Browsing by Author "Waibi, William Mugowa"

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    Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource Constrained Setting
    (International journal of pediatrics, 2020) Egesa, Walufu Ivan; Waibi, William Mugowa
    Preterm birth complications are responsible for almost one-third of the global neonatal mortality burden, and respiratory distress syndrome remains the single most common cause of these preventable deaths. Since its inception, almost half a century ago, nasal continuous positive airway pressure (NCPAP) has evolved to become the primary modality for neonatal respiratory care in both the developed and developing world. Although evidence has demonstrated the effectiveness of low-cost bubble NCPAP in reducing newborn mortality, its widespread use is yet to be seen in resource-constrained settings. Moreover, many tertiary hospitals in developing countries still utilise an inexpensive locally assembled bNCPAP system of unknown efficacy and safety. This review provides a brief overview of the history, physiological benefits, indications, contraindications, and complications of bNCPAP. Evidence regarding the effectiveness of low-cost bNCPAP in the neonatal intensive care unit is also summarised. The article further details a locally assembled bNCPAP system used in resource-constrained settings and highlights the care package for neonates receiving bNCPAP, failure criteria, and strategies for weaning.
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    Capacity for delivery of paediatric emergency care and the current use of emergency triage, assessment and treatment in health facilities in the Busoga region, Uganda—A mixed methods study
    (Public Library of Science, 2024-09-04) Laucaityte, Goda; Fahnehjelm, Fredrik Wikander; Akongo, Dorothy; Tenywa, Emmanuel; Hildebrand, Karl; Kyangwa, Moses; Ssemwogerere, Racheal Kwagala; Waibi, William Mugowa; Hildenwall, Helena
    The implementation of structured guidelines, such as the World Health Organisation's Emergency Triage, Assessment and Treatment has been shown to reduce in-hospital mortality, addressing the high burden of early in-hospital deaths. We evaluated the capacity to provide paediatric emergency care at higher-level health facilities in the Busoga sub-region, Uganda, and explored healthcare workers' perceptions of quality care. This assessment aimed to inform policy and facilitate the implementation of guidelines. A comprehensive mixed-methods study was conducted, comprising a facility audit, a survey of healthcare providers to assess their knowledge, and focus group discussions with facility staff. The study included all public and private not-for-profit facilities that provide in-patient paediatric care in Busoga. Quantitative data were analysed using descriptive statistics and linear regression, while thematic analysis with the framework method approach was applied to qualitative data. A total of 14 focus group discussions, 14 facility audits, and 100 surveys with healthcare providers were conducted. Essential equipment for paediatric emergencies and staff shortages were identified as primary barriers to quality care and key contributors to worker demotivation. Referrals were one of the main challenges, with only 25% of facilities accessing a fuelled ambulance. Knowledge scores were higher among healthcare professionals who had undergone emergency management training and participated in refresher courses (mean 13.2, 95% CI 11.6-14.8, compared to 9.2, 95% CI 8.0-10.3). Participants who felt well-prepared achieved markedly higher scores on knowledge surveys than those feeling unprepared (mean 12.2, 95% CI 11.2-13.1, versus mean 8.5, 95% CI 7.3-9.7). Qualitative discussions demonstrated positive attitudes of healthcare workers toward ETAT guidelines. Results underscore the importance of focused training with refresher sessions to enhance health workers' knowledge and confidence in managing paediatric emergency cases. However, substantial limitations in staffing numbers and the availability of necessary equipment need to be addressed for overall quality of care improvement.The implementation of structured guidelines, such as the World Health Organisation's Emergency Triage, Assessment and Treatment has been shown to reduce in-hospital mortality, addressing the high burden of early in-hospital deaths. We evaluated the capacity to provide paediatric emergency care at higher-level health facilities in the Busoga sub-region, Uganda, and explored healthcare workers' perceptions of quality care. This assessment aimed to inform policy and facilitate the implementation of guidelines. A comprehensive mixed-methods study was conducted, comprising a facility audit, a survey of healthcare providers to assess their knowledge, and focus group discussions with facility staff. The study included all public and private not-for-profit facilities that provide in-patient paediatric care in Busoga. Quantitative data were analysed using descriptive statistics and linear regression, while thematic analysis with the framework method approach was applied to qualitative data. A total of 14 focus group discussions, 14 facility audits, and 100 surveys with healthcare providers were conducted. Essential equipment for paediatric emergencies and staff shortages were identified as primary barriers to quality care and key contributors to worker demotivation. Referrals were one of the main challenges, with only 25% of facilities accessing a fuelled ambulance. Knowledge scores were higher among healthcare professionals who had undergone emergency management training and participated in refresher courses (mean 13.2, 95% CI 11.6-14.8, compared to 9.2, 95% CI 8.0-10.3). Participants who felt well-prepared achieved markedly higher scores on knowledge surveys than those feeling unprepared (mean 12.2, 95% CI 11.2-13.1, versus mean 8.5, 95% CI 7.3-9.7). Qualitative discussions demonstrated positive attitudes of healthcare workers toward ETAT guidelines. Results underscore the importance of focused training with refresher sessions to enhance health workers' knowledge and confidence in managing paediatric emergency cases. However, substantial limitations in staffing numbers and the availability of necessary equipment need to be addressed for overall quality of care improvement. MEDLINE - Academic
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    Compartment Syndrome Following Intramuscular Self-injection of Kerosene and Rodenticide: A case report
    (International journal of surgery case reports, 2021) Asiimwe, Daniel; Egesa, Walufu Ivan; Waibi, William Mugowa; Kajoba, Dickson; Kumbakulu, Patrick Kumbowi
    Kerosene and rodenticides are used in many households in developing countries. This case report aims to discuss the progression and management of a patient with intentional kerosene and rodenticide poisoning. To our knowledge, this is the first documented case of blended kerosene-rodenticide poisoning in medical literature. This report describes a 23-year-old man who survived after intramuscular self-injection of 5 ml of kerosene mixed with a rodenticide into his left upper limb, with intent to commit suicide. He was admitted to our hospital following a convulsion and brief loss of consciousness. Compartment syndrome developed within 24 h of admission, necessitating urgent fasciotomy, repeated surgical debridement, limb elevation, wound cleaning and dressing, in addition to intravenous fluids, antibiotics, and close observation. Blood transfusion, phytomenadione (vitamin K1), tetanus toxoid, and analgesics were recommended. The patient also received physiotherapy, and was treated for depression. The limb healed completely, with contractures at the left wrist joint. Injected kerosene and rodenticide may result in compartment syndrome and variable local and systemic complications which require multifaceted care and a prolonged follow-up period. Seemingly minor injuries at presentation may quickly progress into considerable complications such as compartment syndrome. It is imperative that physicians comprehensively investigate patients with poisoning for multiorgan dysfunction. Anticipation of local and systemic complications of injected poisons and timely medical and surgical intervention is life-saving.
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    Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature Review
    (Case Reports in Infectious Diseases, 2021) Kajoba, Dickson; Egesa, Walufu Ivan; Petit, Habonimana Jean; Laker, Goretty; Waibi, William Mugowa; Asiimwe, Daniel
    Congenital malaria is the presence of malaria parasites in a blood smear obtained from a neonate usually within 24 hours to 7 days of life. It has for long been regarded a rare condition. However, recent data indicate that congenital malaria complicates around 35.9% of live births globally, 0–37% in Sub-Saharan Africa and about 4–6.1% in Eastern Uganda. We present a 2-day-old neonate who presented with fever, irritability, and failure to breastfeed. Laboratory tests indicated that the neonate had a positive Giemsa-stained peripheral smear for Plasmodium falciparum, with a positive malaria rapid diagnostic test (MRDT) for P. falciparum malaria. The mother had a negative peripheral film for malaria and a negative MRDT. The neonate was managed with intravenous artesunate with improvement.
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    Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants
    (International Journal of Pediatrics, 2021) Egesa, Walufu Ivan; Odoch, Simon; Odong, Richard Justin; Nakalema, Gloria; Asiimwe, Daniel; Ekuk, Eddymond; Twesigemukama, Sabinah; Turyasiima, Munanura; Lokengama, Rachel Kwambele; Waibi, William Mugowa; Abdirashid, Said; Kajoba, Dickson; Kumbakulu, Patrick Kumbowi
    Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.