Browsing by Author "Sekimpi, Patrick"

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    Charcot arthropathy of the diabetic foot in a sub-Saharan tertiary hospital: a cross- sectional study
    (BioMedical Central, 2019) Wanzou, Jean Paul Vwakya; Sekimpi, Patrick; Komagum, Johnson Owonda; Nakwagala, Frederick; Mwaka, Erisa Sabakaki
    Abstract Background: Charcot foot arthropathy is a potentially limb-threatening condition that leads to progressive destruction of the bones and joints in the neuropathic foot. One of its main causes is diabetes mellitus whose prevalence is steadily increasing. The acute phase is often misdiagnosed thus leading to foot deformity, ulceration and increased risk of amputation. There is a paucity of literature on this condition from sub-Saharan Africa. This study aimed at determining the extent of Charcot foot arthropathy, the radiological patterns of Charcot foot arthropathy and patient’s factors associated with Charcot foot arthropathy among adult patients with longstanding diabetes in an African setting. Methods: This was a cross-sectional study that was carried at a national referral and university teaching hospital in Kampala, Uganda. One hundred patients with longstanding diabetes mellitus were consecutively recruited. Patients with a history of having diabetes mellitus for at least seven years since diagnosis were considered to have a longstanding disease. Clinical assessment of both feet was done. Weight-bearing radiographs of the selected foot were taken and evaluated using the Sanders and Frykberg and modified Eichenholtz classifications. A blood sample was taken for glycosylated haemoglobin (HbA1c). Data were summarized using descriptive statistics and student t-test. Results: The proportion of Charcot foot arthropathy among patients with longstanding diabetes was 12% of which one-third (4 out of 12) were acute cases. Fifty percent of the lesions were in the forefoot and 50% in the midfoot. Seventeen percent of lesions were at the inflammatory stage of the modified Eichenholtz classification, 50% at the developmental stage, 25% at the healing stage, and 8% at the remodelling stage. An abnormal foot radiograph was significantly associated with Charcot foot arthropathy among patients with longstanding diabetes. Conclusion: Charcot foot arthropathy is fairly common in patients with longstanding diabetes mellitus in these settings with one third of patients presenting in the early acute phase. An abnormal weight-bearing radiograph was an associated factor of Charcot foot arthropathy among this specific group of patients. To reduce on the morbidity and limb threatening sequelae of this condition, clinicians are therefore advised to routinely examine the feet of patients with diabetes and send those with suspicious signs and symptoms for radiographic assessment.
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    Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group
    (PLoS Med, 2009) Luboga, Sam; Macfarlane, Sarah B.; Schreeb, Johan von; Kruk, Margaret E.; Cherian, Meena N.; Bergstrom, Staffan; Bossyns, Paul B. M.; Denerville, Ernest; Dovlo, Delanyo; Galukande, Moses; Hsia, Renee Y.; Jayaraman, Sudha P.; Lubbock, Lindsey A.; Mock, Charles; Ozgediz, Doruk; Sekimpi, Patrick; Wladis, Andreas; Zakariah, Ahmed; Babadi Dade, Nameoua; Donkor, Peter; Kabutu Gatumbu, Jane; Hoekman, Patrick; IJsselmuiden, Carel B.; Jamison, Dean T.; Jessani, Nasreen; Jiskoot, Peter; Kakande, Ignatius; Mabweijano, Jacqueline R.; Mbembati, Naboth; McCord, Colin; Mijumbi, Cephas; Miranda, Helder de; Mkony, Charles A.; Mocumbi, Pascoal; Ndihokubwayo, Jean Bosco; Ngueumachi, Pierre; Ogbaselassie, Gebreamlak; Okitombahe, Evariste Lodi; Tidiane Toure, Cheikh; Vaz, Fernando; Zikusooka, Charlotte M.; Debas, Haile T.
    In sub-Saharan Africa, only 46% of births are attended by skilled personnel, compared to 96% in Europe (according to data for the African Region of the World Health Organization [WHO] from 2000 to 2008 [1]). In 2005, slightly over one quarter of a million women died from complications of childbirth [1]; most of these deaths could have been avoided by providing women with access to basic obstetric care and obstetric surgical care. On average, across sub- Saharan Africa, a population of 10,000 is served by two doctors and 11 nursing and midwifery personnel, compared to 32 and 79 respectively serving the same number of people in Europe (WHO data 2000–2007 [1]). A child born in sub- Saharan Africa in 2007 could expect to live only 52 years, which is 22 years less than its European counterpart [1].
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    Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda
    (MC health services research, 2013) Galukande, Moses; Kaggwa, Sam; Sekimpi, Patrick; Kakaire, Othman; Katamba, Achilles; Munabi, Ian; Mwesigye Runumi, Francis; Hagopian, Amy; Blair, Geoffrey; Barnhart, Scott; Luboga, Sam; Mills, Ed.
    The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.