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MROP-Mesh versus Desarda technique for short-term surgical outcomes in open inguinal hernia repair at Kampala International University Teaching-Hospital: A randomized controlled trial
(Kampala International University, 2021-07) Lauben Amagara Kyomukama
Introduction: Surgical outcomes of open Inguinal hernia repairs dictate the best technique to use and tension free repair is the current standard of care. Mesh repair and Desarda techniques are tension free techniques and their outcomes are comparable. The dearth of data comparing affordable mesh and Desarda techniques limits choice in developing countries. This study compares short term surgical outcome of open inguinal hernia repair of MROP mesh with Desarda techniques. Methods: The study adopted a double blinded randomized clinical trial at KIUTH that followed up 66 Males aged 18-65 years with primary inguinal hernia who were recruited and randomly assigned to M-arm (32) and D-arm(34) for open inguinal hernia repair for 14 days for surgical outcomes. Data was recorded using a questionnaire and analysed by Stata 14 . The difference in mean operative time, pain scores-(VAS) and complications were compared using unpaired-student t-test, Fisher’s exact, Mann-whitney(U) and Kruskal-Wallis(H) tests as appropriate. The study was approved by KIU-REC-(Nr.UG-REC-023/202020), UNSCT (UNCST/RC1/94812205) and Clinical trial registry-(PACTR202105846681553). Results: The mean age of 66 males was 46±11 years, 4 years greater in M-arm and majority were illiterate (74.8%). There were risks of familial hernia (36.4%), smoking and alcohol (38%), moderate pain and average long duration of inguinal swelling of 83 months. The mean operative time (minutes) was longer for M-(M=60.78, SD=22.93) than D (M=51.44, SD =30.36) with a variance of 9.3 and p = 0.16 indicating no statistical significance between the two arms. There was moderate pain (D=2.86±0.4,𝑀 = 2.87 ± 0.4) for first two days and mild to no pain at day 7 and 14. while many had acute pain (D-arm 80%, M-arm 74%), 5% (M) had haematoma, scrotal swelling (D=6%, M=18%), and only 2 (3.0%) respondents had surgical site infection with majority 53-(D=49%, M=47%) returning to work by end of day 14 follow up. Conclusion: There was no statistically significant difference in mean operative duration, pain, immediate and intermediate complications, and quality of life after hernioplasty between Desarda and Mesh repair. The null hypothesis of this study is henceforth accepted. Recommendation: Desarda-technique and MROP-mesh should be adopted as standard of care in hernia surgery in low-income countries.
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Prevalence and Factors Associated with Anemia among Pregnant Teenagers in the Third Trimester Attending Antenatal Care Clinic at Hoima Regional Referral Hospital, Western Uganda
(Kampala International University, 2021-11) Sadiq Mohamoud Hassan
Background: Globally, anemia is public health problem leading to increased maternal and perinatal morbidity and mortality. An estimated 41.8% of pregnant women are diagnosed with anemia at some point in their gestation with special groups such as teenagers noted to be most affected. Aim: To determine the prevalence and factors associated with anemia among pregnant teenagers in the third trimester attending ANC at Hoima Regional Referral Hospital. Methods and Materials: This was a cross-sectional study done from August 2021 to October 2021. A total of 288 pregnant teenagers aged between 13 and 19 years attending ANC at HRRH were consecutively enrolled. Interviewer-administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using IBM SPSS statistics version 23. Results: We enrolled 288 participants, (The prevalence of anemia was 26%; with 53% having mild anemia, 40% moderate anemia, and 7% severe anemia. The majority 40 (53.3%) had microcytic anemia, followed by normocytic anemia 25(33.3%) while 10(13.3%) had macrocytic anemia. The factors independently associated with anaemia among pregnant teenagers at the multivariate stage of analysis were uneducated level education (aOR=17.39, CI:4.655-64.988; p=<0.001), nulliparity (aOR=0.47, CI:0.225-0.989; p=0.047) and ANC visits < 4 (aOR=8.80, CI:2.888-26.811; p= <0.001). Conclusions and Recommendations: This study found that anemia prevalence among pregnant teenagers at HRRH was higher than the estimated national anemia prevalence in the reproductive age group. Microcytic anemia remains the most common morphological type affecting pregnant teenagers at HRRH. No formal education and poor ANC attendance is associated with increased risk of anemia among pregnant teenagers at HRRH while nulliparity was protective. There is a great need to strengthen ANC attendance for all pregnant teenagers by the health care authorities at all levels at the hospital, local area, district, and the MOH to reduce the risk of anemia among pregnant teenagers.
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Prevalence, Factors Associated and Susceptibility Profile of Group B Streptococcus Anogenital Colonization Among Third Trimester Antenatal Mothers at Kampala International University Teaching Hospital
(Kampala International University, 2021-11) Charles Muniu Kang’ethe
Background: Group B Streptococcus (GBS), or Streptococcus agalactiae, are catalase negative gram-positive cocci which are recognized as part of the normal flora colonizing gastrointestinal and genitourinary tracts. It is a normal component of the normal vaginal bacterial microbiome, but pregnancy offers good conditions for GBS multiplication in the vagina, sometimes leading to serious complications to the newborn including pneumonia, sepsis and death. The mother may suffer from chorioamnionitis, endometritis, wound infection, sepsis and death. The biggest risk factor for invasive GBS infection is rectovaginal colonization whose worldwide prevalence stands at 5-30%. Locally, data is sparse concerning the prevalence, associated factors and antibiotic susceptibility profile of rectovaginal colonization in pregnant mothers with this lethal organism. Objective: The purpose of this study was to determine the prevalence, factors associated and sensitivity profiles of anogenital GBS colonization among third trimester antenatal mothers at Kampala International University Teaching Hospital (KIU-TH) Methodology: This was a cross-sectional study conducted at the antenatal clinic and maternity ward of KIU-TH between August and October 2021. 348 women were recruited and rectovaginal samples taken. Culture for GBS was done and antibiotic susceptibility determined for positive cultures. Logistic regression was used to analyze data. Results: The prevalence of GBS colonization among third trimester mothers at KIU-TH was 10.1% (95%CI, 7.3-13.7%). In multivariable analysis, being overweight (aOR 2.5 95% CI 1.11-5.64, p=0.028) and having hypertensive disease in pregnancy (aOR 4.97 95% CI 1.03 24.06, p=0.046) were found to be independently significant. All isolates in this study were resistant to ampicillin 10µg, ceftriaxone 30 µg and cefazolin 30 µg. Only 1 isolate (2.86%) was sensitive to clindamycin 2 µg and 3(8.57%) to erythromycin 15 µg. 8 isolates (22.86%) were sensitive to penicillin G 10 µg, 12 isolates (34.29%) to vancomycin 30 µg, while the highest sensitivity;29 isolates (82.86%) was to imipenem 10 µg. Conclusions: GBS colonization in third trimester mothers at KIU-TH falls within the worldwide prevalence of 4-30%. Being overweight or having hypertensive disease in pregnancy is associated with an increased risk of GBS colonization. Isolates show high resistance to antibiotics commonly used in pregnancy
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Incidence And Factors Associated with Adverse Maternal Outcomes Among Women Undergoing Trial of Labour After Caesarean Section Presenting at Hoima Regional Referral Hospital, Western Uganda
(Kampala International University, 2021-11) Abdibasid Shariffali
Background: Whereas many authorities across the world recommend that pilot of labour after caesarean section offering to be for women with one erstwhile lower segment transverse caesarean section who have no contraindications, recommendation from clinical guiding call for women counselling regarding benefits and associated harm for preparation of having another caesarean section compared to attempt for a vaginal deliverance so as to aid this decision. Nonetheless, robust all-inclusive information lacking on the related outcomes so as to enable the counseling of the eligible women about this choice. Aim: To determine the incidence and factors associated with adverse maternal outcomes among women undergoing TOLAC presenting at HRRH, western Uganda Materials and Methods: A prospective cohort study done during the months of August 2021 to October 2021. 350 totality of expectant women above 28 weeks of gestation with previous cesarean section admitted at the maternity ward of HRRH were consecutively enrolled. Interviewer administered questionnaires were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using STATA version 14.2. Results: Of the 350 respondents, 87% established as the adversative maternal outcomes’ incidence. The significant independent socio-demographic and obstetric factors associated with higher odds of adverse maternal outcomes were rural residence (aOR=3.01, CI: 0.002-4.059; p<0.001), low family income (aOR=4.8, CI: 2.21-10.46; p<0.001) and short interpregnancy interval (aOR=0.2, CI: 0.05-0.57; p=0.004). Meanwhile, expectant women that experienced vaginal delivery following erstwhile cesarean section were less likely to experience adverse maternal outcomes at this hospital. Conclusions and recommendations: The incidence of adverse maternal outcomes among pregnant women undergoing TOLAC at HRRH is very high. Most women who undergo TOLAC at HRRH do not succeed. Women of rural residence; low family income and short interpregnancy interval have higher odds of adverse maternal outcomes. Meanwhile, expectant women that experienced vaginal delivery following prior caesarean section have less likelihood of facing adverse maternal outcomes. There is need for further studies to ascertain the cause of failure among women undergoing TOLAC at HRRH. Rural women of low socioeconomic status and short interpregnancy interval need to be sensitized by attending health care providers on risk of adverse outcomes and therefore the need for close monitoring during labour while under trial at HRRH.
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Assessing the effect of patients’ health literacy levels on early post-operative surgical care outcomes at rural based hospitals in Western Uganda
(Kampala International University, 2021-08) Michael Loduk
Brief introduction and problem to be addressed: inadequate health literacy exposes patients to poorer surgical outcomes yet currently there is a paucity of studies on health literacy and associated impact on surgical care outcomes. Hence, this study aimed to provide an assessment of the effect of health levels on early postoperative surgical care outcomes at the rural hospital setting. Subject and Methods: we conducted a cross-sectional study where patients of sound minds, aged ≥18 years and seeking surgical care or already received the service were requested to participate in the assessment of their health literacy levels, wellbeing, any presence of surgical wound infection, and whether they had comorbidities and prior encounter with a doctor before the current visit. Major Results: based on the Short Assessment of Health Literacy-English (SAHL-E), prevalence of inadequate health literacy among the 244 participants was 79.9% and had a statistically significant association with the early postoperative surgical outcomes of pain severity (correlation coefficient, -.594**, p-value < 0.05), wound infection (-.383**, < 0.05), and patient’s wellbeing (.672**, < 0.05). However, no statistical significance noted with having seen a doctor (-0.040, > 0.05), comorbidity (-0.103, > 0.05) or wound site (0.013, > 0.05). Conclusion and recommendation: health literacy’s strong statistical association with early postoperative surgical outcomes could possibly have a positive predictive value that would help the surgical care teams in mitigating its undesirable effects. So, healthcare providers should therefore embrace early preoperative health literacy evaluation in order to enhance the holistic postoperative patients’ care and improve the record systems.
Keywords: Health literacy. Surgical outcomes.