable due to technical reasons. Overall, this approach led to a specific diagnosis of BL in 122 cases and to a specific diagnosis of either DLBCL or DLBCL/BL in 94% of cases that were not diagnosed as BL. We also evaluated the scoring system on 27 cases of BL confirmed on gene expression/microRNA expression profiling. Phase 1 of our scoring system led to a diagnosis of BL in 100% of these cases.Item Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda(Tropical Medicine & International Health, 2006) Fabiani, Massimo; Nattabi, Barbara; Ayella, Emingtone O.; Ogwang, Martin; Declich, SilviaTo estimate differences in fertility by HIV serostatus and to validate an adjustment method for estimating the HIV prevalence in the general female population using data from an antenatal clinic. methods We used Cox regression models to retrospectively estimate the age-specific relative fertility (RF) of HIV-positive compared to HIV-negative women among 3314 antenatal clinic attenders in northern Uganda. RF and the age distribution of women in the general female population were used to extrapolate the antenatal clinic-based HIV prevalence. This procedure was indirectly validated by comparing the adjusted estimate with those based on standard adjustment factors derived from general female populations in Uganda and Tanzania. results HIV-positive women reported a lower fertility than HIV-negative women [age-adjusted RF ¼ 0.83, 95% confidence interval (CI): 0.75–0.93]. Except for girls aged 15–19 (RF ¼ 0.96, 95% CI: 0.74– 1.24) HIV-positive women in all age groups were less fertile (20–24 year: RF ¼ 0.83, 95% CI: 0.67– 1.01; 25–29 years: RF ¼ 0.79, 95% CI: 0.62–1.00; 30–49 year: RF ¼ 0.79, 95% CI: 0.65–0.96]. Adjusting the antenatal clinic-based HIV prevalence (11.6%) for these differences yields a higher estimate (13.8%) that is lower than those based on standard adjustment factors derived from general female populations (from 14.6% to 17.7%). conclusions The age-specific pattern of differential fertility by HIV serostatus derived from antenatal clinic data is consistent with findings from population-based studies conducted in Africa. However, differences in fertility between HIV positive and HIV-negative clients underestimate those in the general female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.Item Differences in hospital admissions for males and females in northern Uganda in the period 1992—2004: a consideration of gender and sex differences in health care use(Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007) Accorsi, Sandro; Fabiani, Massimo; Nattabi, Barbara; Ferrarese, Nicoletta; Corrado, Bruno; Iris, Robert; Ayella, Emintone O.; Pido, Bongomin; Yoti, Zabulon; Corti, Dominique; Ogwang, Martin; Declich, SilviaTo inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210 319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992—2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0—14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15—44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (≥45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.Item Malariological baseline survey and in vitro antimalarial drug resistance in Gulu district, Northern Uganda(The Middle European Journal of Medicine, 2008) Prugger, Christof; Engl, Michael; Ogwang, Martin; Ploner, Franz; Ploner, Martin; Gluderer, Doris; Wernsdorfer, Gunther; Wernsdorfer, Walther H.A comprehensive, representative malaria survey has been carried out in a population of internally displaced persons (IDP) in the district of Gulu, Northern Uganda. It included 74 households and 390 persons, and covered socio-economic and environmental information, individual physical data, malaria and the drug sensitivity of Plasmodium falciparum. The prevalence of infections with Plasmodium falciparum was 54.4% at a geometric mean asexual parasitaemia of 229/μl blood, typical for hyperendemic conditions. P. falciparum turned out to be highly resistant to chloroquine and amodiaquine. It showed also reduced sensitivity against lumefantrine and artemisinin, obviously the result of the liberal use of the lumefantrine-artemether combination without evidence-based indication.Item Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors’ Perspectives in Post-Conflict Northern Uganda(Int J Health Policy Manag, 2021) Mac-Seing, Muriel; Ochola, Emmanuel; Ogwang, Martin; Zinszer, Kate; Zarowsky, ChristinaEmerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors’ perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. Methods: Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people’s organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. Results: We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. Conclusion: This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.Item Uganda experience—Using cost assessment of an established registry to project resources required to expand cancer registration(Cancer epidemiology, 2016) Wabinga, Henry; Subramanian, Sujha; Nambooze, Sarah; Mary Amulen, Phoebe; Edwards, Patrick; Joseph, Rachael; Ogwang, Martin; Okongo, Francis; Parkin, D. Maxwell; Tangka, FlorenceThe objectives of this study are (1) to estimate the cost of operating the Kampala Cancer Registry (KCR) and (2) to use cost data from the KCR to project the resource needs and cost of expanding and sustaining cancer registration in Uganda, focusing on the recently established Gulu Cancer Registry (GCR) in rural Northern Uganda. Methods: We used Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool) to estimate the KCR’s activity-based cost for 2014. We grouped the registry activities into fixed cost, variable core cost, and variable other cost activities. After a comparison KCR and GCR characteristics, we used the cost of the KCR to project the likely ongoing costs for the new GCR. Results: The KCR incurred 42% of its expenditures in fixed cost activities, 40% for variable core cost activities, and the remaining 18% for variable other cost activities. The total cost per case registered was 28,201 Ugandan shillings (approximately US $10 in 2014) to collect and report cases using a combination of passive and active cancer data collection approaches. The GCR performs only active data collection, and covers a much larger area, but serves a smaller population compared to the KCR. Conclusion: After identifying many differences between KCR and GCR that could potentially affect the cost of registration, our best estimate is that the GCR, though newer and in a rural area, should require fewer resources than the KCR to sustain operations as a stand-alone entity. The optimal structure of the GCR needs to be determined in the future.Item Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda(World Journal of Surgery, 2019) Kisa, Phyllis; Ajiko, Margaret; Male, Doreen Birabwa; Galiwango, George; Kakembo, Nasser; Kambugu, Joyce B.; Muhumuza, Moses Fisha; Muzira, Arlene; Nabukenya, Mary T.; Nakku, Doreen; Nankunda, Jolly; Ogwang, Martin; Okello, Innocent; Ssenyonga, Peter; Tumukunde, JanatThere is a significant unmet need for children’s surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children’s surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders’ meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. The stakeholders’ meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and short-term objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. Collaborations between disciplines, both within LMICs and with international partners, are required to advance children’s surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children’s surgical capacity. Such a process may prove useful in other LMICs with a wide range of children’s surgery stakeholders.Item Using prevalence data from the programme for the prevention of mother-to-child-transmission for HIV-1 surveillance in North Uganda(AIDS, 2005) Fabiani, Massimo; Nattabi, Barbara; Ayella, Emingtone O.; Ogwang, Martin; Declich, SilviaTo validate the use of data from a programme for the prevention of motherto- child transmission (PMTCT) in estimating HIV-1 prevalence in North Uganda. Methods: The study was conducted at St. Mary’s Hospital Lacor. We compared the estimated prevalence for 3580 attendees at the antenatal clinic who were selected for anonymous surveillance to that for 6785 pregnant women who agreed to undergo voluntary counselling and testing (VCT) for enrolment in the PMTCT programme. Logbinomial regression models were used to identify the factors associated with both VCT uptake and HIV-1 infection, which could bias the prevalence estimates based on PMTCT data. Results: In 2001–2003, the age-standardized prevalence was similar (11.1% in the anonymous surveillance group and 10.9% in the VCT group). The estimates were also similar when compared for each year tested. Analogously, no important differences were observed in age-specific prevalence. Of the factors associated with HIV-1 infection, only time of residence at current address [prevalence proportion ratio (PPR) ¼ 1.05; 95% confidence interval (CI), 1.00–1.10], marital status (PPR ¼ 1.05; 95% CI, 1.01–1.10) and partner’s occupation (PPR ¼ 1.05; 95% CI, 1.01–1.10) were associated with VCT uptake, yet the associations were weak. Conclusions: The prevalence estimated based on the VCT data collected as part of the PMTCT programme could be used for HIV-1 surveillance in North Uganda. At the national level, however, it needs to be evaluated whether PMTCT data could replace, or instead be combined with, the data from sentinel surveillance.