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Background The advances in diagnostic technology such as the Helical Multi-Detector Computed Tomography (MDCT) have improved the outcome of several diseases, especially in emergencies and children. However, the upsurge in utilization is associated with global unjustified CT procedures, 10-30% of which are performed among children. MDCT imparts relatively high radiation doses with increased risk of radiation induced cancers and wastage of imaging resources. This is a radiation and public health concern in low resource setting especially sub-Saharan Africa, which has a youthful population. Quality improvement in medical imaging requires measuring compliance of imaging-referrers’ ordering practice behavior against an evidence-based tool such as clinical imaging guidelines. To the best of our knowledge, there is paucity of such studies in the sub-Saharan Africa. This study therefore aimed at determining the frequency and proportion of inappropriate requisitions for commonly performed CT examinations among children and young adults. Methods This was a retrospective review for CT requisition forms (CTRFs) for patients aged 35 years and below from 6 hospital-based CT units performed from 1st July 2018 to 31st December 2018. The level of appropriateness for each request was determined using the online Appropriate Use Criteria (AUC)” ESR iGuide Results A total of 931 CTRFs were assessed, 80% of which were head CT scans. Overall, 34.5% CTRFS were inappropriate. Inappropriate Ct requisition was significant associated with the category of hospital, age, non-trauma indication, the anatomical scan region, and the non- use of contrast media agent. A total of 40(4.3%) CTRFs were not categorized because of insufficient clinical information Conclusions The findings show significant levels of performed CT procedures, especially for head region, non-traumatic and non-contrasted among adult patients could be avoided or replaced by procedures that use less or non-ionizing radiation. What is now needed is a pilot study (ies) to investigate causes of inappropriate use of diagnostic imaging and evaluate the effects of some strategies such as education, training and the use of CIGs on such clinical practices in low resource setting

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

Background With funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice. Methods Ten faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula. Results Between April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020. Conclusions To our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, cross-institutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.

BackgroundRecent increases in health professions education (HPE) research in sub-Saharan Africa (SSA), though substantial, have predominantly originated from single institutions and remained uncoordinated. A shared research agenda can guide the implementation of HPE practices to ultimately influence the recruitment and retention of the health workforce. Thus, the authors aimed to generate and prioritise a list of research topics for HPE research (HPER) in SSA.MethodsA modified Delphi process was designed to prioritise a shared agenda. Members of the African Forum for Research and Education in Health (AFREhealth) technical working group (TWG) were asked to first list potential research topics. Then, members of the same TWG and attendees at the annual AFREhealth academic symposium held in Lagos, Nigeria in August 2019 rated the importance of including each topic on a 3-point Likert scale, through two rounds of consensus seeking. Consensus for inclusion was predefined as ≥70% of respondents rating the topic as “must be included.”ResultsHealth professions educators representing a variety of professions and 13 countries responded to the survey rounds. Twenty-three TWG members suggested 26 initial HPER topics; subsequently 90 respondents completed round one, and 51 completed round 2 of the modified Delphi. The final list of 12 research topics which met predetermined consensus criteria were grouped into three categories: (1) creating an enabling environment with sufficient resources and relevant training; (2) enhancing student learning; and (3) identifying and evaluating strategies to improve pedagogical practice.ConclusionsEstablishing research priorities for HPE is important to ensure efficient and appropriate allocation of resources. This study serves as a reminder of how the prevailing context within which HPE, and by implication research in the field, is undertaken will inevitably influence choices about research foci. It further points to a potential advocacy role for research that generates regionally relevant evidence.

Soil-transmitted helminths (STH) have remained a major threat to humans, especially children in developing countries, including Nigeria. Interventions have always been geared towards school-aged children, neglecting preschool-aged children and occupational risk adults. The Soil-Transmitted Helminthiasis Advisory Committee (STHAC) recently suggested incorporating other at-risk groups.

Background Despite evidence of the impact of interprofessional education (IPE) strategies to improve the efficiency and quality of training, few undergraduate health professions education programmes in sub-Saharan Africa have implemented such approaches. Furthermore, few pre-service health professions educational institutions have developed educational interventions that target trainees during the transition between pre-service training and professional practice. We developed HIV-specific, interprofessional, team-based resources to better support trainees during the transition period. Methods Between April 1 and July 31, 2019 ten faculty members representing nine medical and nursing schools in Uganda and South Africa developed a training package focused on core clinical, public health, IPE, and quality improvement (QI) domains related to HIV service delivery. Using small-group learning principles, they developed 17 case-based modules to address a diverse set of HIV-related topics, including, but not limited to, HIV prevention, diagnosis, linkage to care, treatment, and management of opportunistic infections. All modules were aimed at newly, or nearly, qualified health-care professionals, including nurses, doctors, pharmacists, and laboratory scientists and were intended to be taught in workshops that will complement existing institution-specific HIV curricula. Findings Training resources were launched in August, 2019; in the following 6 months, 66 nursing and medical schools and their affiliated training sites in 14 countries in sub-Saharan Africa used the training modules to support interprofessional training for health professionals in training. In the first 6 months of the project, 3500 learners participated in the training. Interpretation Further evaluation of this project and its effects on pedagogical approaches, trainee competencies, as well as wider changes in the organisation and delivery of HIV care, are warranted. The collaborative, interinstitutional, interprofessional approach to curriculum development could provide a benchmark for how best-practice approaches to education can be rapidly disseminated and scaled up across training programmes in Africa. Funding Health Resources and Services Administration, HRSA

The Medical Education Partnership Initiative (MEPI) supports medical education capacity development, retention, and research in Sub-Saharan African institutions. Today, MEPI comprises more than 40 medical schools in Africa and 20 in the United States. Since 2011, the MEPI Coordinating Center, working with the MEPI schools and the U.S. government, has laid the groundwork and served as a catalyst for the creation and development of MEPI "communities of practice" (CoPs). These CoPs encompass seven components, some of which are virtual while others are tangible. They include technical working groups, principal investigator site visit exchanges, an annual symposium, a MEPI journal supplement, the MEPI Web site, newsletters, and webinars. Despite certain challenges and the question of sustainability, the presence within the MEPI network of an organization focused on promoting group consciousness and facilitating collaborative projects is an asset that is likely to continue to pay dividends for the foreseeable future.

A major goal of the Medical Education Partnership Initiative (MEPI) is to improve local health systems by strengthening medical education in Sub-Saharan Africa. A new approach to collaboration was intended to overcome the one-sided nature of many partnerships that often provide more rewards to institutions from wealthy countries than to their Sub-Saharan African counterparts. The benefits of this MEPI approach are reflected in at least five positive outcomes. First, effective partnerships have been developed across a diverse group of MEPI stakeholders. Second, a "community of practice" has been established to continue strengthening medical education in Sub-Saharan Africa. Third, links have been strengthened among MEPI health science schools in Sub-Saharan Africa, their communities, and ministries of both health and education. Fourth, respect among partners in the United States for a culture of ownership and self-determinism among their African counterparts committed to improving education has been enhanced. And finally, performance metrics for strengthening of health science education in Sub-Saharan Africa have been advanced. Meanwhile, partner medical schools in the United States have witnessed the benefits of collaborating across traditional disciplinary boundaries, such as physicians working within highly functioning community-based health care teams with many of the participating schools in Sub-Saharan Africa. MEPI demonstrates that North-South as well as South-South partnerships, with an explicit focus on improving local health systems through better education, can be designed to empower partners in the South with support from collaborators in the North.

Background. Radiographers are increasingly being called on to take on new roles, such as X-ray film interpretation in imaging departments. In Uganda, where this study was conducted, there are just >40 radiologists in a population of ~40 million. In many hospitals, especially in rural areas, clinicians often rely on radiographers to obtain an opinion to assist with proper patient management. Therefore, Ugandan radiographers are being trained in basic radiographic interpretation to address the shortage of radiologists. Objective. To determine the diagnostic accuracy of graduate radiographers in interpreting chest radiographs. Methods. This was a cross-sectional retrospective study involving 57 graduate radiographers who were provided with 53 randomly selected chest radiographs to interpret. The validation of a radiographer’s interpretation of a radiograph was aided by the opinion of two senior radiologists. SPSS version 25 software (IBM Corp, USA) was used to analyse the findings and the radiographer’s performance was assessed using the receiver operating characteristic (ROC). The mean abnormality location sensitivity, overall radiographer sensitivity, specificity and false-positive rates were calculated. Results. The radiographers’ diagnostic accuracy was high. The abnormality location sensitivity was 88.7%, overall sensitivity 76.6%, specificity 79.7% and false-positive rate 20.1%. Conclusion. The study demonstrated that radiographers, if trained, can accurately report on chest radiographs to an acceptable standard.

Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are: 1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively I participate in the education process. 2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes. 3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists. 4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services. 5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions. 6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries. In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

Introduction The Faculty of Medicine, Makerere University is the oldest health professions training institution in East Africa having started in 1924. The radiography degree course started in 2001 and Makerere remains the only institution in the East African region offering this degree course. The faculty adopted a Problem based Learning/Community based education curriculum in order to stimulate students' interests to consider working in rural areas. Attracting and retaining radiographers and other health professionals in rural areas is a recognized problem in Uganda and overseas and strategic actions to enhance the rural health workforce and its ability to deliver the required services are paramount. A range of factors in different domains can be associated with recruitment and retention. By consulting students, some of these factors can be identified and addressed. Methodology It was a descriptive exploratory study involving 31 students. Data was collected through a questionnaire and focus group discussions. Results 58% of the students reported that they would consider rural radiography practice while 42% would not. Key motivational factors cited to work in rural areas were; attractive salaries/incentives, community based training curricular, opportunities for further training and well equipped rural health facilities. Conclusion This study has shown that students would consider working in rural areas provided the working conditions are improved upon.

Human immunodeficiency virus (HIV) is a significant health problem in many developing countries with seroprevalences in the range 5–25%. Ultrasound is the most widely available and affordable method of assessing HIV-related abdominal morbidity. Before antiretroviral therapy is administered, it is imperative that any comorbidity is diagnosed and treated. Awareness of the range of sonographic appearances of abdominal pathology in HIV is important so that a prompt and accurate evaluation can be made. Although ultrasound appearances in HIV vary between different populations and with different grades of immunosuppression, some disease conditions manifest with a characteristic, although not pathognomonic, picture. This aim of this review is to describe the spectrum of ultrasound appearances of the abdominal organs in HIV patients and explain their aetiology.

Background : Curriculum evaluation is key to continuous assurance of quality of education. Objectives: To assess the teachers’ perceptions on how well student teaching and learning activities were conducted at an institution that had practiced PBL for five years. Methods: A cross sectional descriptive study. 150 teachers from 23 departments at the College of Health Sciences participated in the study. A 25 item self-administered questionnaire was used to collect data. Activities evaluated included; students assessment, self-directed learning, feedback and clinical exposure. Data were entered in epi data and analysed using SPSS. Ethical approval was obtained. Results : The participants’ average teaching experience was eight years. The PBL/COBES approach mostly achieved the aim of producing self-directed and lifelong learners. Half of the teaching staff actively provided regular feedback about the learning and teaching activities they were involved in. Early clinical exposure was widely accepted as a highly rewarding appropriate teaching and learning strategy. COBES activities were well organized although involvement of College staff was low. Conclusion : PBL/COBES program was successfully executed and had high acceptance among Faculty. The biggest challenge was getting all staff to provide regular feedback. Self institutional curriculum review can be done cheaply and quickly to provide feedback for continual curriculum improvement. Key words : Problem Based Learning, Evaluation, Curriculum, University

Background African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning. Methods Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These interviews were recorded, transcribed and coded to identify common themes. Results All of the consortia have prioritized efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilize limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalization of collaborative activities. Conclusions The consortia described in this paper demonstrate a paradigm shift in the relationship between medical schools in four African countries. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding that was leveraged to form in-country partnerships has created a culture of collaboration, overriding the history of competition. The positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.

Background: Globally, road traffic accidents are a major cause of death and disability. The developing countries bear a disproportionately large share of the RTAs which account for about 85% of the deaths. Most of these RTAs result in head injury, which globally, most scholars and medical practitioners consider a significant economic, social and medical problem. In Mulago National referral hospital, RTA is the leading cause of surgical admission. Objective: To describe the cranial computed tomography (CT) scan findings in adults following RTA in Mulago hospital. Methods: Using CT, detailed analysis of 178 adult patients with head injury following RTA was performed. Data was analyzed using SPSS version 16 and presented in tables and graphs. Data recorded included socio-demographic characteristics, clinical and CT variables. Results: Seventy seven percent of the respondents were between 18- 39 years. 52.6% of patients had open head injury. Headache was the most common clinical variable followed by dizziness and aphasia. The most common CT characteristic was extra cerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral haemorrhage was commonest in the frontal lobe followed by parietal lobe. Conclusion: Public health interventions like advocacy and education of the population on safe and responsible road usage should be emphasized to reduce on RTAs. Keywords: Computed tomography scan, road traffic accidents, head injury, Uganda

Background Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability. Methods In-depth interviews were conducted with the heads or directors of the four medical education departments using a structured interview protocol developed by the study group. An inductive approach to analysis of the interview transcripts was adopted as the texts were subjected to thematic content analysis. Results Medical education departments, also known as units or centers, were established for a range of reasons including: to support curriculum review, to provide faculty development in Health Professions Education, and to improve scholarship in learning and teaching. The reporting structures of these departments differ in terms of composition and staff numbers. Though the functions of departments do vary, all focus on improving the quality of health professions education. External and internal funding, where available, as well as educational innovations were key enablers for these departments. Challenges included establishing and maintaining the legitimacy of the department, staffing the departments with qualified individuals, and navigating dependence on external funding. All departments seek to expand the scope of their services by offering higher degrees in HPE, providing assistance to other universities in this domain, and developing and maintaining a medical education research agenda. Conclusions The establishment of medical education departments in Sub-Saharan Africa is a strategy medical schools can employ to improve the quality of health professions education. The creation of communities of practice such as has been done by the MEPI project is a good way to expand the network of medical education departments in the region enabling the sharing of lessons learned across the continent.

Background Deep venous thrombosis (DVT) is a major cause of morbidity and mortality among postoperative patients. Its incidence has been reported to range between 16% and 38% among general surgery patients and may be as high as 60% among orthopaedic patients. The most important clinical outcome of DVT is pulmonary embolism, which causes about 10% of hospital deaths. In over 90% of patients, occurrence of DVT is silent and presents no symptoms until onset of pulmonary embolism and/or sudden death. The only effective way of guarding against this fatal condition is therefore prevention/prophylaxis. However, prophylaxis programs are usually based on the estimated prevalence of DVT in that particular community. There is currently no data concerning rates of postoperative DVT in Uganda. The purpose of the study was therefore to determine the prevalence of DVT among postoperative patients at Mulago Uganda’s National Referral Hospital. Methods A cross sectional descriptive study was conducted between March and June 2011. Eligible patients were identified and screened and patient details were collected. Clinical examinations were done on postoperative days (PODs) 1, 2, and 4 and Doppler ultrasounds were done on POD 7 and POD 21 to assess for DVT. Patients found with DVT were treated appropriately according to local treatment guidelines. Results A total of 82 patients were recruited, 4/82 (5%) had DVT. The most common risk factor was cancer. The overall mean age was 45 years (range 20–83 years). The male to female ratio was 1.6:1. Participants with more than one risk factor for DVT were 16/82 (20%). Conclusions Prevalence of DVT among major post-abdominal surgery patients was low (5%). Cancer was the most common associated factor apart from surgery.

Road traffic accidents (RTAs) are a major global public health problem and are now a recognized neglected pandemic. Head injuries cause immediate death in 25% of acute trauma. We conducted this study to determine the immediate outcomes in adult with head injury following RTA. A prospective study was conducted among 178 adult patients and followed up for two weeks to determine immediate outcomes. Multivariate logistic regression analysis was used to determine predictor variables of immediate outcome. Majority had moderate disability (38.2%), then severe disability (25.8%) and good recovery (24.7%) at two weeks. Persistent vegetative state and death occurred in 2% and 9% of patients respectively. Sixty-three percent of patients had favourable outcome. Convulsions, intracerebral haemorrhage had significant p-values at bivariate analysis (0.019, 0.008 respectively) at GCS. Vomiting, convulsions, extra cerebral haemorrhage and intracerebral haemorrhage had significant association P values (0.000, 0.001, 0.000 and 0.000 respectively) at two weeks by GOS. Level of consciousness (p-value = 0.000), intracerebral haemorrhage (p = 0.003), skull fractures (p = 0.001) and surgery (p = 0.016) were statistically significant at multivariate analysis. GCS and GOS were important in assessment of immediate outcomes at 2 weeks but GOS was a more reliable assessment tool.

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.

Background Despite breast abscess becoming less common in developed countries, it has remained one of the leading causes of morbidity in women in developing countries. A randomized controlled trial was conducted at Mulago hospital complex in Kampala Uganda to establish whether ultrasound guided needle aspiration is a feasible alternative treatment option for breast abscesses. Results A total of 65 females with breast abscess were analyzed, of these 33 patients were randomized into the ultrasound guided needle aspiration and 32 patients in the Incision and drainage arm. The mean age was 23.12, most of them were lactating (66.2%), primipararous (44.6%) with peripheral abscesses (73.8%) located in the upper lateral quadrant (56%).The mean breast size was 3.49 cm. The two groups were comparably in demographic characteristic and breast abscess size. Survival analysis showed no difference in breast abscess healing rate between the two groups (Log rank 0.24 df 1 and P = 0.63). Incision and drainage was found to be more costly than ultrasound guided aspiration (cost effective ratio of 2.85). Conclusion Ultrasound guided needle aspiration is therefore a feasible and cost effective treatment option for both lactating and non lactating breast abscesses with a diameter up to 5 cm by ultrasound in an immune competent patient

BACKGROUND: Maternal mortality is related to obstetric complications in pregnancy some of which could be revealed by obstetric sonography. Obstetric sonography has become part of routine antenatal care in both urban and rural settings. The objective of the study was to assess the utilization of obstetric sonography in a rural hospital of Uganda, including the frequency and appropriateness of its usage as well as determine whether there was any relation between number of obstetric scans, patient management and obstetric outcomes. METHODS: It was a retrospective study in which review of all obstetric charts and obstetric scan requisition forms for all deliveries in Ndejje Health Centre (Uganda) was done. RESULTS: During the study period, there were 105 singleton deliveries, and these mothers underwent a total of 232 obstetric scans. More than half (53.4%) of the scans were classified as inappropriate. There were no significant differences in the number of scans between low- and high-risk pregnancies or between uncomplicated deliveries and those in which induction or instrumental or operative delivery occurred, nor was there any relation between number of scans and obstetric outcome. CONCLUSION: Obstetric sonography has become popular in rural health settings as part of antenatal care. However, it was over-used in the health centre. This overuse was not associated with any identifiable effect on obstetric outcome. Therefore, more appropriate use of obstetric sonography, in accordance with evidence-based guidelines, is recommended

Background Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major reform to become a more influential force in society. It is important that its medicine and nursing graduates are equipped to best address the priority health needs of the Ugandan population, as outlined in the government’s Health Sector Strategic Plan (HSSP). The assessment identifies critical gaps in the core competencies of the MakCHS medicine and nursing and ways to overcome them in order to achieve HSSP goals. Methods Documents from the Uganda Ministry of Health were reviewed, and medicine and nursing curricula were analyzed. Nineteen key informant interviews (KII) and seven focus group discussions (FGD) with stakeholders were conducted. The data were manually analyzed for emerging themes and sub-themes. The study team subsequently used the checklists to create matrices summarizing the findings from the KIIs, FGDs, and curricula analysis. Validation of findings was done by triangulating information from the different data collection methods. Results The core competencies that medicine and nursing students are expected to achieve by the end of their education were outlined for both programs. The curricula are in the process of reform towards competency-based education, and on the surface, are well aligned with the strategic needs of the country. But implementation is inadequate, and can be changed: • Learning objectives need to be more applicable to achieving competencies. • Learning experiences need to be more relevant for competencies and setting in which students will work after graduation (i.e. not just clinical care in a tertiary care facility). • Student evaluation needs to be better designed for assessing these competencies. Conclusion MakCHS has made a significant attempt to produce relevant, competent nursing and medicine graduates to meet the community needs. Ways to make them more effective though deliberate efforts to apply a competency-based education are possible.

In 2003, the College of Health Sciences, Makerere University, changed its curriculum from a traditional one to a student-centred problem-based/community-based type for all undergraduate students. Since then, radiography students have been using a logbook to record their learning experiences. However, the logbook shows only a daily record of numbers of examinations done, with neither increased understanding nor reflection. The purpose of this study was to assess the effectiveness of a student portfolio as a tool for showing evidence of learning and devise a practical portfolio assessment strategy.This was a descriptive cross-sectional study involving both radiography students and teachers. Self-administered questionnaires and focus group discussions were used to collect information on portfolios. SPSS was used for quantitative data and chi-square to test significance and also multivariate analysis. For qualitative data, thematic analysis was used.Initially, the students did not know about portfolios. Only 33.3% of the teachers competently knew about them. There was general confusion between a portfolio and a logbook. After implementation, respondents said that the student learning experiences were now evident through the portfolio work. We discovered that assessing the entire portfolio content was not practical, but rather assessing few selected items using an oral interview was more feasible and sustainable.With portfolios, students reflect on what they learn, which is not possible with a logbook only. Carefully selecting manageable portfolio content and assessing the portfolio work are the major factors that can sustain the process.

Rationale and Objectives The objectives of this article are: To explore the impact of the Radiological Society of North America–sponsored “Teach the Teachers” training course and other capacity building interventions (CBIs) on Uganda's ultrasound (US) training capacity; compare performance of students undertaking a modular diploma ultrasound course to the non-modular; and compare performance among various health cadres undertaking US training. Materials and Methods The impact of the “Teach the Teachers” training course and other capacity building interventions were evaluated through analysis of the planning, implementation, sustainability, and output of the training center. Comparison of students' performance in the modular and non-modular diploma courses was by a retrospective cohort methodology using odds ratios. Comparison of performance was by analyzing their mean test scores using a paired Student t -test. Results To date, 306 students from nine African countries have successfully completed the US diploma training. Fifty (16%) are non-Ugandans. The non-modular cohort has performed better than the modular (OR = 3.2) in the final written examination. The mean test scores for the final written examinations were: 73.4%, 71.9%, 61.2%, and 57% for the doctors, radiographers, assistant physicians, and nurses/midwives, respectively. Conclusion The Radiological Society of North America–sponsored “Teach the Teacher's course in US” together with other capacity building interventions have led to an established center of excellence for US training in Uganda.

INTRODUCTION The Faculty of Medicine, Makerere University, is the oldest health professionals' training institution in East Africa. It has been training health professionals since 1924. In 2001, a bachelors degree in radiography commenced. After a curriculum review, the university's longstanding traditional curriculum was converted to a problem based learning curriculum with a focus on Community Based Education and Service (COBES). As a component of COBES, radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities. This study was designed to obtain radiography teachers' and students' opinions of the significance and relevance of this community based training to radiography training. METHODS Cross-sectional descriptive study. RESULTS Both students and teachers (91.4%) affirmed the community training to be significant and relevant to radiography training. In total, 71.4% of the students had participated in X-ray services and 39.2% in ultrasound services during COBES; and 68.6% of the students reported the need to be better prepared for the COBES training. CONCLUSION Both students and teachers confirmed COBES to be relevant to Ugandan radiography training.

Hysterosalpingography (HSG) is still a commonly used investigation in the evaluation of the female genital tract and the main indication for HSG is infertility.The purpose of this study was to find the pathology detected at HSG in patients with infertility in our setting.A retrospective review of 289 consecutive patients who underwent hysterosalpingography using ionic water-soluble contrast media was done at 2 private x-ray units in Kampala. Clinical notes and radiological findings were analysed for demographic data, uterine status, tubal and pelvic pathology.The commonest age group seen was 26-30 yrs. Most were of low parity. Secondary infertility was commoner than primary infertility. Abnormal findings at hysterosalpingography were found in 83.4%. The commonest finding was tubal blockage.The commonest pathology found on HSG in women presenting with infertility in Kampala is tubal blockage possibly secondary to chronic pelvic inflammation. The fact that secondary infertility is common points to pelvic infection complicating mismanaged pregnancies, septic abortions or sexually transmitted infections. A study to establish associated factors is recommended.

Diverticular disease of the colon has been reported to be a disease of the western world, however of recent it has been described in the Africans.To study the clinical, demographic and radiological features of diverticular disease of the colon in Kampala, Uganda.A retrospective and prospective descriptive study was carried out between January 1995-December 1996 and January 1998-December 2000. The period January 1995-December 1996 was retrospective while January 1998-December 2000 was prospective. Thirty one consecutive patients were found to have diverticular disease of the colon at barium enema studies in two major hospitals and two private x-ray units in Kampala, Uganda.Thirty-one patients were seen during the study period; all were over 40 years of age. The commonest presenting complaint was rectal bleeding in 13 patients followed by abdominal pain in 12 patients. Most patients were found to eat a mixed type of diet, that is both low and high residue food. Radiologically the diverticulae appeared as flask shaped or rounded outpouchings at barium enema. This would sometimes be accompanied by a serrated appearance of the affected area. The commonest site affected was the sigmoid colon followed by the ascending colon.Although it was previously reported that diverticular disease was unknown in black Africans, it has been noted that cases are now being increasingly discovered. It is recommended that our index of suspicious for diverticular disease of the colon and its complications should also increase.

Background Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country's health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap.

Uganda, like the rest of Africa, is faced with serious health challenges including human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), other infectious diseases and increasing non-communicable diseases, yet it has a significant shortage of health workers. Even the few health workers available may lack desired competencies required to address current and future health challenges. Reducing Uganda's disease burden and addressing health challenges requires Ugandan medical schools to produce health workers with the necessary competencies. This study describes the process which a consortium of Ugandan medical schools and the Medical Education Partnership for Equitable Services to all Ugandans (MESAU) undertook to define the required competencies of graduating doctors in Uganda and implement competency-based medical education (CBME).A retrospective qualitative study was conducted in which document analysis was used to collect data employing pre-defined checklists, in a desktop or secondary review of various documents. These included reports of MESAU meetings and workshops, reports from individual institutions as well as medical undergraduate curricula of the different institutions. Thematic analysis was used to extract patterns from the collected data.MESAU initiated the process of developing competencies for medical graduates in 2011 using a participatory approach of all stakeholders. The process involved consultative deliberations to identify priority health needs of Uganda and develop competencies to address these needs. Nine competence domain areas were collaboratively identified and agreed upon, and competencies developed in these domains.Key successes from the process include institutional collaboration, faculty development in CBME and initiating the implementation of CBME. The consortium approach strengthened institutional collaboration that led to the development of common competencies desired of all medical graduates to address priority health challenges in Uganda. It is important that the MESAU consortium continues engaging all stakeholders in medical education to support the implementation and sustainability of CBME in Uganda.

The Medical Education Partnership Initiative (MEPI) is a $US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals.We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs.There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services.The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent.

Objectives: The first objective of the study was to develop an index termed as the ‘Imaging Coverage’ (IC), for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU) would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems’ performances. Results: The IC developed and tested as an index for the imaging system′s performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the highest for general radiography followed by ultrasound. Conclusion: The IC for the five selected hospitals was 36% and the HBU was 186 per thousand, reflecting low performance levels, largely attributable to inadequate funding. There were shortfalls in imaging requisitions and inefficiencies in the imaging systems, financing, and health policy. Although the proportion of inappropriate imaging was small, reducing this inappropriateness even further would lead to a significant total saving, which could be channeled into investigating more patients. Financial resources stood out as the major limitation in attaining the desired performance and there is a need to increase budget funding so as to improve the performance of the imaging health systems.

Objectives: Uganda, has limited health resources and improving performance of personnel involved in imaging is necessary for efficiency. The objectives of the study were to develop and pilot imaging user performance indices, document non-tangible aspects of performance, and propose ways of improving performance. Materials and Methods: This was a cross-sectional survey employing triangulation methodology, conducted in Mulago National Referral Hospital over a period of 3 years from 2005 to 2008. The qualitative study used in-depth interviews, focus group discussions, and self-administered questionnaires, to explore clinicians’ and radiologists’ performancerelated views. Results: The study came up with following indices: appropriate service utilization (ASU), appropriateness of clinician's nonimaging decisions (ANID), and clinical utilization of imaging results (CUI). The ASU, ANID, and CUI were: 94%, 80%, and 97%, respectively. The clinician's requisitioning validity was high (positive likelihood ratio of 10.6) contrasting with a poor validity for detecting those patients not needing imaging (negative likelihood ratio of 0.16). Some requisitions were inappropriate and some requisition and reports lacked detail, clarity, and precision. Conclusion: Clinicians perform well at imaging requisition-decisions but there are issues in imaging requisitioning and reporting that need to be addressed to improve performance.