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BACKGROUND: Few data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS. RESEARCH QUESTION: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda? STUDY DESIGN AND METHODS: A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses. RESULTS: Four hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59/79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio2 ratio (OR, 0.99; 95% CI, 0.98-0.99; P < .001) and respiratory rate (OR, 1.07; 95% CI, 1.03-1.12; P = .002) at admission and NIV (OR, 6.31; 95% CI, 2.29-17.37; P < .001) or IMV (OR, 8.08; 95% CI, 3.52-18.57; P < .001) use were independent risk factors for death. INTERPRETATION: SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting.

Supplemental material, sj-pdf-1-smo-10.1177_20503121231176666 for Informed consent process for emergency surgery: A scoping review of stakeholders’ perspectives, challenges, ethical concepts, and policies by Olivia Kituuka, Ian Guyton Munabi, Erisa Sabakaki Mwaka, Moses Galukande, Michelle Harris and Nelson Sewankambo in SAGE Open Medicine

Supplemental material, sj-pdf-1-smo-10.1177_20503121231176666 for Informed consent process for emergency surgery: A scoping review of stakeholders’ perspectives, challenges, ethical concepts, and policies by Olivia Kituuka, Ian Guyton Munabi, Erisa Sabakaki Mwaka, Moses Galukande, Michelle Harris and Nelson Sewankambo in SAGE Open Medicine

This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.

As noted in the protocol, we planned to assess potential adverse effects and use of what was learned in daily life (far transfer) in the one-year follow-up studies. This addendum to the protocol describes how we will do this.

Background: Many people find it difficult to make decisions about what to believe or do regarding “health actions” (things that they can do to care for their health or the health of others). To avoid being misled by unreliable information and to make good choices, people must be able to understand and apply some basic principles (concepts). The Informed Health Choices (IHC) secondary school resources are designed to help students learn and use nine of these concepts. This is a protocol for a prospective meta-analysis of three cluster-randomized trials in Kenya, Rwanda, and Uganda. Objective: To estimate the effect of using the IHC secondary school resources in addition to the standard curriculum compared to the standard curriculum in the context where the trial is conducted) on students’ ability to think critically about health actions. Methods: The participants are lower secondary school students (age 14-16) and their teachers. The intervention is a 2-3-day teacher training workshop, a teachers’ guide, and 10 40-minute lessons taught to the students during a single school term. The comparison is the standard curriculum in each country. The primary outcome measure is the Critical Thinking about Health (CTH) Test. The test is a measure of an individual’s ability to understand and apply the nine key critical thinking concepts included in the lessons. It includes two multiple-choice questions for each concept. The primary outcome is the proportion of students with a passing score on the test. Secondary outcomes include the average score on the test, the proportion of students with a score that indicates mastery of the nine concepts, retention of what the students learned after one year, self-efficacy, intended behaviours, performance on standard, end-of-term examinations, and teachers’ ability to understand and apply the nine concepts measured using the CTH Test. Overall effects will be estimated using inverse variance methods. We will use mixed effects models with individual student data to estimate variation in effects for the primary and first two secondary outcomes in relation to three potential effect modifiers: use of a projector version compared to a blackboard version of the lessons, class size, and student performance on end-of-term examinations prior to the intervention. Strengths and limitations: Strengths of this meta-analysis are that it is prospective, allowing for collaboration on the design of the trials and certainty that all eligible trials have been included. A limitation is that the review authors are both developing and evaluating the intervention, although there are efforts to minimise bias.

Background: Young people are exposed to many claims about the effects of things they can do to protect or improve health. To make good health choices, they need the ability to assess the reliability of those claims critically. Critical thinking is a core competence in the Rwandan secondary school curriculum and in many countries. However, critical thinking about health is rarely taught in Rwanda. Digital secondary school resources for critical thinking about health can potentially address this gap and if published be widely disseminated at low cost. The objective of the planned study is to evaluate the effects of using digital secondary school resources to help students learn to think critically about health. Methods: We will conduct a two-arm cluster-randomized trial. We will randomly select 84 lower secondary schools from 10 districts representing all five provinces of Rwanda. Using stratified random allocation, we will assign 84 schools to the intervention or control arm. Schools in the intervention arm will teach 10-lessons after teacher training on the content of the secondary school resources. Schools in the control arm will not receive any training and resources. They will carry on with teaching the national curriculum. The primary outcome will be the proportion of students with a predetermined passing score on a test with multiple-choice questions from the Claim Evaluation Tools item bank. The questions measure the ability to apply key concepts related to assessing health claims and making informed health choices. The test will include two questions addressing each of the nine concepts covered by the secondary school resources. Discussion: This is one of three randomized trials to assess the effects of the Informed Health Choices secondary school resources in Rwanda, Kenya, and Uganda. The findings will inform decisions about how to promote critical thinking about health. Trial registration: Pan African Clinical Trial Registry, trial identifier: PACTR202203880375077, Registered on 15th February 2022.

Background To make well-informed choices, people must possess skills to assess the trustworthiness of health-related claims. It is important that young people learn to assess the reliability of claims to inform decisions, both when making their own choices and as citizens participating in a democracy. This trial aims to evaluate the effect of the Informed Health Choices (IHC) teaching resources on secondary school students’ ability to assess health-related claims and make informed choices. Methods This will be a two-arm cluster-randomised trial. We will randomise 80 lower secondary schools to evaluate the IHC secondary school digital teaching resources. The resources for teachers include 10 lessons to be delivered in a single school term, using lesson plans developed for classrooms equipped with only a blackboard or with a projector. Teachers in the intervention arm will be invited to a three-day teacher training workshop. Teachers in the control schools will continue teaching the national curriculum. Uganda’s National Curriculum Development Centre introduced a new competence-based curriculum in 2020. This curriculum has critical thinking as one of seven generic skills to be taught across all subjects. The curriculum does not explicitly include critical thinking about health. The IHC lessons address nine prioritised key concepts. We will use multiple choice questions – two for each key concept - to evaluate the student’s ability to assess claims and make informed choices. We will measure the proportion of students with a passing score at the end of the school term, and again after one year to assess retention of what was learned. Expected results Based on previous work done in Ugandan primary schools, we anticipate that the use of the teaching resources will lead to a large improvement in the lower secondary school students’ ability to assess claims and make informed health choices.

Additional file 1. Interview guides.

Additional file 3. ICT observation checklist.

Additional file 5. COREQ checklist.

Additional file 1

Additional file 1. In-depth Interview guide.

Additional file 1: Table A1. Unit prices (2019/2020 Ugandan and Tanzanian Shillings). Table A2. Resource use specifications by single, double, and triple disease. Table A3. Monthly programme healthcare costs (US$ 2019/20) per patient by disease and facility. This includes staff salaries including non-clinical staff such as cleaners and drivers, drugs, medical consumables and supplies, laboratory testing, medical equipment, physical infrastructure used for patient care. Table A4. Out-of-pocket expenses and loss of earnings (median and ranges) in 2010/2020 US$. Table A5. Projected costs of managing people living with HIV, diabetes, hypertension, and multi-morbidity by gender in Tanzania and Uganda. Table A8. Prevalence of diabetes in Tanzania and Uganda [1]. Table A9. Prevalence of hypertension in Tanzania and Uganda [2, 3]. Table A10. HIV prevalence by age and gender in Tanzania and Uganda. Table A11. Projected impact of aging and differences in survival on the number of people living with HIV, diabetes, hypertension, and multi-morbidity (in thousands) by gender in Tanzania and Uganda. Sample size for the time and motion observational study. Figure A1. The effect of aging on the increase in the number of people with combined conditions (HIV and/or diabetes and/or hypertension) compared to cases in year 2020 by gender in Uganda and Tanzania.

Additional file 1. MEDLINE search string.

Additional file 2: Table S1. Results for each concept one year after listening to the podcast. Table S2. Intended behaviours. Table S3. Self-efficacy. Table S4. Self-reported behaviour - awareness of treatment claims. Table S5. Self-reported behaviour - assessment of the basis of treatment claims. Table S6. Self-reported behaviour - assessment of trustworthiness of treatment claims. Table S7. Self-reported behaviour - assessment of advantages and disadvantages of treatments. Table S8. Subgroup analyses - education. Table S9. Subgroup analyses - child in school that used IHC primary school resources. Table S10. Effect of IHC primary school resources on parents.

Additional file 5. Summary of findings from included empirical studies.

Additional file 4. Quality assessments for included studies.

Additional file 2. Prevalence of stocks of different controlled prescription drugs in Uganda’s private pharmacies Stocking practices of different CPDs among the pharmacies that participated in the questionnaire survey. Tramadol injection, tramadol capsules, diazepam, phenobarbitone, alprazolam, codeine, ketamine, and pethidine injection were the dominant CPDs stocked in Uganda’s pharmacies in decreasing order of prevalence.

Additional file 2. Citations for ‘near miss’ papers that were excluded.

Additional file 3. Characteristics of included studies with reference list.

Additional file 3. Prioritisation of Key Concepts.

Additional file 2. Prevalence of stocks of different controlled prescription drugs in Uganda’s private pharmacies Stocking practices of different CPDs among the pharmacies that participated in the questionnaire survey. Tramadol injection, tramadol capsules, diazepam, phenobarbitone, alprazolam, codeine, ketamine, and pethidine injection were the dominant CPDs stocked in Uganda’s pharmacies in decreasing order of prevalence.

Additional file 3. Distribution of scores and curves.

Additional file 1. The claim evaluation tools.

Additional file 1. The Claim Evaluation Tools.

Focus Group Discussion guide (DOCX 20 kb)

Additional file 2. Structured press releases and a news service

Additional file 1. Documents reviewed for the study.

Coding tree for male partner involvement in PMTCT (DOCX 18 kb)

Additional file 3. Findings from user testing the IHC podcast

Additional file 2. Select demographic, social, economic, epidemiological and health system contextual factors for Peru and Uganda.

Additional file 1. Idea generation and selection

Additional file 1. Questionnaire for female sex workers; Quantitative survey among sex workers in Uganda on STI and HIV screening intentions, practices and psychosocial predictors.

The objective of this research was to design mass media resources to enable the public to assess the trustworthiness of claims about the effects (benefits and harms) of treatments, and make appropriate health choices.

School authority (headteacher) Informed Consent Form â English. (DOCX 29Â kb)

Data collection form for teachers. (DOCX 15Â kb)

Consent form Podcast trial English version. (DOCX 27 kb)

SPIRIT 2013 Checklist: IHC School Trialsâ Checklist. (DOC 120Â kb)

Setting a standard for the ‘Claim 12’ and ‘Claim 9’. (DOCX 25 kb)

Research participant (teacherâ s) Informed Consent Form â English. (DOCX 27Â kb)

Setting a standard for the “Claim 12” and “Claim 9”. (DOCX 28 kb)

Safety Monitoring and Adverse Events Form. (DOCX 28Â kb)

The Claim Evaluation Tools. (PDF 997Â kb)

Consent form Podcast trial Luganda translated version. (DOCX 29 kb)

Search words. (DOCX 13Â kb)

Emergent themes from qualitative data analysis. (DOCX 14 kb)

Assessment of nursesâ knowledge in ethics and their perceptions on continuing ethics education.

Objective The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections. Study Design Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses. Results A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P = .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05-0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64). Conclusion Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.