Browsing by Author "Olupot-Olupot, Peter"
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Item Bacterial Aetiology and Antibiotic Susceptibility Profile of Post-Operative Sepsis among Surgical Patients in a Tertiary Hospital in Rural Eastern Uganda(Microbiology research journal international, 2018) Masifa, George; Jacob, Stanley Iramiot; Muhindo, Rita; Olupot-Olupot, Peter; Nanteza, AnnPost-operative wound sepsis remains a surgical challenge of public health concern constituting approximately 20% of the health care-associated nosocomial infections. This study aimed at determining the prevalence and antimicrobial resistance patterns of bacterial pathogens isolated from post-operative wound infections at Mbale Regional Referral Hospital. Materials and Methods: This was a descriptive cross-sectional study conducted from June to October 2015. Study participant samples were sub-cultured upon reception in the Microbiology laboratory and the isolated bacterial pathogens were analysed. Phenotypic antimicrobial susceptibility profiles were determined using the Kirby-Bauer method. Interpretation of the zone diameters was done following the Clinical and Laboratory Standards Institute guidelines. Phenotypic screening for Methicillin-resistant Staphylococcus aureus (MRSA) was performed using oxacillin (1 μg). D-test was also performed for phenotypic screening of inducible clindamycin resistant Staphylococcus aureus, Data were entered into Microsoft Excel and analysed using IBM SPSS statistics (version 16). Results: Overall post-operative sepsis was 69/80 (86.2%) with Staphylococcus aureus as the most predominant organism 41/104 (39.4%) followed by Escherichia coli 22/104 (21.2%) and Klebsiella species 15/104 (14.4%). Of the 41/104 isolated Staphylococcus aureus, 27/41(65.9%) were MRSA strains and 5/41 (12.2%) were inducible clindamycin resistant Staphylococcus aureus strains. The isolated Staphylococcus aureus was resistant to multiple drugs though susceptible to vancomycin and clindamycin. In addition, none of the isolated Enterococci species was vancomycin resistant. Although most of the isolated Gram-negative organisms were sensitive to imipenem, resistance was observed for tetracycline, trimethoprim/sulphamethoxazole, and ceftriaxone. Conclusion: Staphylococcus aureus was the most common causative agent associated with postoperative sepsis with most of the strains being MRSA. Multi-drug resistance was observed in 63/104 (60.6%) of the isolated organisms in our study. Hence the need to better develop and strengthen antimicrobial stewardship programs as well as to understand the carriage of antimicrobial resistance genes among these organisms.Item Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial(BMC medicine, 2013-03-14) Maitland, Kathryn; Kiguli,Sarah; Olupot-Olupot, Peter; Akech, Samuel O.; Opoka, Robert O.; Nyeko, Richard; Nteziyaremye, JuliusEarly rapid fluid resuscitation (boluses) in African children with severe febrileillnesses increases the 48-hour mortality by 3.3% compared with controls (nobolus). We explored the effect of boluses on 48-hour all-cause mortality byclinical presentation at enrolment, hemodynamic changes over the first hour, andon different modes of death, according to terminal clinical events. We hypothesizethat boluses may cause excess deaths from neurological or respiratory eventsrelating to fluid overload.Item Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial(BMC medicine, 2013-03-14) Maitland, Kathryn; Kiguli, Sarah; Olupot-Olupot, Peter; Akech, Samuel O.Early rapid fluid resuscitation (boluses) in African children with severe febrileillnesses increases the 48-hour mortality by 3.3% compared with controls (nobolus). We explored the effect of boluses on 48-hour all-cause mortality byclinical presentation at enrolment, hemodynamic changes over the first hour, andon different modes of death, according to terminal clinical events. We hypothesizethat boluses may cause excess deaths from neurological or respiratory eventsrelating to fluid overload.Item Hematologic, Immunologic and Outcome Characteristics of Severe acute respiratory syndrome 2 (SARS-COV-2) among People Living with HIV in Eastern Uganda: A Retrospective Study(medRxiv, 2025-02-23) Otaala, Timothy; Opito, Ronald; Mugisha, Kenneth; Bakashaba, Baker; Watmon, Benedicto; Etolu, Wilson; Lubaale, Moses Yovani; Olupot-Olupot, PeterGlobally People Living with HIV (PLWHIV) are prone to severe opportunistic infections with Coronavirus disease of 2019 (COVID-19) inclusive. Dual infection of HIV and COVID-19 could complicate the clinical outcomes of these patients. This study sought to determine hematologic, immunologic, virologic and outcome characteristics of people with HIV and COVID-19 co-infections in two Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. A retrospective review of medical records of PLHIV and contracted COVID-19 virus was conducted in two large regional referral hospitals in Eastern Uganda using a data abstraction tool. Data was captured using Kobo collect toolbox, downloaded in Microsoft Excel and analyzed using STATA version 15.0. Descriptive statistics was reported as frequencies and proportions, while contingency and comparisons were done at the bivariate level analysis. The penalized logistic regression was conducted at multivariate level to establish the factors associated with COVID-19 severity among PLHIV. A total of 100 patient records had 38%(n=38) of individuals aged 40-50 years and 62%(n=62) females. Most patients (6 in 10) were peasants with 79%(n=79) having low-income levels. Other than HIV, 3 out of 10 patients had comorbidities. Also, 30 had haematological records, of which 9 (30%) had leucocytosis and 3, leucopoenia. Further, 67% had immunologic records, of which 22 (33%) had CD4 counts <200 cells/mm3. Only 22% of patients had viral load results, of which 8 (36) were unsuppressed. Nineteen percent (19/100) patients had severe COVID-19 and 14% (14/100) died. Socio-demographic factors significantly associated with severe COVID-19 outcomes were being male (P=0.026) and having other comorbidities (P<0.001). A significant proportion of PLHIV co-infected with COVID-19 had abnormal hematological and virological status possibly due to varying socio-demographic characteristics. Clinical outcomes of HIV and COVID-19 co-infection may therefore vary depending on an interplay between host factors, viral factors, and comorbidities.Item Is fat mass a better predictor of 6-month survival than muscle mass among African children aged 6–59 months with severe pneumonia?(BioMed Central, 2024-09) Nalwanga, Damalie; Musiime, Victor; Kiguli, Sarah; Olupot-Olupot, Peter; Alaroker, Florence;; Opoka, Robert;; Tagoola, Abner; Mnjalla, Hellen; Mogaka, Christabel; Nabawanuka, Eva; Giallongo, Elisa; Karamagi, Charles; Briend, André; Maitland, KathrynPneumonia remains the leading cause of mortality among children under 5 years. Poor nutritional status increases pneumonia mortality. Nutritional status assessed by anthropometry alone does not provide information on which body composition element predicts survival. Body composition proxy measures including arm-fat-area (AFA), arm-muscle-area (AMA), and arm-muscle-circumference (AMC) could be useful predictors. To compare the ability of fat and muscle mass indices to predict 6-month survival among children with severe pneumonia. This prospective cohort study was nested in the COAST-Nutrition trial (ISRCTN10829073, 06/06/2018) conducted between June 2020 and October 2022 in Uganda and Kenya. We included children aged 6-59 months hospitalized for severe pneumonia with hypoxemia. Children with severe malnutrition, known chronic lung or cardiac diseases were excluded. Anthropometry and clinical status were assessed at enrolment and at follow-up to day 180. We examined Receiver Operator Characteristic (ROC) curves of fat and muscle mass indices with 6-month survival as the outcome, and compared the areas under the curve (AUCs) using chi-square tests. Cox survival analysis models assessed time-to-mortality. We included 369 participants. The median age was 15-months (IQR 9, 26), and 59.4% (219/369) of participants were male. The baseline measurements were: median MUAC 15.0 cm (IQR 14.0,16.0); arm-fat-area 5.6cm (IQR 4.7, 6.8); arm-muscle-area 11.4cm (IQR 10.0, 12.7); and arm-muscle-circumference 12.2 cm (IQR 11.5, 12.9). Sixteen (4.3%) participants died and 4 (1.1%) were lost-to-follow-up. The AUC for Arm-Fat-Area was not significantly higher than that for Arm-Muscle-Area and Arm-Muscle-Circumference [AUC 0.77 (95%CI 0.64-0.90) vs. 0.61 (95%CI 0.48-0.74), p = 0.09 and 0.63 (95%CI 0.51-0.75), p = 0.16 respectively], but was not statistically different from MUAC (AUC 0.73 (95%CI 0.62-0.85), p = 0.47). Increase in Arm-Fat-Area and Arm-Muscle-Circumference significantly improved survival [aHR 0.40 (95%CI 0.24-0.64), p = < 0.01 and 0.59 (95%CI 0.36-1.06), p = 0.03 respectively]. Survival prediction using Arm-Fat-Area was not statistically different from that of MUAC (p = 0.54). Muscle mass did not predict 6-month survival better than fat mass in children with severe pneumonia. Fat mass appears to be a better predictor. Effects of fat and muscle could be considered for prognosis and targeted interventions. PubMedItem A Mathematical Model Approach for Prevention and Intervention Measures of the COVID{19 Pandemic in Uganda(Asian Research Journal of Mathematics, 2022) Kamugisha Mbabazi, Fulgensia; Gavamukulya, Yahaya; Awichi, Richard; Olupot-Olupot, Peter; Rwahwire, Samson; Biira, Saphina; Luboobi, Livingstone S.The human{infecting corona virus disease (COVID{19) caused by the novel severe acute respiratory syndrome corona virus 2 (SARS{CoV{2) was declared a global pandemic on March 11th, 2020. Current human deaths due to the infection have raised the threat globally with only 1 African country free of Virus (Lesotho) as of May 6th, 2020. Different countries have adopted different interventions at different stages of the outbreak, with social distancing being the first option while lock down the preferred option for flattening the curve at the peak of the pandemic. Lock down is aimed at adherence to social distancing, preserve the health system and improve survival. We propose a Susceptible{Exposed{Infected{Expected recoveries (SEIR) mathematical model to study the impact of a variety of prevention and control strategies Uganda has applied since the eruption of the pandemic in the country. We analyze the model using available data to find the infection{free, endemic/infection steady states and the basic reproduction number. In addition, a sensitivity analysis done shows that the transmission rate and the rate at which persons acquire the virus, have a positive influence on the basic reproduction number. On other hand the rate of evacuation by rescue ambulance greatly reduces the reproduction number. The results have potential to inform the impact and effect of early strict interventions including lock down in resource limited settings and social distancing.Item Neonatal tetanus in eastern Uganda: improved outcome following the implementation of a neonatal tetanus protocol(Tropical Doctor, 2020) Burgoine, Kathy; Egiru, Emma; Ikiror, Juliet; Acom, Linda; Akol, Sylivia; Olupot-Olupot, PeterNeonatal tetanus remains a significant, yet avoidable, cause of neonatal death. Despite the 34,000 deaths that occur globally from neonatal tetanus every year, there has been little research into the management of neonatal tetanus. Until worldwide elimination of neonatal tetanus is achieved, the case management of this devastating illness needs to be improved. We describe an improved outcome of neonatal tetanus following the introduction of a neonatal tetanus protocol including diazepam, magnesium sulphate, bubblItem Reagent Strips as an Aid to Diagnosis of Neonatal Meningitis in a Resource-limited Setting(Journal of tropical pediatrics, 2019) Burgoine, Kathy; Ikiror, Juliet; Naizuli, Ketty; Achom, Linda; Akol, Sylivia; Olupot-Olupot, PeterWithout early recognition and treatment, neonatal meningitis (NM) has a high mortality and morbidity. Although some neonates have features of NM, many do not. In many low-resource settings, the laboratory support to diagnose NM is not available, and bedside diagnostics are needed. Methods: This retrospective study was conducted in a neonatal unit in Uganda. Clear cerebrospinal fluid samples were routinely screened for glucose, protein and leukocytes on a ComburVR -10 urinalysis reagent strip. A definitive diagnosis was made using laboratory analysis. The results of the screening and definitive tests were compared. Results: The reagent strip showed moderate sensitivity and high specificity for leukocytes 10 106 cells/l, high sensitivity for protein 100 mg/dl and high specificity for glucose<50 mg/dl. Conclusion: The use of reagent strips has the potential to improve and hasten the diagnosis of probable NM in settings where adequate or timely laboratory support is not available.Item Side-Effects following Oxford/AstraZeneca COVID-19 Vaccine in Tororo District, Eastern Uganda: A Cross-Sectional Study(MDPI AG, 2022-11) Onyango, Jagire; Mukunya, David; Napyo, Agnes; Nantale, Ritah; Makoko, Brian T; Matovu, Joseph K B; Wanume, Benon; Okia, David; Okello, Francis; Okware, Sam; Olupot-Olupot, Peter; Lubaale, YovaniAbstract: Effective, safe and proven vaccines would be the most effective strategy against the COVID-19 pandemic but have faced rollout challenges partly due to fear of potential side-effects. We assessed the prevalence, profiles, and predictors of Oxford/AstraZeneca vaccine side-effects in Tororo district of Eastern Uganda. We conducted telephone interviews with 2204 participants between October 2021 and January 2022. Multivariable logistic regression was conducted to assess factors associated with Oxford/AstraZeneca vaccine side-effects using Stata version 15.0. A total of 603/2204 (27.4%) of the participants experienced one or more side-effects (local, systemic, allergic, and other side-effects). Of these, 253/603 (42.0%) experienced local side-effects, 449/603 (74.5%) experienced systemic side-effects, 11/603 (1.8%) experienced allergic reactions, and 166/603 (27.5%) experienced other side-effects. Ten participants declined to receive the second dose because of side-effects they had experienced after the first dose. Previous infection with COVID-19 (adjusted odds ratio (AOR): 4.3, 95% confidence interval (95% CI): 2.7–7.0), being female (AOR: 1.3, 95% CI: 1.1–1.6) and being a security officer (AOR: 0.4, 95% CI: 0.2–0.6) were associated with side-effects to the Oxford/AstraZeneca vaccine. We recommend campaigns to disseminate correct information about potential side-effects of the Oxford/AstraZeneca vaccine and strengthen surveillance for adverse events following vaccination.Item Staged implementation of a two tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda(BMJ global health, 2018) Burgoine, Kathy; Ikiror, Juliet; Akol, Sylivia; Kakai, Margaret; Talyewoya, Sara; Sande, Alex; Otim, Tom; Okello, Francis; Hewitt-Smith, Adam; Olupot-Olupot, PeterNeonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHORecommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in lowresource settings adopt a similar approach.Item Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial(The Lancet Global Health, 2022) George, Elizabeth C.; Uyoga, Sophie; M’baya, Bridon; Kyeyune Byabazair, Dorothy; Kiguli, Sarah; Olupot-Olupot, Peter; Opoka, Robert O.; Chagaluka, George; Alaroker, Florence; Williams, Thomas N.; Bates, Imelda; Mbanya, Dora; Gibb, Diana M.; Walker, A. Sarah; Maitland, KathrynThe TRACT trial established the timing of transfusion in children with uncomplicated anaemia (haemoglobin 4–6 g/dL) and the optimal volume (20 vs 30 mL/kg whole blood or 10 vs 15 mL/kg red cell concentrates) for transfusion in children admitted to hospital with severe anaemia (haemoglobin <6 g/dL) on day 28 mortality (primary endpoint). Because data on the safety of blood components are scarce, we conducted a secondary analysis to examine the safety and efficacy of different pack types (whole blood vs red cell concentrates) on clinical outcomes. Methods This study is a secondary analysis of the TRACT trial data restricted to those who received an immediate transfusion (using whole blood or red cell concentrates). TRACT was an open-label, multicentre, factorial, randomised trial conducted in three hospitals in Uganda (Soroti, Mbale, and Mulago) and one hospital in Malawi (Blantyre). The trial enrolled children aged between 2 months and 12 years admitted to hospital with severe anaemia (haemoglobin <6 g/dL). The pack type used (supplied by blood banks) was based only on availability at the time. The outcomes were haemoglobin recovery at 8 h and 180 days, requirement for retransfusion, length of hospital stay, changes in heart and respiratory rates until day 180, and the main clinical endpoints (mortality until day 28 and day 180, and readmission until day 180), measured using multivariate regression models. Findings Between Sept 17, 2014, and May 15, 2017, 3199 children with severe anaemia were enrolled into the TRACT trial. 3188 children were considered in our secondary analysis. The median age was 37 months (IQR 18–64). Whole blood was the first pack provided for 1632 (41%) of 3992 transfusions. Haemoglobin recovery at 8 h was significantly lower in those who received packed cells or settled cells than those who received whole blood, with a mean of 1·4 g/dL (95% CI –1·6 to –1·1) in children who received 30 mL/kg and –1·3 g/dL (–1·5 to –1·0) in those who received 20 mL/kg packed cells versus whole blood, and –1·5 g/dL (–1·7 to –1·3) in those who received 30 mL/kg and –1·0 g/dL (–1·2 to –0·9) in those who received 20 mL/kg settled cells versus whole blood (overall p<0·0001). Compared to whole blood, children who received blood as packed or settled cells in their first transfusion had higher odds of receiving a second transfusion (odds ratio 2·32 [95% CI 1·30 to 4·12] for packed cells and 2·97 [2·18 to 4·05] for settled cells; p<0·001) and longer hospital stays (hazard ratio 0·94 [95% CI 0·81 to 1·10] for packed cells and 0·86 [0·79 to 0·94] for settled cells; p=0·0024). There was no association between the type of blood supplied for the first transfusion and mortality at 28 days or 180 days, or readmission to hospital for any cause. 823 (26%) of 3188 children presented with severe tachycardia and 2077 (65%) with tachypnoea, but these complications resolved over time. No child developed features of confirmed cardiopulmonary overload. Interpretation Our study suggests that the use of packed or settled cells rather than whole blood leads to additional transfusions, increasing the use of a scarce resource in most of sub-Saharan Africa. These findings have substantial cost implications for blood transfusion and health services. Nevertheless, a clinical trial comparing whole blood transfusion with red cell concentrates might be needed to inform policy makers.