Search

Purpose To describe the organizational characteristics of functional ICUs in Uganda. Methods A descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that admitted critically ill patients and had the ability to provide mechanical ventilation. ICUs were selected based on information of their existence. Direct structured interviews were carried out with the ICU directors. Results Of the fourteen ICUs reviewed, 12 were functional, and a majority were located in the central region. There were 55 ICU beds making up a ratio of 1.3 ICU beds per million population. The ICU beds comprised 1.5 % of the total bed capacity of studied hospitals. Most of the ICUs [11] were mixed (paediatric-adults), anaesthesia-led (nine) and five operated in a closed model. There were 171 ICU nurses, of whom 13 had formal training in critical care nursing. The majority of the ICUs had a nurse to patient ratio ≥ 1.2; nine during the day and seven at night. Conclusions This study shows limited accessibility to critical care services in Uganda. With a high variability in the ICU operational characteristics, there is a need for standardization of ICU care in the country.

Background: Preoperative information about pain has been shown to improve postoperative pain perception and reduce postoperative analgesia requirements. However, there is limited data regarding the effect of preoperative counselling in low resource settings. This study aimed at assessing the effect of preoperative information about pain on postoperative pain experience measured as postoperative pain using a verbal numerical rating scale (VNRS) and patient satisfaction with pain management. Methods: A randomised, double blind, controlled trial was done in Mulago National Referral Hospital (MNRH), Kampala. We prospectively enrolled 400 participants aged 18years and above scheduled for elective orthopaedic surgery. The consented patients were randomised to either receive the specific preoperative information about pain or not. The primary end points were postoperative pain score and patient satisfaction. A total of 340 were analysed with 170 in either arm. Secondary analyses where done to determine the factors that were associated with postoperative pain and patient satisfaction.Results: In both arms, the lowest pain score was 0/10 at 0 hours and the highest was 7/10 at 12 hours. A statistically significant difference between the intervention and control arms for the median pain score at 48hours (4/10 vs. 5/10) P-value= 0.029 was seen but none at 0, 12, 24hours. There was no difference in satisfaction with pain management (P value=0.059). Conclusion: Preoperative information about pain improves postoperative pain experience and may negatively impact patients’ satisfaction with pain management due to unmet expectations.Trial registration: Clinicaltrials.gov, NCT03056521. Registered 17 February 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03056521

Severe Traumatic brain injury (STBI) is a leading cause of morbidity and mortality among young individuals worldwide with worse outcomes being registered in low-income countries. Brain trauma foundation recommends the management of patients with TBI in the intensive care unit (ICU) to prevent secondary brain injury for improved outcome. However, Uganda being a low-income country, still grapples with the availability of ICU resources and space. Information regarding burden, predictors and short-term outcomes of ICU patients with TBI in Uganda has never been reconnoitered. A multicenter prospective observational cohort was conducted between 2013 to 2015 at four Ugandan ICUs. During the study period, we consecutively enrolled 387 critically ill, adult patients with TBI to determine the burden, predictors and short term outcomes in these patients. Baseline demographics, clinical and treatment parameters were recorded and followed till discharge from ICU or death. Of 387 patients enrolled in the study, 277 (71.6%) had moderate TBI, while 113 (29.2%) patients had STBI. The highest burden of TBI was recorded among patients assaulted through mob violence, recorded at 17/21 (81.0%), as shown in table 5. The overall mortality was at 34.4% (95/277) among patients with moderate or severe TBI, and 46.9% (53/113) among patients with STBI alone. Mortality was relatively higher among patients brought by the police, and those brought in at night. Multivariate analysis showed patient intubation, lack of antibiotic use, failure to transfuse, tracheostomy tube not inserted, and being involved in RTA or sustaining a fall were significantly associated with mortality among patients with TBI. We found a high burden of TBI and mortality among ICU patients. Despite limited resources in the local setting, inexpensive and locally available measures can reduce on the length of patient’s stay in the ICU and eventually decrease on the mortality. Improvement in prehospital as well as early trauma and airway care, antibiotic use, blood transfusion plus public health safety measures may reduce on the burden of TBI as well as improve outcomes.

Background Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country. Methods Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p

Background Childbirth is one of the most painful experiences of a woman’s life. Authorities in the fields of obstetrics and anaesthesia encourage use of labour analgesia. Unlike in high-income countries, pain relief in labour in Africa is not a well established service, especially in the low-income countries like Uganda. Little is known about whether parturients would be amenable to labour analgesia. We sought to determine knowledge, attitudes and use of labour analgesia among women attending the antenatal clinic at Mulago National Referral Hospital. Methods Upon obtaining institutional approval, we conducted a cross-sectional descriptive study. Women were requested to complete the researcher-administered survey following informed consent. The study was conducted in the general antenatal clinic at the Mulago National Referral Hospital. Results Of 1293 participants interviewed, only 7 % of the participants had knowledge of labour analgesia. Of the multiparous mothers 87.9 % did not have labour analgesia in their previous deliveries, although 79.2 % of them had delivered in a national referral hospital. The commonest reason for refusal of labour analgesia was to experience natural childbirth. 87.7 % of the participants wanted labour analgesia for their next delivery. Conclusion There is a wide gap between the desire for labour analgesia and its availability. Obstetricians and anaesthesiologists have a role to educate the women, and to provide this much desired service.

Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU). There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda.Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU). Comparisons were made usingt-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set atP<0.05.Results. Of 160 patients, 81 (51%) had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium.Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

Background Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. Methods We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis. Results The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036). Conclusions Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis. Trial registration Pan African Clinical Trial Registry PACTR201311000610495. Date of trial registration: 12th August 2013.

Background: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of mortality rates as high as 40% among Ugandan critically ill HIV-negative patients, the use of CD4 T cell counts as a measure of the immune status has never been explored among this population. This study assessed the immune status of adult critically ill HIV-negative patients admitted to Ugandan intensive care units (ICUs) using CD4 T cell count as a surrogate marker.