School of Medicine (Sch. of Med.)

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    The pathology of chronic pancreatic disease in Uganda
    ( 1970) Owor, Raphael
    Chronic pancreatic disease may be defined pathologically as a condition characterized by loss of pancreatic lobular architecture with replacement of most of the parenchyma by fibrous tissue. These features are accompanied by variable degrees of acinar atrophy and duct dilatation. Intraduct calculi are frequently but not invariably present. This entity must be distinguished from simple fibrosis of the pancreas which may be mild or moderate but does not lead to architectural disorganization. From a general survey of the literature it is apparent that this distinction has not been made by many authors and therefore it is difficult to estimate the frequency of the disease in any one area. However, there is evidence to show that the disease is common in the United States of America, parts of West Europe, South Africa and Australia. In these countries the disease is frequently associated with chronic alcoholism. In comparative study of Autopsy materials in Glasgow and Kampala I find that chronic pancreatic disease is uncommon in Glasgow where acute haemorrhagic pancreatitis is common. In Kampala where “silent” acute interstitial pancreatitis is seen chronic pancreatic disease is common.
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    Immunity to malaria
    ( 1970) Mody, N. J.
    Section I: literature is reviewed and the pattern of the development of immunity in a population exposed to high malarial endemicity is followed. This is followed by a brief discussion of specific aspects of malarial immunity in an immune population. Section II: two major groups of Ugandan populations were included in the present study. First comprised of pregnant females and their newborns, and second of patients with Tropical Splenomegaly Syndrome. A. Pregnant females and their newborns i. Malarial immunity during pregnancy Increased parasitaemia during pregnancy, in a previously immune female was investigated to elucidate if there was any breakdown in humoral defense. Fifty pregnant females were followed during their pregnancy and were compared with a control group of forty non-pregnant females and seventeen males. Concentrations of serum gamma-globulins and immuno-globulins were found to be normal during pregnancy. The levels of malarial fluorescent antibodies and their distribution in IgG, IgA were also normal during pregnancy. A reciprocal relationship between antibody levels and parasitaemia was established. Thus the results of this study indicated no depression of humoral immunity during pregnancy. Evidence is reviewed to support the possibility of a breakdown in cellular immunity during pregnancy, pregnancy, preventing lysis of ingested malaria parasites by macrophoges, probably as a result of the effect of corticosteroids, which are synthesized in increasing amounts during pregnancy. ii. Intra-uterine infections Intra-uterine infections are known to lead to fetal synthesis of IgM and /or IgA leading to elevated levels of IgM and /or IgA in cord blood sera at birth. In this study, elevated levels of IgM and/or IgA were detected in 18.6% of the cord blood sera tested. Intra-uterine infections play an important role in the etiology of congenital malformations and in postnatal morbidity and mortality. It is suggested that “African macroglobulinaemia” may have its origin in the intra-uterine priming and fetal synthesis of IgM as a result of intra-uterine infections. Defining the population of the newborn likely to have had intra-uterine infection will permit further study of etiological agents and postnatal effects of such infections in Uganda population. An attempt was made to study the possibility of malaria as en etiological agent responsible for intra-uterine infections in these neonates. There was no correlation between levels of malaria antibodies in these samples and elevated levels of immunoglobulins, neither could IgM malaria antibodies be demonstrated in cord blood sera. It was, therefore, concluded that malaria may not be one of the etiological agents responsible for intra-uterine infections in our population in Uganda. iii. Fetal Levels of IgG Placental transfer of maternal IgG was demonstrated, beginning early during intra-uterine life and increasing exponentially to attain maternal levels in the fetus term. iv. Congenital Malaria Must be rare in an immune population as amply recorded in literature and supported in the present study, where none of the 88 neonates had parasites in their peripheral blood smear. v. Malarial placental parasitization and birth-weights Many reports have recorded the effect of malaria placental parasitization on birth-weights. In the present study such a relationship was not obvious. Factors known to affect birth-weights, like sex of the newborn, its birth-rank, nutritional state of the mother and placental sufficiency seem not to have been taken into consideration in older studies. In the present study fetal plasma proteins, especially albumin and gamma-globulins have been demonstrated to be related to maturity at birth. Probably the degree of parasitization, rather than just the presence of parasites in placental smears, together with other placental lesions may be more relevant to placental insufficiency leading to lower birth-weights. vi. Malarial antibodies in cord blood sera Fluorescent antibodies were detected in significant titres in cord blood sera of immune mothers, thus at birth the neonate has a passively acquired immunity against malaria. vii. Malarial antibodies in colostrum Fluorescent antibodies were detected in breast milk of immune mothers, and their neonates may be acquiring further protection against malaria as a result of ingesting these antibodies. B. Tropical Splenomegaly Syndrome (a) From the following two studies it was possible to rule out the possibility of a defect in antibody response to antigenic stimuli, leading to exaggerated IgM synthesis, in TSS patients i. Antibody response to E. coli Vi antigen in TSS patients was normal and resulted in the synthesis of both IgG and IgM antibodies. ii. The distribution of malarial antibodies in IgG, IgA and IgM in TSS patients was normal too. (b) 7S IgM, monomeric units were detected in almost 30% of TSS patients. This may be the effect or the cause of increased synthesis of IgM in TSS patients. Presence of 7S IgM monimeric units in test sera is likely to lead to over-estimation of IgM by radial immunodiffusion technique. (c) Immuno fluorescence study on liver biopsies has demonstrated antibody synthesis by hepatic sinusoidal lymphocytic infiltrates and the possibility that Kupffer cells are engaged in ingesting antigen/antibody complex. (d) Long term malarial prophylaxis has been shown to lead to clinical improvement in TSS patients. In the present study malarial prophylaxis has been shown to reduction in concentrations of IgM though the IgG, IgA and MFAT seem not to be affected during the period of observation.
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    Mombasa bar-girls: a study of prostitution and venereal disease in a Kenya seaport
    ( 1970-03) Rutasitara, W.K.
    Africa in particular East Africa is in a rapid process of remolding herself in attempt to catch up with the rest of the developed world. She is undergoing a process of industrialisation which is accompanied by increasing urbanisation. People of different cultures have left rural communities for the urban centres and there they formed societies of different social structures from that of their original homes. Those social groups are of varying patterns and often they are based on certain key points such as common beliefs and practices, common need, work, or recreational places. Like birds of the same feather members of the same social group always flock together. Together with these changes, there has also grown up revolutionary changes in attitudes and behaviour amongst the people. What was a taboo food years back is a favourite dish today. What could have been mentioned in a social group previously, for example, matters relating to sexual reproductive happenings and experiences, are today spoken of without inhibition. Such changes in attitude and behaviour of people in some of the “new communities” have given rise to certain groups which are special problem groups in medicine, public health and sociology. One of these special problem groups is that group of people who are known under a multitude of names such as prostitutes, Bar-maids, Bargirls, “Malaya”, “Mbwa kachoka” etc…..
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    Syphilis in Uganda: (the history, clinical features and cellular immunity
    ( 1971-01) Masawe, Aaron E. John
    The history of syphilis in Uganda, the clinical patterns, and the cellular immune mechanisms among the indigenous subjects with syphilis have been studied. Concerning the history it was shown and discussed that the disease was unknown in this country until the arrival of the Arab Slave Traders in 1848. After 1880 the disease rampaged the country “in epidemic fashion” and necessitated the setting up of the anti-venereal disease campaign that has lived until today and which underlined the foundation of Medical Services and higher medical education in this country. The predisposing factors for the so called syphilis epidemic included: (a) the announcement by Kabaka that venereal diseases were virtuous and every man had to acquire to remain a man, and (b) the religious wars between different religious factions. Of the clinical pattern, it was deducted both from the historical review and from the study that lesions of syphilis amongst the indigenous population are severe and exuberant in the early stages of the disease and somehow puzzling in the late stages.
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    D-xylose absorption in Ugandan patients with fever
    ( 1973) Wankya, B. M.
    Using 25gm oral dose D-xylose tolerance test was performed on 19 normal subjects and 24 subjects with fever. In the normal subjects, blood D-xylose levels showed a peak between one and two hours and then declined gradually to resting levels after five hours. The mean blood D-xylose levels were lower in the patients with fever and had a prolongation of absorption when compared to the controls. On the basis of both low 5-hour urine D-xylose and low blood levels at one hour after the oral dose a significant number (50%) of patients suffering from fever due to pulmonary tuberculosis and fever due to acute bacterial infection had evidence of D-xylose mal-absorption. In the probable absence of primary jejunal mucosal disease, the intestinal absorptive, disfunction has been attributed to systemic bacterial infection. The intestinal absorptive disfunction was also present in the two patients with chronic myeloid leukaemia. The effect of chronic myeloid leukaemia and myeleran on the jejunal mucosa is yet unknown and requires elucidation. The possible pathogenesis and consequences of this subclinical mal-absorption are discussed.
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    Some aspects of malaria in Mulago Hospital
    ( 1974) Masembe, Rachel N
    Thirty patients with malaria were studied. Seven had cerebral malaria, ten severe and thirteen non-severe malaria. Age ranged from seven weeks to eight years with equal sex distribution. All were febrile except two infants and convulsions were common especially in the cerebral and severe group. Severe anaemia of less than 5gm. per 100 ml. was confined to the children under 6 months. There was evidence of haemolysis in half the patients of the whole group. Parasite densities were low even in those with cerebral malaria and did not correlate with anaemia. Reasons for these findings are discussed. Thrombocytopenia was not severe and was confined to those with severe malaria. Fibrinogen levels were normal and factor V abnormality was found in only one patient. Prothrombin times serum F.D.P. levels were not done. There is insufficient data to make firm conclusions about presence or absence of IVC in cerebral malaria cases. Further studies are suggested.
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    Cardiovascular findings in patients with Sickle Cell Disease
    ( 1974) Mugerwa, R.D.
    SUMMARY Fifty homozygous sicklers and ten heterozygous sick cell patients selected from the sickle cell clinic cardiac clinic and inpatients on the medical wards of Mulago Hospital from the basis of this dissertation. It starts with a historical review and pathology of sickle cell disease. Cardiovascular alterations in Anaemia with emphasis on physiological and pathological considerations in sickle disease are then discussed. The findings among the patients studied are described dwelling mainly on presenting symptoms, cardiovascular findings notably cardiomegally, murmurs, abnormal heart sounds, electro-cardio graphic and X-ray abnormalities. A discussion of findings with reference to work on the same subject by other writers is presented. Some of the possibilities haemodynamic alterations in sickle cell disease are outlined and a need to for further elaborate studies in this condition is stressed.
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    Plasma rennin activity in the African hypertensives
    ( 1974) Muguma, John
    Early reports, particularly from East Africa, concerning surveys of arterial pressures in Africans showed hypertension as an unusual event in the indigenous population (Donnison, 1929; Vint, 1937). This impression has in the last two decades been gradually dispelled and it is now known that hypertension is at least as common in African population as it is in the Caucasian. (William 1944, Callander 1953, Uys 1956, Schrine 1959, Abrahams and Alele 1960, Shaper and Williams 1961, Binder 1961, Smith 1966, Akinkugbe, 0.0. 1968). The etiology of essential hypertension remains largely unknown, but most workers tend to agree with Sir George Peckering who says that, “Like other measurable characters of the higher animals, arterial pressure is determined by the interaction of nature and nurture, heredity and environment”. For instance hypertension is a very rare event in the Gilbert Islands, and genetic factors have been advanced to explain this curiosity. On the other hand arterial hypertension is rampant in Northern Japan, and the possible explanation, has been too much salt consumed at table.
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    Cardiovascular findings in patients with sickle cell disease
    ( 1974) Mugerwa, R. D.
    Fifty homozygous sicklers and ten heterozygous sickle cell patients selected from the Sickle Cell Clinic, Cardiac Clinic and inpatients on the medical wards of Mulago Hospital form the basis of this dissertation. It starts with a historical review and pathology of sickle cell disease. Cardiovascular alterations in anaemia with emphasis on physiological and pathological considerations in sickle cell disease are discussed. The findings among the patients studied are described dwelling mainly on presenting symptoms, cardiovascular findings notably cardiomegally, murmurs, abnormal heart sounds, electro-cardiographic and x-ray abnormalities. A discussion of findings with reference to work on the same subject by other writers is presented. Some of the possible haemo-dynamic alterations in sickle cell disease are outlined and a need for further elaborate studies in this condition is stressed.
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    The relationship between the haemolytic crises in sickle cell anaemia, and the deficiency of the red cell enzyme glucose-6-phosphate dehydrogenase
    ( 1975-01) Kibuka, musoke ; Mukkaanya, Moses E
    Seventy-two patients with proved haemoglobin SS were studied in respected of their haemoglobin, reticulocyte counts, serum bilirubin and their Glucose-6-phosphate dehydrogenase values in international units per gram of Haemoglobin. Of the whole group 18% were found to be deficient in the enzyme. A retrospective study of these patients was carried out to see if those who were deficient in the enzyme are those who experienced haemolytic crises. Records at the Sickle Cell Clinic did not reveal any well documented case of a haemolytic crisis having occurred in any of these patients, a few had clinical evidence of increased haemolysis. One patient who had evidence of increased haemolysis was discussed in detail and was thought to be Glucose-6-Phosphate Dehydrogenase deficient, and it was suggested that the increased haemolysis was precipitated by ingestion of aspirin. It has been suggested that a detailed study if those patients was Sickle Cell anaemia and Glucose-6-Phopsphate Dehydrogenase deficiency is required to establish the occurrence of haemolytic crises and find the precipitating factors.
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    Pulmonary hypertension in endomyocardial fibrosis with emphasis of its severity
    ( 1976-02) Zirembuzi, G. W.
    Eighty cases of pulmonary hypertension were found from 148 cases of endomycordial fibrosis studied by cardiac catheter. All were African patients the majority being Ugandans of Rwanda and Tanzania origin and a fair number of indigenous Ugandans. The vast majority of the cases came from districts around Kampala, which probably emphasizes more the importance of their proximity to the hospital than of actual clustering of the disease, although further epidemiologic study is required to throw light on this tendency to the apparent clustering. Pulmonary hypertension was common and it was particularly severe in left ventricular disease alone or when predominating in biventricular disease. Of 18 cases considered to have very severe pulmonary hypertension 8 had mitral incompetence. With regards to age and sex, below the age 20 years pulmonary hypertension was more frequent in the males than in the females while above 20 years of age there were more female than male cases. There were also more female than male cases in the severe pulmonary hypertension group where the age ranged from 11 to 50 years with a majority under 25 years.
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    Developing methods of evaluation appropriate to undergraduate teaching in general practice at Glasgow University
    (University of Glasgow, 1977-04) Murray, Thomas Stuart
    The teaching of general practice in the undergraduate medical curriculum now takes place in all medical schools in the United Kingdom. The main expansion has taken place after the Report of the Royal Commission on Medical Education in 1968. The teaching in general practice was introduced into already crowded curricula and it has therefore been important to justify this teaching. The developments at each University have been dependent on the local circumstances and this has led to a variety of teaching methods. The need for general practice teaching is discussed and this is followed by a description of the present teaching at all the Universities in the United Kingdom. Methods of evaluation have undergone recent changes and the methods used in this thesis are those that are accepted by educationalist. The undergraduate teaching of general practice presents difficulties in an evaluation. Firstly with the teaching being new, the literature is sparse on the subject and guide-lines are difficult to find. Secondly, almost all the teaching is carried out by full-time general practitioners; the students are in groups of two or four and observational data is impossible to obtain without a large team of evaluators. Thirdly, the teaching of general practice at present is not subjected to traditional examination techniques and therefore data cannot be compiled from that source. Traditional evaluation depended on measurable data and it is this which has had most criticism because it is too restrictive and misses the complexity of the teaching/learning situation. The current approaches give a more global view of the teaching but all evaluation procedures have advantages and disadvantages. In the present study a number of approaches have been used, utilising the advantages of the different methods and recognising some of the disadvantages. The teaching of general practice in Glasgow was expending during the time of study; some parts were developing while others were an established part of the teaching and these factors had to be taken in account when choosing methods of evaluation. The teaching in third year, when the student is present at a patient's initia1 consultation in a new illness, was introduced at the beginning of the present study. A pilot study was carried out to determine the feasibility and desirability of this teaching. As a result of this, the teaching was given in the following academic year to the majority of students in the year. Further evaluation was carried out and as a result this teaching is now an accepted part of the curriculum. Any innovation in general practice teaching in Glasgow will continue to be assessed in this way and will not be introduced into the curriculum unless it adds a further dimension to the hospital teaching. The opinions of both students and tutors are sought early and any alterations can be introduced at an early stage. The teaching in fourth year, the long-term care of the chronic sick, is an accepted part of the curriculum and the introduction of recording booklets allowed the teaching to be standardised and both the teaching and the students to be evaluated. The teaching in fifth year was at an early stage at the beginning of the present study and the methods chosen for evaluation were similar to those used in third year. The Department of General Practice in Glasgow introduced to the teaching of medical students the technology of a computer. This study was part of a National Programme and was an innovation in a British medical school. This new teaching method was evaluated and the print-outs of the students' performance which the computer could provide gave an additional method of evaluation. Computer-assisted learning is now being used in other Departments in the medical school and the teaching materia1 and methods are being transferred to other Universities. This teaching method has considerable application. In medicine and further development will continue. Any teaching method using high technology can be difficult to justify on an economic basis but in medicine with the high cost of training a doctor, this teaching can be cost-effective. The collaborative teaching with the hospital departments is at an early stage and seems to form a useful addition to the hospital teaching. This will expand and probably involve other disciplines. The senior elective as a formal part of the course was introduced for the first time during the period of evaluation. Although the number of students was limited, the format and the variety of practices have been appreciated. The tutor force continued to grow throughout the period of the study and a significant number of the general practitioners in the Glasgow area are now involved in this teaching. This large number of tutors creates problems in the uniformity of methods and standardisation of teaching. There are regular meetings with the tutors and evaluation data is presented with each tutor being given his own data when he is able to compare this to that of the group. These meetings with visits to the general practitioners in their own surgeries have helped to create a unity of purpose. The questionnaire to the University teachers of general practice in other centres and to the Glasgow tutors has shown that there is a greater uniformity of opinion about general practice teaching than had been realised. There was also little difference between the full-time University teachers and the part-time tutors in their opinions about teaching. In the teaching in third and fifth year, a record was kept of all the teaching consultations. This provided a record of conditions seen and allowed a comparison with the corresponding morbidity in a general practice situation. The student learning was measured in the third year and the opinions of those concerned were sought in both years. The detailed marking of the recording booklets and the computer print-outs provided the main basis for the evaluation in fourth year. The elective period was evaluated using a questionnaire and the tutors' opinions were gathered in each part of the teaching. The methods used to evaluate were appropriate for the course in Glasgow but many are applicable to other courses in general practice in other Universities.
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    The heamatological manifestations of rheumatoid arthritis in Ugandan patients
    ( 1978) Lutalo, Samuel Kiyingi
    The heamatological manifestations were studied in 107 Ugandan Rheumatoid Arthritis (RA) patients, of whom 82 and 25 were retrospectively and prospectively respectively studied. A mild to moderate normocytic, normochromic anaemia with an either normocellular or hypercellular narrow was found. The serum iron levels were relatively low. The presence of anaemia was associated with Rheumatoid Factor (RF) positively. HSR was markedly elevated out of proportion to the mild to moderate anaemia. The total leucocyte and platelet counts were normal but there was a significant eosinophilia, monocytosis and neutropenia. The significance of these findings is discussed. The heamatological manifestation of RA in Uganda is compared and contrasted to that found in the Western World, Malaysia and Western Nigeria
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    Immediate and late prognosis of intracranial birth injuries
    ( 1978-02) Sseremba, J. M.
    Birth injury is defined by Potter (1961) as any condition that affects the foetus adversely during labour or delivery. The definition in Nelson’s Textbook of Pediatrics is quite in agreement. These birth injuries are further subdivided into those due to mechanical factors and those due to anoxia.
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    The past and present radiographic manifestations of pulmonary tuberculosis at Mulago Hospital
    ( 1989-04) Iga-Matovu, Deogras
    A cross-sectional study of the chest radiographs of adult tuberculosis patients, seen at Mulago Hospital, in 1972, 1979 and 1988 was carried out between August and December 1988. The aim of the study was to determine the past and present radiographic manifestations of pulmonary tuberculosis with the hope of demonstrating the presence or absence of a changing pattern in the radiographic manifestation of the disease and probably come up with an explanation as to the possible cause. Clinical notes and chest radiographs of 96, 106 and 205 patients seen in 1972, 1979 and 1988, respectively, were studied. The clinical notes were analysed for symptoms, laboratory results and heaf test results. The chest radiographs were analysed for radiographic signs. 38 of the 205 patients seen in 1988 had undergone the ELISA test. There was gradual increase in the number of young adults and females presenting with pulmonary tuberculosis, over the years. The symptomatology was little changed, with only hemoptysis being significantly less frequent in 1988 than in 1972 and 1979. Sputum negativity, for AAFBs, was commoner in 1988 (3.9%) than in 1972 (0.9%). The sputum negative patients had either positive cervical lymph node or pleural biopsies or both. Of the 38 patients tested for HIV seropositivity, 28 (73.4%) were positive and only 10 (35.7%) of these were females. The symptomatology was not much different from the non-tested group. Hemoptysis was less common among the HIV seropositive patients (10.7%) than the HIV seronegative (30%). Sputum negativity was seen only among HIV seropositive patients (14.3%). Positive cervical lymph node and pleural biopsies were seen in 7.1 % of HIV seropositive patients for each. Significant differences were observed in the radiographic features over the years. More patients were presenting with features of primary tuberculosis in 1988 than in 1972 and 1979. There was gradual decrease in the number of patients presenting with fibro-nodular opacities, fibrosis, cavitation, lung collapse, and calcifications over the years. On the other hand, there was gradual increase in the number of patients presenting with diffuse infiltrates, pleural effusion, hilar and mediastinal lymphode enlargement. The above trend was magnified among the HIV seropositive patients. Less upper lobar lesions were seen in the HIV seropositive patients than the HIV seronegative ones and the reverse for lower lobe infiltrates. Normal chest x-rays were seen in 2 patients (1%) of the 1988 group, both of whom were HIV seropositive. One patient (1%) had a normal chest x-ray in the 1972 group. No significant differences were noted in the frequency of massive consolidation, nodular opacities, pneumothorax and emphysema, over the years although miliary nodular opacities were less common among HIV seropositive patients than HIV seronegative ones.
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    Factors affecting mothers' utilization of maternal services in Kibale District
    ( 1995-01) Kyamanywa, Janet Kuteesa
    This report presents findings from a study entitled "Factors affecting Mothers' Utilization of maternal services in Kibale District". Studies carried out earlier in this district indicated that the use of Antenatal care (ANC) services was as low as 32% (Balinda, 1991). Given the importance of ANC in the promotion of maternal and child survival, this study attempted to find out the factors which were responsible for the low user rates. The study also attempted to establish why some women attended. A community based study was carried out. Ninety mothers who had a child in the two years proceeding the study were interviewed. The major findings of the study were:- (1) Ninety five (95%) had received ANC services at least once in the last pregnancy, 5% did not attempt to seek ANC services (2) Although the majority of the women reported having received ANC services once, many did not attend as is medically recommended in terms of time of booking and the frequency of visiting. While mothers are expected to start as early as possible (between 1st and 3rd times) only 14% of the mothers were able to start within this period, 81% started attending 4th-6th, 5% started between the 7th and 9th months of gestation. Furthermore, mothers are expected to make a minimum of five visits during the course of pregnancy. The majority of mothers (78%) made less than four visits, while only 22% made the recommended number of visits. The period when a mother is booked and the frequency of visits made during the course of pregnancy is important in ANC delivery services, so further analysis was made to find out mothers who booked early, and made enough (at least five) with an effort to establish the quality of utilization of ANC services by mothers. It was found out that 36% of the mothers utilized the services adequately, ie. they were booked between 1st and 3rd months of pregnancy, and they made five visits. (3) The factors which were found to be associated with non-utilization and inadequate utilization were: i) Long distance between mothers' home and ANC centre. The mean distance travelled to the health centre was 6.25 km. Indeed mothers who were living nearer attended more frequently than whose who were living far. All (100%) mothers who were living 5 km from the ANC utilized the services, while 92% of those who were living beyond 5 km did so. In case of mothers who stay away from the health centre, non attendance was aggravated by lack of bicycle and sickness. In-depth interview with women who did not make enough visits, established that mothers could not make enough enough visits because they were sick. This is an expected response which should be noted. Women should not regard ANC for curative purposes, but for preventive and detection of conditions which may be harmful to the mother and baby. ii) Another constraining factor to the utilization of ANC services were the individual determinants, notably education. The more educated a mother was the more likely it was for her to use the health services. A high proportion (48%) of those with secondary education women made five visits as compared to 18% of the now/primary of the educated women. iii) The health status of the mother: Many mothers were not booked early because they had no health problems, 50% were booked late because they had no complaint. This indicates limited knowledge of purpose of ANC particularly the clinical importance of early booking. iv) Dissatisfaction with the quality of care. Only 54% were not satisfied with the services. From indepth interviews, it was established that this dissatisfaction affected subsequent visits. It reduced on the number of visits during the subsequent pregnancy. Some travelled longer distances for better quality ANC. (4) Generally women had a positive attitude towards ANC. 98% agreed that they had to attend ANC when they were pregnant. No cultural factors were found to be associated with non or poor utilization. From the above the following issued need to be addressed at policy level. i. Health education should be structured. This should address the knowledge gaps it when to book ANC services, and why and how frequent they should use the services. ii. There is need to introduce alternative services which are accessible and acceptable. This could be done by the MOH, emulating the strategies by safe motherhood of training pregnant monitors who examine, monitor women when they are pregnant, then refer them to health centres if necessary. iii. There is need to strengthen the TBA health care system. iv. Elimination of mass illiteracy should be given high priority.
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    The aetiology of pulmonary infections among AAFB sputum smear negative HIV adults presenting to Mulago hospital
    ( 2000) Worodria, William
    Background: Pulmonary infections are an important cause of complications in up to 60% of HIV infected patients during the course of their disease. Tuberculosis (TB) is a common cause of such infections. Sub-Saharan Africa has two thirds of the world's infection (21 million people infected). Dual infection with HIV and TB is common and sputum smear negative TB is a common finding in advanced AIDS disease. Thirty percent of sputum Acid Alcohol Fast Bacilli (AAFB) smear negative patients have been found to have TB. A previous bronchoscopic study by serwadda and others on 4a AIDS patients with pulmonary disease found TB in 9 (22.5%), Kaposia's sarcoma in 6 (15%), Pyogenic bacteria in 4 (10%) and Cryptococcus in 3 (7.5%) of the patients, leaving 45% of patients without identifiable cause of their pulmonary disease. Similarly other African studies have not been able to identify up to 45% causes of respiratory disease. Purpose: This study was conducted to determine the prevalence and pattern of pulmonary infections among sputum smear AAFB negative HIV seropositive patients with pulmonary symptoms and pulmonary infiltrates on chest radiograph. The causative agents were to be identified and their relative proportions determined. Materials and Methods: Consecutive adult patients admitted to Mulago Hospital medical wards with respiratory symptoms of at least 3 weeks with infiltrates on chest radiograph and no previous history of TB treatment were enrolled into the study. Two spot and one early morning sputa were screened for AAFB. Pre-test counselling was done before HIV serology and post-test counselling was done before giving the results. Chest radiographs were done and reported on by a radiologist. Patients who were AAFB negative and HIV positive were requested to participate in the study. Consenting patients had bronchoscopy done on them and bronchoalveolar lavage (BAL) fluid obtained. The BAL fluid was stained for AAFB and for P.carinii organisms. It was also cultured for pyogenic bacteria, fungi and for mycobacteria. Data collection was done using predesigned forms, after which the data was entered and analysed using the Epi lNFO 6 statistical programme. Results: One hundred and ninety eight patients were screened for entry into the study. Forty eight of these patients were sputum smear positive for AAFB and were started on TB treatment. Of the remaining 150, 67 were excluded for various reasons leaving 83 patients who met inclusion criteria and had bronchoscopy done and BAL fluid obtained. Thirty-two (38.6%), were found to have P. carinii infection, 20 (24.1%) patients had TB, 9 (10.8%) patients had PKS and pyogenic bacteria were identified in 7 (8.4%) patients. No fungi were identified. No aetiological diagnosis was made in 24 (29.9%) patients. Nine (10.8%) patients had more than one diagnosis. Conclusions: By the use of bronchoscopy, it was possible to identify PCP (38.6%), PTB (24.1%), PKS (10.8%) and pyogenic bacteria (8.4%) among AAFB sputum smear negative, HIV positive adults presenting to Mulago Hospital with pulmonary symptoms.
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    Community knowledge on drugs commonly used for self-medication in Mbarara District
    ( 2000-11) Mwoga, Joseph Ngobi
    Introduction: There is a concern that the high level of self-medication may be contributing to a large disease burden as a result of inadequate treatments and drug resistance. The study therefore aimed at assessing the community's knowledge on drugs commonly used for self-medication and the factors associated with self-medication in order to add more insight into the design of appropriate interventions for improving rational use of drugs. Objectives: Specifically, to identify the drugs commonly used in self-medication; the health problems for which the said drugs are used; the sources of these drugs; what the people know about the drugs they use in self-medication, where they obtain that knowledge and the factors that are associated with self-medication. Methods: A cross-sectional study that used qualitative and quantitative methods of data collection was conducted in Mbarara District between December 1909 and November 2000 Using a multistage cluster sampling technique, a total of 360 household heads or their spouses were interviewed using a standardised, pre-tested semi-structured questionnaire Also using a standard pre-tested guide, eight FGDs were also conducted with community members Three drugs were chosen to test the knowledge of the community Knowledge was operationally defined and limited to knowing what the drugs are used for and in doses as prescribed by the standard treatment guidelines. Qualitative data was analysed using master sheets while quantitative data was analysed using EPINFO software package. Results: Drugs most commonly used for self-medication were antimalarials (Chloroquine, Fansidar, Carnoquine, Quinine) 55.3%, analgesics (Aspirin, Panadol, Hedex, Action) 43.9%, and antibacterials (Co-trimaxazole, Penicillin, Tetracycline) 21.7% The health problems Tor which these drugs are used were fever 83.9%, cough 31.9%, and abdominal pain 14.4% The sources of the drugs doubled as the sources of the knowledge about the drugs and these included drug shops and private clinics 45%, ordinary shops 26.7%, government health units 20.8% The drugs Chloroquine, Septrin, and Mebendazole were respectively known by 42.8%, 15%, 7.8% of the respondents Correct knowledge about the drugs was found to be associated with acquisition of formal education Factors found to be associated with self-medication were; formal education. Those with formal education were more likely to seek for treatment from a health worker when they fell sick [OR=1.84, CL=1.07-3.15] and therefore less likely to practice self-medication. Other factors were: lack of money, long distances to health facility, lack of drugs in health units, non-severe illnesses, rude and corrupt health workers, and smelly dirty health units. Conclusions: Drugs commonly used in self-medication are antimalarials, analgesics and antibacterials. The illnesses for which the said drugs are used are fever, cough, and abdominal pain. The sources of these drugs and knowledge about them are drug shops and private clinics, ordinary shops and government health units. There are a few people out in the community who have correct knowledge about the drugs they use in self-medication. People without any formal education tend to practice self-medication more that those with some formal education. Recommendations: National Drug Authority should evaluate the informal sources of drugs and then regulate them The District Health Management Team should provide training programs for the informal health care providers on prevention and treatment of common diseases. The Health Sub-District staff should plan for and implement activities to provide support supervision for the informal health care providers. The health professional councils should strengthen the regulation and control of their members through routine supervision. Government of Uganda should empower its people (the communities) by providing universal education since the latter is a predictor of correct knowledge about drugs and tends to reduce likelihood of self-medication.
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    Case records and commentaries submitted in partial fulfilment for the award of masters of medicine degree (obstetrics and gynaecology) of makerere university.
    ( 2001) Nakintu, Nuru
    GENERAL INTRODUCTION Mulago hospital complex is the national, referral and one of the teaching hospitals in Uganda. It is situated about two kilometers from the city center and has abed capacity of 1200 beds. It provides training for doctors, nurses and allied medical workers. It also carries out community based outreach programmes and research in all disciplines of medicine. It is a complex comprising of New Mulago and Mulago Hill Assessment center where patients are screened at arrival and sent to the appropriate departments. The hospital has specialized departments in Medicine, Surgery, Paediatrics, Obsterics and Gynaecology, Radiology, Anaesthesian and Public Health. Department of Obstetrics and Gynecology. This is located on the 5th floor in New Mulago but has other units in New Mulago and Mulago Hill assessment center. In New Mulago, there are departmental offices, the lying-in wards, labour ward, theater, outpatients’ clinics and antenatal clinic. Other services include human reproductive research unit with laboratories and data units. Professors, Consultants, Lecturers, Registers, Senior and juniors house officers and the nursing/mid wife staff run the department. Others include theatre attendants, record clerks, social workers, counselors and nursing aides. These are allocated to different firms. The wards in this department include antenatal, postnatal, gynaecological emergency and patients clinics include antenatal, gynaecological and infertility. The workload done by the department includes about 20,000-23,000 deliveries/year and about 5,000-6,000 gynecological patients/year. WARDS Gynaecological emergency ward (5A Annex): This ward caters for the emergencies that present to the hospital. It has an admission room, lying-in ward with a bed capacity of 16 beds and a minor theater. Some of the emergencies dealt with include abortions, ectopic pregnancies, acute pelivic inflammatory infections, complications of pregnancy before 28 weeks of gestation and complications of pueperium. Minor operative procedures such as evacuation of the uterus for incomplete abortions are carried out in the side room minor theater. The majority of patients seen in this ward come with abortion related problems and about 3,000 abortions are seen per year. Labour ward: This is an emergency ward which is covered 24 hours by a team on duty consisting of consultant/ registrar, senior and junor house officers and midwifes who rotate in shifts. The patients come form several places which include in-patients, transfers from OMMC, those booked in New Mulago hospital, referrals from near by maternity centers/private clinics and those who did not receive any form of antenatal care and from the surrounding districts. In Mulago about 22,000 deliveries are conducted per year with a caesarean section rate varying between 13-18%. Activities in the labour ward Admission: Registration Relocation of files to booked patients Administration of files to referral and the unbooked patients Checking of blood pressure, temperature and taking social-demographic details Examination room The admitting doctor takes the relevant history and examines the patients then decides the mode of management. OMMC: This maternity center is run by midwives daily and caters for mothers who are assessed as low risk. They transfer any mothers with complications of pregnancy and labour to New Mulago. There’s a postnatal ward where parturient mothers are observed for at least 24 hours. Family planning clinic and VSC centre This provides general family planning services and also offers other reproductive health services such as counseling, immunization and treatment of sexually transmitted diseases. The VSC centre performs bilateral tubal ligation, vasectomy, implantation of Norplant and other contraceptive methods. Outpatient clinics: In New Mulago the outpatients are seen in different clinics according to their disease conditions and the clinics are run on firm basis on different days. These include antenatal, gynecological and infertility clinics that are run by the specialists, senior house officers, intern doctors and midwives. Laboratories: The department runs side room laboratories for simple investigations while the major ones are sent to the hospital major laboratories located on the third floor. There are also laboratories in the reproductive research unit. Imaging Imaging procedures required in the management of patients such as ultra sound sonography and X-rays are found on the second floor in the radiology department. The patients with gyaecological cancers who require radiotherapy are referred to the radiotherapy unit. Patients with mild medical conditions in pregnancy but not in labour and those in latent labour are treated and sent to the antenatal lying-in ward for further management. Those in labour are sent to the first stage room where they are monitored using a partogram until they reach the second stage of labour. Deliveries are carried out in the second stage room which has facilities for normal, assisted instrumental, breech and twin deliveries and a resuscitation area for the new born babies. Labour ward also consists of an intensive care room reserved for patients who are high risk or have complications of pregnancy. These include conditions such as pre-eclampsia, eclampsia, ante partum haemorrhage, chronic medical illness such as cardiac, sickle cell disease and diabetes in labour and those requiring induction of labour. The mothers and babies are observed for at least six hours in the labour ward and are then transferred to the postnatal lying-in wards. Mothers with babies born before arrival with in 24hours are also admitted to the labour ward to manage complications and for observation. Operating Theatre: This has three operating rooms; one for elective surgery and the other two for emergency operations. Anaesthetists come from the department of anaesthesia. The private patients are operated in the private theatre on the 6th floor. On the average about 5614 operations are performed annually with the majority being emergency operations. Special care unit: This is an intensive unit for the management of the newly born babies. It is located on the same floor and is managed by the department of paediatrics. It is within easy reach of the labour ward and is open 24 hours. This unit caters for babies who are prematures, have low Apgar scores, birth asphyxia and any abnormalities from labour ward, other centers or from home. The mothers with babies in SCU are admitted in the general ward (mothers’ club), from where they go to see and breast-feed their babies. In case of illness they are managed by the doctors/nurses on the ward.
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    A survey of the Prevalence of Refractive Errors among Children in Lower Primary School in Kampla District.
    ( 2001) Mayeku, Robert
    BACKGROUND: The prevalence of refractive errors in children in most developing countries is not known. WHO has initiated the refractive error study in children (RESC) program to try and address this problem in the vision 2020. The right to sight. In Uganda, like in many developing countries there is almost no established vision screening program for children on commencement of primary school, such that those with early onset of refractive errors will have many years of poor vision. THE AIMS AND OBJECTIVES of this study was to determine the prevalence of refractive errors among school children attending lower primary in Kampala district, determine the frequency of the various types of refractive errors and their relationship to sex and ethnicity. METHODOLOGY: This descriptive cross sectional study was carried out in Kampala district and a multi stage type of sampling was used to select the 700 participants aged between 6 and 9 years. A total of 623 children of them had a vision testing done on them at school using the same protocol. Of this 301 (48.3%) were males and 322 (51.7%) females – M: F ratio of approximately 1:1. Seventy five children had a detailed ocular examination including retinoscopy under cyclopegia and fundoscopy according to the set criteria of a visual acuity of < 6/9 and / or a squint in either or both eyes. RESULTS: There were 73 children with refractive errors, giving a prevalence rate of 11.6%. The 2 children who were emmetropic at retinoscopy had fundus abnormalities. Of the refractive errors, the commonest type was astigmatism constituting 52.0% followed by hypermetropia and myopia (37.0% and 11.o% respectively). On further analysis of the astigmatic type it was found that the commonest component was the hypermetropic subtype accounting for 42.1% followed by the mixed (31.6%) and myopic (26.3%). There was no significant sex and ethnic influence in the frequency and distribution of refractive errors in this study. CONCLUSION: From this study, there is a need to have a regular and simple vision testing in school children at least at commencement of school to detect those who may have early onset of refractive errors for referral. This needs a wider population based survey top establish the national figures for prevalence of refractive errors, covering wider age strata, in view of creating a national program for vision screening in schools.