School of Health Sciences (Health-Sciences)

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    The prevalence of plasmodium falciparum placental malaria and its association with prenatal sulfadoxime-pyrimethamine prophylaxis among HIV positive mothers in Mulago hospital.
    ( 202-05) Namale, Ssebuliba Leticia
    INTRODUCTION: HIV positive (HIV+) women are more susceptible to malaria infection during pregnancy than their HIV negative (HIV-) counterparts but the actual prevalence of infection in Ugandan pregnant women is not known. HIV infection limits the pregnant woman’s capacity to control P. falciparum parasitaemia with resultant placental malaria. This is the major determinant of its impact on foetal growth and survival. Although prenatal SP prophylaxis seems to be protective to pregnant women in general, there is growing concern that the recommended two doses prenatally may be inadequate in HIV+ mothers was determined. SIGNIFICANCE OF THE STUDY: The study gave an insight into the situation of malaria among the HIV+ pregnant women. The protection of the standard two-dose prenatal SP was not known well established due to the inadequate sample size and therefore a large b-error although these preliminary results seem to suggest that two-dose SP may not be sufficient for the HIV+ mothers. OBJECTIVES: The aim of the study was to determine the prevalence of p. falciparum placental malaria among HIV+ mothers and its association with prenatal SP prophylaxis. METHODOLOGY: This was a hospital based cross-sectional study of HIV+ pregnant women. The participants in this study were recruited at delivery from an ongoing Nevirapine cohort study in Mulago hospital where their HIV status had been determined. The history of prenatal SP prophylaxis was determined by self-report. A specimen of placental blood was collected and examined for malaria parasites using fields stain. The prevalence of placental malaria was determined. Inferences about the protection offered to HIV+ mothers by the standard two-dose prenatal SP prophylaxis were made according to its association with placental malaria. STUDY REQUIREMENTS: Quantitative data was collected using a structured questionnaire. Qualitative data on the practice of SP chemoprophylaxis was collected using key informant interviews of doctors who ran the antenatal clinics. DATA MANAGEMENT AND ANALYSIS: The prevalence of placental malaria among the HIV+ mothers was determined. The analysis also included the calculation of the odds ratio (OR), chi-squared values (X2) and their p-values and confidence intervals (CI). Adjusted ORs were calculated to control for potential confounders. Logistic regression was done to determine the association between the outcome and the variables of interest. Qualitative data was transcribed and analyzed manually. RESULTS: The prevalence of placental malaria was 9.4%. The prevalence of placental malaria among the SP users was 9.5% and among the non-users, 9.2%. The difference between the groups was not significant. The association between prenatal SP prophylaxis and placental malaria was not significant. CONCLUSION: The prevalence of placental malaria among HIV+ mothers in Mulago hospital is high. Placental malaria among HIV+ mothers is not parity specific. These preliminary results suggest that two-dose SP prophylaxis may be inadequate for HIV+ mothers but are not conclusive due to the large type II error resulting from a sample size.
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    Causation and prevention of stillbirths and postnatal deaths: Mulago Hospital, 1970-1971
    ( 1973) Marasha, B. J.
    The object of this study is to summarise causes of stillbirths and postnatal deaths based on a review board meeting of Obstetricians and Paediatricians in Mulago Hospital, so as to try and prevent these causes in future. It is hoped that by combining a concise and simple text with a very liberal use of illustrations, tables and graphs the information in these pages can be easily assimilated. The tabulated characteristics of stillbirths as compared to live births are to try and see whether there were any factors predominant in stillbirths than in live births within Mulago Hospital during 1970 and 1971. The modification of a labour graph is one of those ideas based on personal experience of the author. But although the study was written by a single author, reviews of Physicians on causation of stillbirths and postnatal deaths are hinted to make further recommendations for training of staff for further preventive measures. The justification of this study is a step to tackle this problem.
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    Incidence of Australia antigen in Ugandan subjects with sickle cell disease
    ( 1973) Kigonya, E
    Two hundred patients with homozygous S-haemoglobinopathy (HbSS) were assayed for Au-Ag and Au-Ab. Three (1.5%) patients had positive Au-Ag and one (0.5%) was positive for Au-Ag. The results indicate that the incidence of Au-Ag and Au-Ab, in repeatedly transfused patients with HbSS, is not higher than that of the general population. Does the sickle-cell-gene impart some indirect protection to these patients against the existence of the Au-Ag? Incidental findings were the high incidence of hepatomegaly (78.5%) and splenomegaly (6%).
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    The challenge to restoring basic health care in Uganda
    (Elsevier Science, 1998) Okello, D.O ; Lubanga, R. ; Guwatudde, D. ; Sebina-Zziwa, A.
    This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organization (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilites, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.
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    The effect of bacille Calmette-Guérin vaccination at birth on tuberculin skin test reactivity in Ugandan children
    (International Union Against Tuberculosis and Lung Disease, 1999) Mudido, P. Musoke ; Guwatudde, D. ; Nakakeeto, M. K. ; Bukenya, G. B. ; Nsamba, D. ; Johnson, J. L. ; Mugerwa, R. D. ; Ellner, J. J. ; Whalen, C. C.
    SETTING: In Uganda, bacille-Calmette Guérin (BCG) vaccination coverage at birth is between 82 and 84%. OBJECTIVE: To evaluate the effect of neonatal BCG vaccination on tuberculin skin test positivity in Ugandan children exposed to infectious cases. DESIGN: As part of an ongoing prevalence study of household contacts of new tuberculosis cases, 365 children were evaluated to determine if BCG vaccination at birth had an impact on tuberculin skin testing. The children were classified as contacts (179) and non-contacts (186) depending on the presence of a sputum acid-fast bacilli (AFB) smear-positive adult tuberculosis case in the household. RESULTS: Regardless of prior BCG vaccination, children exposed to a smear-positive adult were more likely to have a positive skin test (purified protein derivative > 5mm) (68% versus 36%, P < 0.01). BCG-vaccinated children below 1 year of age without a known household contact with active tuberculosis had a lower frequency of tuberculin skin reactions (29%) compared to their counterparts in the contact households (65%, P = 0.031). CONCLUSION: BCG vaccination at birth had no important effect on the interpretation of the tuberculin skin test reactivity in this group of Ugandan children. The tuberculin skin test remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated children.
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    Injury patterns in rural and urban Uganda
    (BMJ Publishing Group, 2001) Kobusingye, O. ; Guwatudde, D ; Lett, R
    Objectives—To describe and contrast injury patterns in rural and urban Uganda. Settings—One rural and one urban community in Uganda. Methods—Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. Results—In the rural setting, 1673 households, with 7427 persons, were surveyed. Injuries had an annual mortality rate of 92/100 000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2322 households, with 10 982 people, were surveyed. Injuries had an annual mortality rate of 217/100 000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1000/ year. Leading causes of death were drowning in the rural setting, and road traffic in the city. Conclusion—Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.
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    Community-acquired pnemonia in Ugandan adults: short-term parenteral ampicilin therapy for bacterial pnemonia
    (American Society of Tropical Medicine and Hygiene, 2001) Yoshimine, Hiroyuki ; Oishi, Kazunori ; Mubiru, Francis ; Nalwoga, Hawa ; Takahashi, Hidehiko ; Amano, Hideaki ; Ombasi, Philip ; Watanabe, Kiwao ; Joloba, Moses ; Aisu, Thomas ; Ahmed, Kamruddin ; Shimada, Masaaki ; Mugerwa, Roy ; Nagatake, Tsuyoshi
    A hospital-based prospective study of 99 patients with community-acquired pneumonia (CAP) was carried out in Kampala, Uganda. We evaluated microbiological etiologies, clinical features and effectiveness of short-term parenteral ampicillin followed by oral amoxicillin for these patients in relation to HIV-status. We demonstrated a very high prevalence (75%) of HIV-1 infection. No significant difference was observed with respect to age, gender, prior antibiotic usage, symptoms, laboratory data or bacterial etiology between HIV-1-infected and HIV-uninfected CAP patients. Most strains of Streptococcus pneumoniae (n = 19) and Haemophilus influenzae (n = 8) isolated from HIV-1-infected patients were penicillin-resistant (95%) and β-lactamase producing (75%) strains, respectively. A high percentage of good clinical response was found in both HIV-1-infected (81%) and HIV-uninfected (86%) among 39 patients with CAP due to a defined bacterial pathogen. These data support the use of short-term parenteral ampicillin for patients with bacterial CAP irrespective of HIV-status.
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    Knowledge, Attitudes and Practise of Patients regarding Management of their Condition.
    ( 2001) Murunyu, David L.
    Tuberculosis (TB) has always been a public concern in most developing countries. It is a disease of global importance. A third of the world’s population is estimated to have been infected with mycobacterium TB; 8 million new cases of TB emerge each year. The TB crisis is likely to escalate due to the HIV. Epidemic (W.H.O 1998). WHO declared TB a global emergency in 1993 and indeed it is now a leading infectious killer of adults in the productive age bracket. It is estimated that TB kills nine million people globally annually. Trends of notification of TB cases in Uganda from 1991-1996, indicated 19,016 cases in 1991, 20, 662 in 1992, 21648 in 1993, 23, 822 in 1994, 25, 248 in 1995 and 27122 in 1996. These figures show that the number of TB cases has been increasing country wide. This study, which aimed at assessing the knowledge attitude and practice of TB out-patients as regards management of their condition, was carried out in Mbale hospital. It addressed the following objectives; To determine patient’s knowledge as regards T.B management To find out beliefs and attitudes towards the management of T.B by TB patients at Mbale regional hospital. To assess the cultural and habitual practices of T.B patients regarding their condition. To find out problems experienced by health workers in the management of T.B patients. The study used a non probability- convenience sampling procedure which involved both qualitative and quantitative approaches. Data was collected using questionnaires written in English language and administered to the respondents by the researcher and two assistants who were enrolled nurses. The sample size was 61 TB out-patients, both males and females were involved in this study and the respondents were all above 14 years of age. Data was analyzed with the help of a statistician using EPIINFO computer package and presented in form of pie-charts, bar graphs, frequency tables and percentages. Findings included; Most of the respondents were from rural areas, were of low economic and educational status of whom the majority were not vaccinated against TB etc. In this study, the majority of the respondents believed that TB is spread through sharing utensils, air droplets ate. It was also shown that majority of TB patients report late for treatment due to ignorance about the disease, also most of the patients have never been health educated about TB. Basing on these findings, it is recommended that the Ministry of Health pays more attention to health education, for the community and the patients who should be made aware of their role in the control of TB. Government and the ministry of health should put more emphasis on TB vaccination, case finding, case holding and follow up.
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    Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1-positive and HIV-negative adults in Uganda
    (International Union Against Tuberculosis and Lung Disease, 2001-04) Luzze, H. ; Elliott, A. M. ; Odida, M. ; Joloba, M. L. ; Oweka-Onyee, J. ; Nakiyingi, J. ; Quigley, M. ; Okwera, A.
    SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. OBJECTIVES: To compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculous pleurisy who are negative and positive for the human immunodeficiency virus (HIV). DESIGN: Adults with suspected pleural tuberculosis were screened by clinical examination, thoracocentesis and closed pleural biopsy. Biopsy material was cultured on Middlebrook 7H-10 solid medium and in BACTEC 12B radiometric vials. Pleural fluid was cultured using Löwenstein-Jensen slants, BACTEC and Kirchner liquid medium. RESULTS: Of 156 individuals enrolled, 142 had tuberculosis, of whom 80% were HIV-positive. Among those with tuberculosis, HIV-positive patients had a more severe and longer illness. The size of effusions was similar in HIV-positive and HIV-negative patients. A higher proportion of HIV-positive patients had parenchymal infiltrates but this difference was not statistically significant. Pleural fluid lymphocytosis was present in all HIVnegative and 97% of the HIV-positive patients. HIVpositive patients had lower pleural fluid lymphocyte counts. Pleural fluid cultures were more often positive in HIV positive patients. BACTEC and Kirchner liquid media gave higher yields than solid media. CONCLUSION: HIV-positive patients with tuberculous pleurisy had a more severe illness than HIV-negative patients. Mycobacterial cultures from HIV-positive patients were more often positive, suggesting more mycobacterial extension from the lungs into the pleural space. Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis.
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    Involvement of Husbands in Antenatal Care in Ayivu County, Arua District.
    ( 2001-05) Afayo, Robert
    ABSTRACT The main objective of this study were: to determine the awareness among the husbands about the need for their wives to attend to ANC from trained personal, to describe the perception among husbands on ANC in Arua District and to identify factors influencing use of ANC from the men’s point of view. A descriptive cross-sectional study was carried out in Arua district north western Uganda between February and March 2001. A total of 78 husbands were interviewed using a semi structured questionnaire. The results revealed that the antenatal services were underutilized. The men were largely peasants (52.6%) with (43.6%) of them attaining primary level. The majority (96.2%) of men were currently married implying high need for involvement in anc. While most men (89.7%) had heard about ANC, the study revealed mixed perceptions about anc. Antenatal care is largely thought of as treatment of any complication that develop. It was revealed that men are not aware of what antenatal care comprised of with only (44.9%) able to mention two or more elements comprising antenatal care. Even then, those concepts are not clearly understood and husbands do not fully realize the importance of seeking antenatal health care from formal health units. The study also revealed that (11.4%) husbands knew at least three activities carried out in anc. This implies that the majority (78.9%) are not aware of their responsibilities in ANC activities. The study also showed that there is insufficient antenatal care visit for men in Arua district. For instance, the majority of men (53.8%) had ever accompanied their wives for antenatal care. Although most men (56.4%) had adequate knowledge about the importance of antenatal care, there was no significant difference between both groups (higher education and lower education ) in their level of adequacy in knowledge about antenatal care. The major sources of information about ANC were wives (37.2%), health workers (20.5%) and radio (15.4%). In conclusion utilization of ANC was greatly influenced by the men’s perceptions, awareness and source of information. The wives were the main source of information about maternal health services. It was recommended that health workers should be equipped with fresh information through seminars in order to address men’s perception, awareness and information problems concerning their wives ANC attendance. There should also be room for both husbands and wives for attending antenatal care so that the husband can access information from the health care providers.
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    Knowledge Attitudes and Practise of Postnantal Mothers regarding Care of the Umbilical Cord.
    ( 2001-06) Achora, Susan
    Cord functions and neonatal tetanus contribute significantly to high neonatal mortality rates in developing countries. In 1992, Uganda was identified as one of the countries contributing 80% of the estimated causes of neonatal tetanus(NNT) deaths (WHO/RHT/SMS 9.994).These infections are preventable and can be reduced by practicing clean delivery, clean cord care and by avoiding harmful practices and increasing tetanus toxoid immunization coverage of women of child bearing age. OBJECTIVES This study was aimed at assessing the knowledge, attitudes, and practice of mothers regarding care of the umbilical cord. METHODS A cross-sectional descriptive study was done, using pre-tested questionnaires covering the sociodemographic, knowledge, attitudes and practice domains. An observational check list was also used. A total of 40 postnatal mothers were interviewed and observed. Data was analyzed manually. RESULTS The overall knowledge of mothers regarding cutting and tying the cord was good. T he knowledge on postnatal cord care continuity was dependant on who was caring for the cord, that was better knowledge was exhibited by the mothers who were helped by the students on domiciliary midwifery experience. There was a knowledge gap on the appropriate duration of cord care. There was also a relationship between maternal knowledge and antenatal attendance, i.e. better knowledge for mothers who attended antenatal clinic. There was a negative attitude (fear of handling the cord) by mothers, for various reasons, which hindered appropriate cord care practices. Although nearly half of the mothers (47.7%) used surgical spirit for cord care, a significant number 52.3% still applied traditional substances, which were harmful. From observation the general living conditions and home hygiene of mothers were poor. There was a gap between knowledge and practice. This disparity could be accounted for by poverty, cultural beliefs, and lack of Health Education. CONCLUSION: - Maternal knowledge regarding cord care was generally good, but some negative attitudes such as fears of handling the cord before healing and observing cultural practices of applying local substances, present a high risk factor for cord infections. This meant that these mothers’ practice regarding cord care was poor. Recommendations derived from the study were that the ministry of Health should revise the national policies and standards of cord care, strengthen Health Education on cord care at all points of contact with the mothers; increase tetanus toxoid immunization coverage of child bearing age women; Update health staff on cord care, and provide community education, information and communication on cord care.
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    Domestic violence among women seeking pos-abortion care
    (Elsevier, 2001-07) Kaye, Dan
    Domestic violence victims are unlikely to make contraception choices [1], may have unplanned unwanted pregnancies [2], and thus resort to abortion [1,2]. Probably, many women with abortion complications are victims. The objective is to determine the prevalence, severity and factors associated with domestic violence among such women. This cross-sectional study was conducted in the gynecological emergency ward of the national referral hospital, Mulago, with permission from the hospital’s Ethical Committee.
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    Views and Opinions of Mothers and husbands Towards the Presence of Husbands in the Labour Ward s during ChildBirth.
    ( 2001-09) Ssentamu, Asuman
    ABSTARCT Poor obstetric care contributes significantly to high maternal mortality rate(MMR) in developing countries. In Uganda MMR is estimated at 506/100,000 live births compared to 27/100,000 live birth in developed countries (safe motherhood issue 1998). Labour, the end result of pregnancy is an event with psychological, social and emotional meaning for the mothers and their families. The practice in Uganda hospitals restricts male partners or companions from entering the labour wards; mothers are not able to communicate with their relatives except by transmitting a message through the health workers. This research has been done to assess the views of mothers toward the presence of their husbands in the labour ward during childbirth. The general objective of the study was to study the views and opinions of mothers and fathers towards the presence of husbands in the labour ward during childbirth. The specific objectives included the; (1) Assessing the knowledge of mothers and fathers about the benefits of presence of husbands during childbirth. (2) Ascertaining reasons why husbands were reluctant to accompany their wives in the labour. (3) To determine views and opinions of mothers and fathers towards presence of husband in the labour ward. The study was a cross-sectional descriptive done using pretested semi-structured questionnaire covering socio-demographic, views and opinions and knowledge domains. It was conducted in upper Mulago hospital postnatal ward (UMHPNW) within Mulago hospital, a national referral hospital located 5km north of Kampala city, Uganda’s capital city. Questionnaires were distributed to 78 postnatal mothers and 20 fathers using purposive sampling method. Data was analyzed and findings revealed that a significant number of fathers and mothers were ignorant about the benefit of the presence of husbands in the labour ward during childbirth and hence the idea of husbands access to the labour ward was totally new. In a nutshell, there is a need for the ministry of health (MOH) and health organizations in general to initiate perinatal studies involving males together with their wives at antenatal clinics. The study should focus on the care of women in pregnancy and labour, and also the importance of husbands in labour so as to minimize this ignorance.
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    Citywide trauma experience in Kampala, Uganda: a call for intervention
    (BMJ Publishing Group, 2002) Kobusingye, O.C ; Guwatudde, D. ; Owor, G ; Lett, R.R
    Objectives: To describe injuries and their emergency care at five city hospitals. Setting: Data were collected between January and December 1998 from casualty departments of the five largest hospitals of Kampala city, Uganda, with bed capacity ranging from 60 to 1200. Methods: Registry forms were completed on trauma patients. All patients with injuries were eligible. Outcome at two weeks was determined for admitted patients. Results: Of the 4359 injury patients, 73% were males. Their mean age was 24.2 years, range 0.1–89, and a 5–95 centile of 5–50 years. Patients with injuries were 7% of all patients seen. Traffic crashes caused 50% of injuries, and were the leading cause for patients ≥10 years. Fifty eight per cent of injuries occurred on the road, 29% at home, and 4% in a public building. Falls, assaults, and burns were the main causes in homes. Fourteen per cent of injuries were intentional. Injuries were severe in 24% as determined with the Kampala trauma score. One third of patients were admitted; two thirds arrived at the hospital within 30 minutes of injury, and 92% were attended within 20 minutes of arrival. Conclusions: Injuries in Kampala are an important public health problem, predominantly in young adult males, mostly due to traffic. The majority of injuries are unintentional. Hospital response is rapid, but the majority of injuries are minor. Without pre-hospital care, it is likely that patients with serious injuries die before they access care. Preventive measures and a pre-hospital emergency service are urgently needed.
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    What could be achieved with greater public hospital autonomy? Comparison of public and PNFP hospitals in Uganda.
    (Wiley InterScience, 2002) Seangooba, Freddie ; Atuyambe, Lynn ; McPake, Barbara ; Hanson, Kara ; Okuonzi, Sam
    The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not-forprofit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals’ performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy.
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    Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy
    (Elsevier, 2002) Kara, Hanson ; Atuyambe, Lynn ; Kamwanga, Jolly ; McPake, Barbara ; Ssengooba, Freddie
    Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralization and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional ‘decentralization’ of authority to district level authorities includes district hospitals; and some measure of ‘autonomy’(known as ‘self accounting status’ in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and hospital mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralization of control over personnel is more advanced. These two components – the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralization of control over key resources – seem to us the key tools to address the stubborn problems of hospitals.
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    A Comparative study of Hypo-Osmolar and Standard ORS solutions in treating Children with Persistent Diarrhoea Admitted to Mulago Hospital
    ( 2003) Wobudeya, Eric
    In 1991, The WHO and UNICEF estimated that Persistent Diarrhoea accounted for 10% of all Diarrhoea episodes in the under fives and that i accounts for 30-50% of the about 2.2 million Diarrhoea-related death per year in the under five age group. Dehydration is one of the risk factors for mortality in persistent Diarrhoea among others. Standard ORS solution which is the main mode of management of dehydration, has shown no significant effect on the duration of Diarrhoea or on the volume of stool output in children with acute Diarrhoea but a few studies done on hypo-Osmolar ORS solution in persistent Diarrhoea have shown some beneficial effects.
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    Participatory planning for the transformation of the Faculty of Medicine into a College of Health Sciences
    (Makerere University Medical School, 2003) Dodge, Cole P ; Sewankambo, Nelson ; Kanyesigye, Edward
    The Makerere University, Faculty of Medicine was established in 1924, seventy-seven years ago. The year in which the current Dean, Professor Nelson Sewankambo enrolled was 1971. In 1971 the in take was 120 and his graduating class in 1976 was 86. The admissions for medical students in 1999 was 110 in the MBChB degree and 94 doctors were graduated. This represents zero growth between 1971 and 1999 in admissions and less than ten per cent increase in graduates.
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    Case records and commentaries
    (Makerere University, 2003) Wanyama, John
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    Tuberculosis in household contacts of infectious cases in Kampala, Uganda
    ( 2003) Guwatudde, D. ; Nakakeeto, M. ; Jones-Lopez, E. C. ; Maganda, A. ; Chiunda, A. ; Mugerwa, R. D. ; Ellner, J. J. ; Bukenya, G. ; Whalen, C. C.
    Tuberculosis remains a serious threat to public health, especially in sub-Saharan Africa. To determine the host and environmental factors responsible for tuberculosis in African households, the authors performed a prospective cohort study of 1,206 household contacts of 302 index cases with tuberculosis enrolled in Uganda between 1995 and 1999. All contacts were systematically evaluated for active tuberculosis and risk factors for active disease. Among the 1,206 household contacts, 76 secondary cases (6%) of tuberculosis were identified. Of these cases, 51 were identified in the baseline evaluation, and 25 developed during follow-up. Compared with index cases, secondary cases presented more often with minimal disease. The risk for secondary tuberculosis was greater among young children than adults (10% vs. 1.9%) and among human immunodeficiency virusseropositive than -seronegative contacts (23% vs. 3.3%). Host risk factors could not be completely separated from the effects of environmental risk factors, suggesting that a household may represent a complex system of interacting risks for tuberculosis.