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ItemPrevalence, types and factors associated with late arrhythmias following paediatric open-heart surgery of cardiac anomalies among children attending the Uganda Heart Institute(Makerere University, 2025)Globally, the prevalence of pediatric cardiac anomalies requiring open-heart surgery is on the increase, with improved access to diagnosis and cardiac surgeries in low- and middle-income countries. Late arrhythmias, defined in this study as those occurring more than 30 days post-surgery, have been noted as a potential complication following these procedures. However, the prevalence, types, and risk factors associated with late arrhythmias after open heart surgery for congenital and acquired heart diseases in Ugandan patients remain unexplored. This study aims to address this gap by investigating these key aspects in the Ugandan context. Objective: To determine the prevalence, types, and factors associated with late arrhythmias among children attending the outpatient department at the Uganda Heart Institute, following open-heart surgery performed either within or outside Uganda. Methods: This was a retrospective chart review that included children aged 1 month to <18 years with cardiac anomalies who had undergone open-heart surgery in or outside Uganda and were >30 days post-surgery. Children who attended Uganda Heart Institute OPD between January 2023 and June 2024 were considered. The surgical diagnosis and patients' biodata were collected from registers, and the surgery date was obtained from their inpatient charts and pre-referral charts then Parents/guardians were contacted to confirm the surgery location and any additional comorbidities. The latest visit data, including anthropometry, ECG, heart rate, SpO2, were then retrieved from the Uganda Heart Institute's registers and ECHO (from an electronic data base), using a pre-tested questionnaire. Wasting was categorized using WHO as weight for length/height Z score < 5 years and BMI for age Z score ≥5years, moderate acute malnutrition was ≥-3SD to <-2SD while severe acute malnutrition was <-3SD. The data was entered into Epidata version 3.1 and exported to Stata version 15 for bivariate and multivariate analyses to assess factors associated with late arrhythmias. Results: The study included 174 children, 48.3% female and 51.7% male, with a median age of 5 years (IQR: 4 to 26 months). Moderate acute malnutrition was present in 19.5% of the children, and 4.6% had severe acute malnutrition. Most children (72.4%) underwent cardiac surgery before age 5, with 60.9% having surgery in India and 24.7% in Uganda. The most common procedure was ventricular septal defect repair (29.9%) followed by Tetralogy of Fallot repair (24.7%) and total anomalous pulmonary venous return repair was the least common (0.7%). Late arrhythmias occurred in 56.3% of the children, including first-degree heart block (3.1%), complete RBBB (43.9%), partial RBBB (51%) and LBBB (2%) Factors significantly associated with late arrhythmias were children aged 4–12 years [aOR 2.44 {95% CI: 1.15-5.19., p=0.020], wasting [aOR 3.93 {95% CI: 1.64-9.42}, p = 0.002)] and history of TOF repair [aOR 5.51, {95% CI: 2.03-14.97}, p=0.001]. Conclusion and Recommendation: Late arrhythmias, particularly RBBB, are common after open-heart surgery in Ugandan children with cardiac anomalies. School age, wasting, and TOF repair increase the risk. Early surgery and nutritional support, are recommended. Keywords: Late arrhythmias; open heart surgery; Cardiac anomalies; Paediatrics; Children.
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ItemClinicopathological characteristics of pancreatic cancer and their association with mortality rate within a year of diagnosis at uganda cancer institute: a five-year retrospective cross-sectional study.(Makerere University., 2025-08)Introduction: Pancreatic cancer is increasingly prevalent in low- and middle-income countries with a poor prognosis. However, its clinico pathological characteristics and outcomes are not well documented in Uganda. Objective: To describe the clinicopathological characteristics of pancreatic cancer and their association with one-year mortality at Uganda Cancer Institute. Methods: A five-year retrospective chart review (July 2018-june 2023) was conducted at UCI, analysing medical records of patients with histologically confirmed and/or radiologically highly suggestive of pancreatic cancer. Data on Socio-demographics, clinical characteristics, histopathological features, radiological features, and one-year mortality were collected using a pre-tested pre-coded tool. Outcomes about whether alive or dead were verified via medical records and telephone follow-ups. Statistical analysis was performed using STATA 16.0 with logistic regression to assess associations between clinicopathological characteristics and one-year mortality (odds ratios-OR and 95%confidence intervals). A p-value <0.05 was considered statistically significant. Results: Of 138 patients (46.4% male and 53.6% female, mean age 54.2 years), epigastric pain was the most common symptom (84.9%) with a median symptom duration of 3.5 months. Tumours were predominantly located in the pancreatic head (68%), followed by the body (21.5%), tail (6.2%), and mixed locations at 4.6%. Adenocarcinoma was the most common histological type (93.8%), followed by intraductal papillary mucinous neoplasm (2.3%), pancreatic neuroendocrine neoplasm (0.8%), acinar cell carcinoma (1.6%), and solid pseudopapillary neoplasm 1.6%. Most tumours were moderately differentiated tumours (58.5%), 31.7% poorly differentiated tumours, and 9.8% well differentiated tumours. The one-year mortality rate was 69.5% with 60%of deaths occurring within 3 months of diagnosis. Weight loss (p value 0.025), low albumin levels (p value 0.023), and elevated levels of CA 19-9(p value 0.029) were significantly associated with mortality. Conclusion: Pancreatic cancer in Uganda primarily affects middle-aged individuals with a slight female predominance and is associated with a high one-year mortality rate (69.5%), driven by late presentation (stage III and IV). Weight loss, low albumin, and elevated CA 19-9 are significant predictors of mortality.
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ItemAcceptability, effect, and cost-effectiveness of mobile-health on antiretroviral therapy adherence among youth: a mixed methods sequential study in Kiryandongo District, Western Uganda(Makerere University, 2025)Adherence to antiretroviral therapy is the principal determinant for achieving and sustaining viral suppression, which decreases progression to Acquired immunodeficiency syndrome (AIDS) and reduces the risk of mortality. Few studies have evaluated mHealth adherence tools among youth in resource-limited settings. This study aimed to evaluate the barriers, enablers, acceptability, effect, and cost-effectiveness of an mHealth tool (Call for Life) on antiretroviral therapy (ART) adherence outcomes among youth in Kiryandongo, Uganda. This was a mixed-methods sequential design with four studies: qualitative studies conducted before (paper 1), a randomized clinical trial (paper 2), a cost-effectiveness analysis study (paper 3) and endline qualitative study (paper 4). The second study involved 206 youth initiating ART or on ART for ≤ six months who were randomized to either the Standard of Care or the mHealth tool plus the Standard of Care .The qualitative analyses were guided by socio-ecological model and information motivation behavioral modes with support from Nvivo 14.0 software. The primary end point was viral load suppression at 12 months and secondary endpoint was viral suppression at 6 months and retention in care. Log binomial analysis through STATA software was performed. The cost-effectiveness analysis outcome was the incremental cost-effectiveness ratio of the intervention in comparison to the standard of care per disability-adjusted life-years. The qualitative results showed multiple barriers to ART adherence at individual and social levels, with travels from home, forgetfulness, stigma, noise from pill bottle, unintended disclosure being the common barriers. The enablers included social support, repacking ART into drug envelopes other than pill bottles and disclosure. The Call for Life interactive voice response tool showed 21.7% more effective on adherence leading to higher proportions of youth with virological suppression. The tool is cost-effective in improving retention and viral suppression in this age group and has an incremental cost-effectiveness ratio of $17 per disability adjusted life year (DALY) averted. The Call for life system was highly acceptable, informative and easy to use among the youth. The major barriers were at individual level and enablers at relationship level. The call for life intervention was effective in viral suppression and retention in care, it was cost-effective compared to usual care, easy to use and acceptable in improving ART adherence, viral suppression and retention in care. This project is among a few that have assessed barriers and enablers of ART adherence, acceptability, effectiveness, and cost-effectiveness of mHealth on viral suppression. The tool is cost-effective in this setting and should be considered by policymakers for the improvement of health outcomes in youth living with HIV.
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ItemFrequency and barriers to upper gastrointestinal endoscopy among patients with dyspepsia at Mulago and Kiruddu hospitals: a prospective cohort study.(Makerere University, 2025)Background: Uganda has a high prevalence of over 50% of uninvestigated dyspepsia, which delays the timely diagnosis of potentially curable diseases like early gastric and oesophageal cancer. Notably, more than 90% of dyspepsia patients in Uganda have structural causes, underscoring the importance of esophagogastroduodenoscopy (EGD) as a definitive diagnostic method. However, the majority of patients with dyspepsia do not undergo EGD due to certain unknown barriers. Objectives: To determine the frequency of EGD and analyze patient-level barriers to EGD among dyspeptic patients at Mulago and Kiruddu Hospitals. Methods: This prospective cohort study was conducted over three months (December 2024–February 2025) and included 423 dyspeptic patients aged 30 years or older who were recommended for EGD at the GI clinics of Mulago and Kiruddu hospitals. Data were collected via interviewer-administered questionnaires during initial in-person interviews and one-month follow-up telephone calls. The primary outcome was EGD attendance. Results: A total of 402 participants were successfully followed up. The cohort had a male-to- female ratio of 1:2.8 and a mean age of 50.4 years (SD ±12.7). The one-month frequency of EGD was 4.48%. The high price of EGD 0.139 (-3.832 – -1.296) was a significant limiting factor to attending EGD. Furthermore, a positive family history 0.27 (0.08 – 0.89) and social history 0.05 (0.01 – 0.20) of GI cancer was a significant barrier to undergoing EGD. However, abstaining from tobacco smoking 5.72 (1.04 – 31.46) as well as former tobacco smoking 9.66 (2.38 – 39.20) and alcohol use 9.12 (2.66 – 31.23) were all significant facilitators to attending EGD. Conclusion: This study experienced a minimal follow-up loss of 4.96%, allowing for a precise estimate that only 4.48% of dyspeptic patients underwent EGD within one month, despite receiving a doctor's recommendation. We recommend a policy review to reduce the price of EGD, which may include a national health insurance scheme that provides for public hospitals, to make EGD more affordable at Mulago and Kiruddu Hospitals. Secondly, qualitative mixed- methods studies with extended follow-up periods are recommended to provide an in-depth understanding of the barriers to attending Endoscopy among patients with dyspepsia.
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ItemShort-term functional and radiological outcomes following primary total knee replacement surgery at mulago national referral hospital and corsu hospital.(Makerere University., 2025-08-01)Background: Total Knee Replacement (TKR) is a widely accepted procedure for end-stage knee osteoarthritis that reduces pain and improves physical function in these patients. Most patients have generally good outcomes however, 20% may experience unsatisfactory outcomes. The variation in outcomes is attributed to several factors including age, BMI, physiotherapy etc. In recent years there has been an increase in TKR surgeries in Uganda, however no studies have assessed functional outcomes among the patients post-TKR. This study aimed to determine the short-term functional outcomes of TKR and factors associated among patients who had undergone TKR in MNRH and CoRSU hospital.Main objective: To evaluate the short-term functional and radiological outcomes following Total Knee Replacement surgery at MNRH and CoRSU hospital.Methods: This was a cross-sectional study conducted at MNRH and CoRSU hospital. 68 participants post-TKR were consecutively recruited to evaluate short-term functional and radiological outcomes, using the Knee Society Score (KSS) and the Knee Society Roentgenographic Evaluation and Scoring System (KSRES) respectively. Demographic data was collected through a structured questionnaire and analyzed using SPSS version 16 to explore relationships between dependent and independent variables.Results: The study assessed 68 participants (70.4% from MNRH and 29.6% from CORSU) with a median age of 65 years, evaluating 78 knees post-TKR at a median follow-up of 13.9 months. Most participants (73.5%) had comorbidities. The median clinical and functional knee scores of 87 and 80 respectively, showing a significant difference (p=0.003). Increased pain correlated with reduced walking and stair-climbing ability (p<0.001). Radiologically, 62.8% of knees had normal femur coronal alignment (2-7° valgus), 79% had neutral tibiofemoral angles, however 24% achieved neutral (90°) tibial component coronal alignment, which was significantly associated with better functional scores (p=0.003). Normal femoral flexion and tibial slope were observed in 50% and 97% of knees, respectively, and minimal radiolucency (9%, none >2mm). Bilateral TKR patients had significantly worse clinical and functional scores compared to unilateral cases (p<0.05), underscoring the impact of surgical extent on outcomes.Conclusion: Primary TKR at both MNRH and CoRSU hospitals yields favorable short-term functional and radiological outcomes, consistent with global studies. However, optimal outcomes may be influenced by patient-specific factors such as the number of knees operated, comorbidities, physiotherapy, and employment status. These findings emphasize the need for individualized post-op care and further longitudinal studies to assess long-term outcomes.