School of Medicine (Sch. of Med.) Collections
Permanent URI for this collection
Browse
Recent Submissions
1 - 5 of 1359
-
ItemAcceptance of Malaria Vaccine and its Determinants among Caregivers of Children under 5 Years at Mulago National Referral Hospital-a Mixed Methods Study.(Makerere university, 2026-10-11)Background: Malaria remains a major public health challenge in Uganda. Although the malaria vaccine offers a promising additional control measure, its successful uptake depends on caregiver acceptance. There’s a critical gap in understanding caregivers’ willingness to accept the vaccine which poses a challenge in effective vaccine implementation. Objective: To investigate the acceptance, knowledge, and perceptions of the malaria vaccine among caregivers of children under the age of five attending Mulago National Referral Hospital. Methodology: This was a convergent parallel mixed methods cross- sectional study. The quantitative component involved a cross-sectional survey of 385 caregivers of children under five attending the Paediatrics Outpatient Clinic at Mulago National Referral Hospital, selected through systematic sampling. An interviewer administered questionnaire was used to collect data on willingness to accept the malaria vaccine, knowledge and perceptions. The qualitative component comprised in-depth interviews with 24 caregivers, selected purposively. Qualitative data was analysed using thematic content analysis. Results: Vaccine acceptance was high at 86.5% though this fell markedly when a hypothetical fee was introduced. Good vaccine knowledge was the strongest independent predictor of acceptance (aOR 2.658, 95% CI: 1.005-7.033, p=0.049). Health worker contact (aOR 2.984, 95%CI: 1.146-7.775, p=0.025) was the primary independent predictor of knowledge. Caregivers perceived the malaria vaccine as beneficial for immunity and cost reduction but expressed safety concerns and unrealistic expectations. Despite high acceptance driven by high malaria burden and trust in government programs, hesitancy persisted due to fear of side effects and negative experiences from COVID 19 spill over within a contested social environment. Conclusions: Malaria vaccine acceptance was near universal but conditional on free delivery and vulnerable to safety misinformation and cross-vaccine distrust. Knowledge was the most critical modifiable determinant of acceptance and health workers were its most powerful driver. Structured health worker counselling and preservation of cost-free vaccine delivery even in an urban setting are essential to translating high acceptance intent into complete, schedule adherent vaccine uptake.
-
ItemWomen's experiences of emergency post-abortion care at Kawempe National Referral Hospital, Uganda(Makerere University, 2026)Post-abortion care (PAC) encompasses emergency treatment, counselling, contraceptive services, and referral linkages. The emergency component of PAC, which is Emergency post-abortion care (EPAC), is a life-saving service for women presenting with acute abortion-related complications such as haemorrhage, sepsis, retained products of conception, and severe pain. In Uganda, where abortion is legally restricted and socially stigmatised, women’s experiences of care are shaped not only by clinical urgency but also by fear, moral vulnerability, provider interactions, and structural health system constraints. While EPAC is essential for survival, there is limited evidence on how women interpret and evaluate their care experiences in referral hospital settings in Uganda. To explore women's experiences of emergency post-abortion care at Kawempe National Referral Hospital, Uganda. A qualitative phenomenological design was employed. Eligible participants varied in age, parity, education, and socio-economic background. Sixteen in-depth interview transcripts from women who had received EPAC at KNRH in March and April 2026 were analysed thematically. The transcripts were analysed thematically using an inductive approach. The Socio-Ecological Model guided interpretation across individual, interpersonal, and facility levels. Rigour was ensured through iterative coding, constant comparison, and close engagement with participants’ narratives. Women’s experiences of EPAC were complex and often contradictory. Six themes were identified: (1) survival and physical relief as the immediate measure of good care; (2) pain, fear, and emotional distress during treatment; (3) reassurance and support as buffers against vulnerability; (4) dignity under pressure: communication and privacy in EPAC; (5) structural barriers across the pathway of care; and (6) experiences beyond discharge: incomplete recovery and uncertainty. Care was frequently evaluated through the lens of survival and physical relief, with many participants describing rapid stabilisation, supportive providers, and timely intervention. Although many participants described survival and physical stabilisation positively, these accounts frequently coexisted with intense procedural pain, fear of death, dismissive communication, compromised privacy, delays, financial burden, and inadequate follow-up after discharge. Experiences extended beyond discharge, with ongoing physical symptoms, uncertainty about recovery and fertility, and variable follow-up support. EPAC at KNRH was experienced not only as a clinical intervention but as a complex encounter shaped by bodily vulnerability, interpersonal dynamics, and system-level constraints. While lifesaving care was often delivered successfully, women’s experiences of care were evaluated through a broader lens that included dignity, communication, pain management, timeliness, and continuity of care. Strengthening EPAC, therefore, requires a shift toward more consistent, patient-centred approaches that integrate clinical effectiveness with respectful care, improved triage, enhanced counselling, and clearer post-discharge support systems/mechanisms.
-
ItemMs(Makerere University, 2026-08-04)Introduction, In Uganda, leukaemia and lymphoma contribute to 33% and 13% of all childhood cancers, respectively, with improving survival rates. However, data on quality of life (QoL) among adolescents who have achieved remission remain limited. The objective of this study was to determine the quality of life (QoL) among adolescents who were in remission from liquid cancers at Mulago National Referral Hospital (MNRH). Methods A cross-sectional study design was used to determine the prevalence of QoL measured as a composite indicator constituted of four domains (Physical, Emotional, Social, and Environmental) using the Pediatric Quality of Life Inventory. Each domain was scored based on a Likert scale ranging from 0(good) to 5(bad), then reverse scored (100 = 0, 0 = 5) and summed for all questions across all 5 domains. An average score was then calculated. QoL was categorised as good (> 70) or poor (<70). Data on explanatory variables (demographics, clinical, social, and lifestyle) were collected. The prevalence of QoL was reported as a percentage, and the modified Poisson regression model was used to determine the factors associated with QoL.Results, The prevalence of Good QoL was 62.6% (95% CI: 53.3 – 71.9). Factors associated with good QoL included being in a relationship (aPR 1.43, 95 % 0.98-2.09, p-value 0.049) and engagement in extracurricular activities (aPR 2.04, 95% CI 1.00-4.14, p-value 0.048). The presence of comorbidities (aPR 0.21, 95% CI 0.21-1.14, p-value 0.043) and persistence of treatment side effects (aPR 0.26, 95% CI 0.13-0.52, p-value 0.000) were associated with poor QoL. The median scores (IQR) per domain were: 78.1 (60.7-93.8), 80 (65-90), 80 (70-100), and 75 (60-85) for Physical, Emotional, Social, and School/work domains, respectively. Conclusion. Prevalence of good QoL was modest, calling for intervention targeting domains with poor functioning, like school and physical domains should be prioritized. Inclusion of survivorship programs into management of adolescents with liquid cancers in remission should be considered.
-
ItemTwenty four hour outcome of pain control and associated factors among adult patients with isolated long bone fractures seen at the Mulago hospital accident and emergency unit.(Makerere University, 2026-10-12)Background: Pain is defined as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue. It is experienced by almost all patients with long bone fractures (LBFs), that significantly impacts their quality of life and recovery outcomes yet studies indicate that acute pain in patients with LBFs is often undertreated, leading to unnecessary suffering and potential complications such as chronic pain. This study aimed to determine the twenty four hour outcome of pain control and associated factors among adult patients with isolated long bone fractures seen at the Mulago National Referral Hospital Accident and Emergency (MNRH A&E) department Methods: We did a fragmented cross-sectional study among 130 adult patients presenting with isolated long bone fractures at the MNRH A&E department. Pain intensity scores were obtained using the NRS tool at admission and during administration of the subsequent treatments up to 4 times in 24 hours. Other relevant data were collected using a structured questionnaire and analyzed using SPSS version 27 Results: The participants' mean age was 30 years and ranged from 18 to 66 years. Males were predominant with a ratio of 2:1. High energy trauma was the most common mechanism of injury accounting for 115 (89%) cases. 85 (65%) participants had closed fractures. Combined tibia and fibula fractures were the most common and occurred in 65 (50%) participants. Overall, 8 (6.2%), 6 (4.6%), 8 (6.2%) and 4 (3.1%) participants had adequate pain control at 6, 12, 18 and 24 hours respectively. Participants with a caretaker and those who were given multimodal analgesia were generally less likely to have inadequate pain control while those with severe pain at admission, inadequate fracture splinting were more likely to have inadequate pain control at all the 4 times of assessment in 24 hours. Conclusion: 93.8%, 95.4%, 93.8% and 96.9% of patients with isolated long bone fractures had inadequate pain control at 6, 12, 18 and 24 hours of assessment respectively. Availability of acaretaker and administration of multimodal analgesia were protective factors against inadequate pain control while severe pain at admission, inadequate fracture splinting and unavailability of analgesic drugs at the MNRH A&E department were risk factors for inadequate pain control. We recommend that MNRH A&E should follow the WHO guidelines on pain management
-
ItemOsteosarcoma survival and its associated factors among adults managed at Uganda cancer institute.(Makerere University, 2026)Background: Osteosarcoma is the most common primary malignant bone tumor and poses significant treatment challenges in low-resource settings. While 5-year survival rates of 60–80% have been achieved in high-income countries through multimodal therapy, outcomes in sub-Saharan Africa remain markedly worse. At Uganda Cancer Institute (UCI),no survival data exist for adults (≥18 years) with osteosarcoma, representing a critical knowledge gap that limits evidence-based care planning for this age group. Objectives: To determine the 5-year overall survival rate and identify factors independently associated with survival among adults with osteosarcoma managed at UCI between 2010 and 2020. Methods: This was a retrospective cohort study of 98 adults with histologically confirmed osteosarcoma treated at UCI between -anuary 2010 and December 2020. Vital status was ascertained from medical records supplemented by telephone follow-up. Survival was estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards regression were used to identify factors associated with survival. Results: Ninety-three patients were included in the survival analysis, contributing 2,579 person-months of follow-up with 68 deaths (73.1%). The 5-year overall survival was 24.2% (95% CI: 15.5%–33.9%) and median overall survival was 18.0 months (95% CI: 13.1–28.7). Survival declined steeply in the first two years, with 1-year and 2-year survival of 62.7% and 43.3% respectively. In the final stratified multivariable Cox model, three independent predictors were identified: receipt of neoadjuvant chemotherapy (aHR=0.42, 95% CI: 0.22– 0.82, p=0.011); ECOG performance status 3 (aHR=2.27, 95% CI: 1.07–4.82, p=0.033) and ECOG 4 (aHR=3.11, 95% CI: 1.26–7.67, p=0.014) compared to ECOG 1; and low tumor grade compared to high grade (aHR=0.40, 95% CI: 0.19–0.83, p=0.014). Conclusion: Adults with osteosarcoma at UCI experience very poor survival, substantially below global benchmarks. Neoadjuvant chemotherapy is the single most important modifiable determinant of survival. Interventions to improve timely access to neoadjuvant chemotherapy, optimize patient functional status prior to treatment, and reduce treatment abandonment are urgently needed to improve outcomes in this setting.