Predictive value of alarm features in diagnosing upper gastrointestinal malignancies among dyspeptic patients:A cross-sectional study in Ethiopia

Objective:The study aimed to determine the overall predictive value of alarm features in diagnosing upper Gastrointestinal(GI)malignancies and significant endoscopic findings among patients undergoing elective Esophagogastroduodenoscopy(EGD)at Tikur Anbessa Special Hospital(TASH)and Adera Medical Centre(AMC).Methods:It was an institution-based cross-sectional study conducted on patients undergoing elective endoscopy for an upper GI complaint from July to September 2022.Data was collected from patient charts,and biopsies were taken for histologic confirmation.The study assessed the association of alarm symptoms and signs with significant upper gastrointestinal(UGI)endoscopic findings and malignancies.Results:142 patients were selected,with an average age of 48.35 and 52.1% being male.Epigastric pain was the most common reason for an endoscopy.62% of patients had at least one alarm feature,the most common being unexplained weight loss and UGI bleeding.The study found a strong association between the presence of alarm features,significant endoscopic findings,and UGI malignancies.The pooled sensitivity and specificity of any alarm feature for any significant finding were 79% and 64.9%,respectively,and for malignancy,100% and 39.7%,respectively.The presence of the alarm feature was associated with an increase of 6.801 in the odds of developing SEF and an increase of 4.199 in the odds of developing malignancy.Conclusions:UGI alarm symptoms and signs like an abdominal mass,persistent vomiting,dysphagia,and UGI bleeding are predictive of significant endoscopic findings and malignancies.Hence,EGD should be done and suspicious lesions should be biopsied early,regardless of gender,age,or duration of symptoms.

In-vitro antimicrobial activity screening of some ethnoveterinary medicinal plants traditionally used against mastitis,wound and gastrointestinal tract complication in Tigray Region,Ethiopia

Objective:To screen the antibacterial activity of nine ethnoveterinary plants traditionally used for the treatment of mastitis,wound and gastrointestinal complications.Methods:Hydroalcoholic exctracts of medicinal plants namely,Achyranthes aspera(A.aspera) L.(Family Asparagaceae),Ficus caria(F.caria)(Family Moraceae).Malvi parviflora(M.parviflora)(Family Malvaceae),Vernonia species(V.species) docal name Alakit.Family Asteraceae),Solatium hastifolium(S.hastifolium)(Family Solanaceae),Calpurinia aurea(C.aurea)(Ait) Benth(Family Fabaceae),Nicotiana tabacum(N.tabacum) L.(Family Solanaceae),Ziziphus spina-christi(Z.spina-christi)(Family Rhamnaceae).Croton macroslachys(C.macrostachys)(Family Fuphorhiaceae).were screened against clinical bacterial isolates of veterinary importance from October 2007 to April2009.The antibacterial activity was tested using disc diffusion at two concentrations(200 mg/mL and 100 mg/mL) and broth dilution methods using 70%methanol macerated leal extracts.Results:With the exception ol S.hastifolium all plant extracts exhibited antibacterial activity.Among the medicinal plants tested C.aurea.C.macrostachyus,A.aspera,N.tabacum and vcrnonia species(Alakit) showed the most promising antimicrobial properties.Conclusions:It can be concluded that many of the tested plants have antibacterial activity and supports the traditional usage of the plants for mastitis,wound and gastrointestinal complications treatment.Further studies into their toxicity and phytochemistry is advocated.

Antibiotics/antibacterial drug use, their marketing and promotion during the post-antibiotic golden age and their role in emergence of bacterial resistance

During the post-antibiotic golden age, it has seen a massive antibiotic/antibacterial production and an increase in irrational use of these few existing drugs in the medical and veterinary practice, food industries, tissue cultures, agriculture and commercial ethanol production globally. The irrational drug use has been further exacerbated by the increased marketing and promotion of these drugs by the pharmaceutical companies thus increasing their accessibility in the public and hence their improper use. The lack of production and introduction of the newer and effective antibiotic/antibacterial drugs in clinical practice in the post-antibiotic golden age has seen an increase in the emergence of the resistant pathogenic bacterial infections creating a significant problem in the global health of humankind. The massive productions of the antibiotic/antibacterial drugs have contributed to the poor disposal of these drugs and hence many of them are discharged in various water bodies contributing to the environmental antibiotic/antibacterial drug pollution. In the environment, these drugs exert pressure on the environmental bacteria by destroying useful bacteria that are responsible for the recycling of the organic matter and as well as promoting the selection of the resistant pathogenic bacteria that can spread in human and animal population thus causing an increase in the observed bacterial disease burden and hence a significant global public health problem. The resistant bacterial diseases lead to the high cost, increased occurrence of adverse drug reactions, prolonged hospitalization, the exposure to the second- and third-line drugs like in MDR-TB and XDR-TB that leads to toxicity and deaths as well as the increased poor production in agriculture and animal industry and commercial ethanol production.

Age-related changes of the corticospinal tract in the human brain A diffusion tensor imaging study

The corticospinal tract （CST） is one of the most important neural tracts for motor function in the human brain. Little is known about age-related changes of the CST. tn this study, we tried to evaluate age-related changes of the CST using diffusion tensor imaging in 60 healthy subjects. The diffusion tensor imaging result revealed that the tract number and fractional anisotropy value were decreased, and the apparent diffusion coefficient （ADC） value was increased with aging. The distribution showed a semilog pattern for tract number, fractional anisotropy and ADC of the CST, and the pattern of each graph was near-linear. When compared with the diffusion tensor imaging parameters of subjects in the 20 s age group, tract number and fractional anisotropy values were significantly decreased in the 50 s-70 s age groups. Likewise, the ADC value was significantly higher in the 50 s-70 s age groups. The CST in the brain of normal subjects degenerated continuously from the 20 s to the 70 s, with a near-linear pattern, and degeneration of the CST began to manifest significantly in the subjects in their 50 s, compared with the subjects in their 20 s.

Effect of Exercise Program on the Rehabilitation of Patients with Cervical Spondylotic Myelopathy

Study Design: A clinical trial of 30 consecutive patients with cervical spondylotic myelopathy (CSM). Objectives: To evaluate the effect of directed physical exercise in patients with CSM and to measure severity of myelopathy before and after an exercise program. Setting: Christian Medical College and Hospital, India. Participants: Thirty patients with CSM (mean age-54.1 years) with Nuricks Grade 2 and 3. Background: Myelopathy of the spinal cord can be caused by degenerative process of the cervical vertebrae and it is the most common type of dysfunction of the spinal cord in adult population. CSM usually develops insidiously and the natural history is not well understood, there is debate over the indication for operative Vs non operative management. Method: Patients participated in a 6-week exercise program, consisting of active exercises to upper and lower extremities, scapulothoracic muscles, and gentle stretches, sub maximal isometric exercises of the deep neck flexors, relaxation and immobilization with a cervical collar. Main Outcome Measures: The mJOA (modified Japanese orthopaedic association score) and ASIA motor and sensory scoring. The results were processed by using Wilcoxon sign rank test. Results: After comparing the values at the beginning and end of the program a satisfactory neurological result (sensorimotor/motor and sensory) was obtained in all thirty patients. Conclusion: The exercise program had a positive impact for most of the variables of the study. Exercise intervention with neck immobilization may be a treatment of choice in early stages of CSM. Future randomized controlled studies would provide insight into the effectiveness and clinical relevance of this intervention.

Knowledge, Attitudes and Perceptions of Secondary School Teenagers towards HIV Transmission and Prevention in Rural and Urban Areas of Central Uganda

HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly;weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.

Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review

Irrational antibiotics/antibacterial (AB) drug use is a global problem, especially in developing countries. This results in an increased emergence of resistance to most common bacteria, higher cost of treatment, prolonged hospitalization and adverse drug reactions. Interventions measures have been instituted to avert the problem but it still persists. A systematic review was conducted to determine the effect of different interventions (education, managerial, diagnostic tests, regulatory, economic and multifaceted) on misuse of AB drugs in developing countries. A total of 722 articles were retrieved and 55 were reviewed. About 10.9% of the studies were from Africa, 63.6% from Asia, 9.1% from Latin America, and 16.4% from Southeastern Europe. A total of 52.7% of the studies were from hospital settings, 5.5% from outpatient departments, 21.8% were from public health care facilities, 12.7% from private pharmacies/drug stores, and 7.3% from the communities. Education intervention had 27.3% studies, managerial had 20%, managerial/education had 3.6%, regulatory had 9.1%, education/regulation had 9.1% and diagnostic had 3.6% studies. Multifaceted intervention had 27.3% studies, with 63% improvement in appropriate AB doses prescribed, 2.6% mean number of AB encounter reduction, 23% AB prescription reduction, 18.3% generic AB prescription improvement, 32.1% reduction in AB use, 89% reduction in AB use in acute respiratory infection, 82% in surgery, 62.7% mean reduction in deliveries, 39% in STDs, 36.3% mean reduction in diarrhea, 14.6% mean reduction AB use in malaria, and 6%-11% in the cost of treating bacteria-resistant organisms. Also noted was 6.3% reductions in mean AB encounters after 1 month of intervention, and then increased to 7.7% after 3 months thus lacking sustainability. Multifaceted interventions were effective in reducing irrational AB drug use in the various health facilities and communities as well as reduction in the emergence of resistance to the commonest bacteria in the developing countries though there was lack of sustainability or continuity of rational drug use over the time.

Toxicity Profile of Karuho Poison on the Brain of Wistar Albino Rats

Various forms of Karuho poisoning are a common traditional mystery and a public health challenge in Goma city, North Kivu in DRC practiced by unscrupulous people. Its signs and symptoms are commonly mistaken by local communities and medical world with those of tuberculosis, HIV/AIDS and typhoid fever;with neurological and psychological symptoms. Study investigated sub-acute toxicity of Karuho poison on brain of Wistar albino rats. Laboratory based experimental study was conducted at Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences. A total of 4 Karuho poisons (OMGKRP, DLNKRP, CHKRP and BHKRP) were screened for acute and sub-acute toxicity. Fifty animals, 10 in each group were daily dosed for 28 days with 1 mg, 5 mg, 20 mg and 5000 mg/kg bwt of OMGKRP (most active following screening) and normal saline for control group using OECD 407 and NIH 2011 guidelines. Behavioral changes were noted. Histopathological changes in brain regions were analyzed. Treated rats by OMGKRP, most active Karuho poison, were associated with sign of depression, piloerection and shortness of breath. Histopathological changes revealed moderate diffuse congestion and mononuclear inflammatory cells infiltration (plasma cells, lymphocytes and macrophage) in cerebral region with severe inflammation observed in meninges of cerebellum. OMGKRP poison induced inflammation of meninges of cerebellar region of brain.

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

Study Objective: Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employment by anesthesia providers, and describe various deployment facilitators described in current literature. Measurements: An exhaustive literature review of the databases Medline, CINAHL, Cochrane Collaboration, Scopus, and Google Scholar was performed applying the search terms “gastric tube”, “complications”, “decompression”, “blind insertion”, “perioperative”, “intraoperative” in various order sequences. A five-year limit was applied to limit the number and timeliness of articles selected. Main Results: Patients are exposed to potentially serious morbidity and mortality from blindly inserted gastric tubes. Risk factors associated with malposition include blind insertion, the presence of endotracheal tubes, altered sensorium, and previous tube misplacements. Pulmonary aspiration risk prevention remains the only indication for anesthesia-related intraoperative use. There are no singularly effective tools that predict or verify the proper placement of blindly inserted gastric tubes. Current placement facilitation techniques are perpetuated through anecdotal experience and technique variability warrants further study. Conclusion: In the absence of aspiration risk factors or the need for surgical decompression in ASA classification I & II patients, a moratorium should be instituted on the elective use of gastric tubes.

In vitro vasodilatory effect of aqueous leaf extract of Thymus serrulatus on thoracic aorta of Guinea pigs

Objective:To investigate the vasodilatory effecl of Thymus serrulatus(T.serrulatus) aqueous leaf extract on KCl(high K^+.80 mmol/L) induced precontracted isolated thoracic aorta rings on guinea pigs and the role of aorta endothelium on this action.Methods:Guinea pig thoracic aorta was removed and placed in an organ bath containing Krebs-Henseleit solution and aorta contractions were recorded isometrically.Results:The results revealed that T.serrulalus aqueous leaf extract(0.5-5 mg/mL)significantly(P<0.001) reduced KCl-induced contractions of guinea pig thoracic aorta in both intact(n=5) and denuded(n=5) endothelium in a concentration dependent manner,and the vasodilatory effect of the extract on intact endothelium was significantly(P<0.05) higher than that on denuded endothelium.Glibenclamide(10 μmol/L) significantly(P<0.001) increased the vasodilatory effect of extract in intact endothelium as compared to methylene blue(10μmol/L).atropine(10 μmol/L) and indomethacin(10 μmol/L).The effecl was more obvious on intact than that on denuded endothelium.Conclusions:The present findings demonstrate that T.serrulalus aqueous leaf extract has vasodilator)' activity which might result in antihypertensive effect and its vasodilatory effect is endothelium-dependent.This might support the traditional claim of the plant in hypertensive.

Hematology and blood serum chemistry reference intervals for children in Iganga district of Uganda

In this study, normal ranges for hematology and serum biochemistry in children aged 1 to 5 years inUgandawere determined. By a cross-sectional study, 1168 children from Iganga, a prospective site for clinical trials in Uganda, were screened. From 1168 households, 460 children were selected for enrollment, while 600 (58%) were excluded because of either a history of fever in the previous 24 hours, presence of asexual malaria parasites in the peripheral blood or presence of fever. Accordingly, 460 children (39.4%) of median age = 3 years were enrolled in the baseline study. While the lower limits of hemoglobin, hematocrit levels, mean corpuscular volume and platelet counts for the Ugandan children were found to be less than conventional reference values of Caucasisan children, the white blood cell count reference values were higher than the international intervals. On the other hand, the upper limits of the reference intervals for serum transaminases, bilirubin, creatinine, urea, total protein and albumin in sera of the Ugandan children were higher than the corresponding values for a Caucasian pediatric population. This study showed that, if hematology test results of the Ugandan children were assessed against “imported” international reference values, up to 44.6% of the study participants would have been excluded from clinical trials or would have been reported as adverse events in such trials. The present study was not only the first report of serum biochemistry reference ranges for children aged one to five years in Uganda but also one of very few such studies in Africa.

Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda

Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing coun-tries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda;these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization.

Effect of taping as a component of conservative treatment for subacromial impingement syndrome

Subacromial impingement syndrome (SIS) has been described as the most common form of shoulder pathology argued that 100% of impingement lesions and 95% of rotator cuff pathology are caused by friction between the acromion and surrounding tissues within the subacromial space. Commonly, rest, Non-steroidal anti-inflammatory drugs (NSAIDS), corticosteroid injections, and mobilization, strengthening exercises will resolve most cases of SIS. The results of the long-term outcome of these treatments, however, are not promising. Purpose: This study focuses on the effect of scapular taping and conventional Physical therapy in increasing isometric muscle strength, decreasing pain, improving function in patients with subacromial impingement syndrome. Study design: Double blinded randomised controlled clinical trial. Subjects were assessed by a blinded researcher using standard physiotherapy measures, Shoulder Pain and Disability Index questionnaire (SPADI), and isometric muscle strength measured using digital dynamo meter. Methodology: The patients in the treatment group (scapular taping group) received scapular taping with conventional exercises and the control group (no scapula taping) group received conventional exercise. Result: When comparing the scores using unpaired t-test with P value set at <0.05, high level of significance was noted for flexor, abductor, external rotator muscle force and SPADI. Conclusion: Scapular taping may be a useful adjunct for promoting proper scapular kinetics & upper thoracic extension and should be used in conjunction with other interventions.

Ever Use of Modern Contraceptive among Adolescents in Uganda: A Cross-Sectional Survey of Sociodemographic Factors

Background: Six in ten sexually active adolescent women in Uganda have an unmet need for contraception yet there is limited data on what is driving its use. This study aimed to determine the associations between sociodemographic factors and modern contraceptive ever-use among adolescents in Uganda. Methods: A crossectional study was conducted among 337 adolescents aged 13 - 19 years who had ever had sex in Wakiso (urban) and Kamuli (rural) districts in Uganda. The outcome of interest was the ever-use of modern contraceptives. Generalized linear models with a Poisson link were used to examine the associations between sociodemographic factors and contraceptive ever use. Results: The weighted prevalence of ever-use of modern contraceptives was 30.9%. Contraceptive ever use was more likely among the older adolescents (adjusted Odds Ratio) aOR 1.31 (95% CI = 1.06 - 1.55), married aOR 1.67 (95% CI = 1.09 - 2.58) and the less educated were aOR 1.79 (95% CI = 1.14 - 2.83) compared to their counterparts. Adolescents living in the urban district (Wakiso) aOR 0.67 (95% CI = 0.49 - 0.92) were less likely to use modern contraceptives. In stratified analysis, the urban poor were more likely to use modern contraceptives (moderate aPR 0.35 95%CI (0.17 - 0.68) ** or high socioeconomic status aPR 0.62, 95%CI (0.28 - 1.37). Conclusions: The study shows low contraceptive ever-use among adolescents. Adolescents with low education and those from rural settings were more likely to ever-use modern contraceptives. Having good knowledge of contraception and discussing sex with parents promoted contraceptives ever-use. We recommend further studies assessing barriers to contraceptive use among adolescents in Uganda.

Prevalence of kala-azar infection in Pokot county, Amudat district, Northeastern Uganda

Introduction: Visceral leishmaniasis (kala-azar) caused by Leishmania donovani and transmitted by the sand-fly Phlebotomus martini is endemic in certain foci in north-eastern Uganda where it is thought to be confined to Pokot county, Amudat district. Amudat hospital records (April 1998-March 1999) indicated that kala-azar accounted for about 17% of hospital in-patients. However the actual prevalence of kala-azar infection in the community in Pokot county is unknown. This lack of information limits efforts geared towards its control. Objective: To determine the prevalence of kala-azar infection in Pokot county. Methods: A cross-sectional study was conducted in Pokot county in March 2010. The study participants were ≥ 5 years and were randomly selected from the age and sex strata in the chosen clusters. A questionnaire that elicited demographic profiles of participants was used for data collection. Standard procedure for direct agglutination test using blood samples collected from participants on blotting papers was performed. Data was entered in EPIINFO 3.3 and exported to STATA 10, where descriptive statistics were generated. Results: The overall prevalence of kala-azar infection in Pokot county was 17.2% but the prevalence of symptomatic infection in the community was 2.5%. The ratio of symptomatic to asymptomatic kala-azar was 1:6. Loroo sub-county had the highest prevalence of kala-azar infection followed by Karita and Amudat sub-counties at 31.9%, 14.6% and 5.3%, respectively. Conclusion: With kala-azar infection prevalence at 17.2% in the community, there is an urgent need to institute control program spearheaded by ministry of health, in the region. Furthermore, recent reports of cases from other districts within the region, the heterogeneous distribution of infection within the county and the current risk factors, including the role of animals in kala-azar transmission in this area need to be evaluated.

Post Abortion Women’s Perceptions of Utilizing Long Acting Reversible Contraceptive Methods in Uganda. A Qualitative Study

Background: About one-third of all pregnancies that occur in low income countries are unintended. An estimated 1.2 million unwanted pregnancies occur in Uganda annually. The majority of the unwanted pregnancies end in unsafe abortion which is one of the five direct causes of maternal mortality. Abortion related complications are responsible for 26% of all maternal deaths in Uganda. Abortion complications can be avoided if women appropriately use contraception to avoid unwanted pregnancy. However, in Uganda the contraceptive prevalence is low at 30% and less than 4% of women rely on long acting reversible contraceptives. Aim: We aimed to explore post-abortion women’s perceptions of using of long acting reversible contraception (LARC). Methods: A qualitative research design was used for data collection and analysis. Thirty in-depth interviews with post abortion women in Mulago hospital were carried out using an interview guide. Interviews were transcribed and coded using nodes and subsequently through query, we derived themes. Results: Emergent themes regarding women perceptions of using LARC methods were myths and misinformation, fear of side effects, women’s lived experiences, relatives’ influence, health providers’ perceptions, lack of knowledge and women desire for spacing children for a long time. Conclusion and recommendations: The majority of women were skeptical about using LARC. There is a need to educate women to dispel myths, misinformation and quality counseling to address the benefits and side effects of LARC. There is also a need to revamp the knowledge and skills of the healthcare providers regarding LARC methods.

Analgesic and Anti-Inflammatory Activity of Total Crude Leaf Extract of <i>Phytolacca dodecandra</i>in Wistar Albino Rats

Background: Pain is a common problem encountered in daily life among humans and animal and it is commonly managed conventionally using modern medicines and traditionally by use of medicinal plants. Phytolacca dodecandra is a common herb in Uganda, used traditionally to alleviate pain and inflammatory conditions. However, its activity in alleviating pain and inflammatory diseases has not been fully scientifically evaluated. Aim of Study: To evaluate the analgesic and anti-inflammatory activity of total crude leaf extracts of P. dodecandra in Wistar albino rats. Materials and Methods: It was a laboratory-based experimental study. Acetic acid-induced writhing test was used to determine the analgesic activity and the histamine-induced paw edema formation for anti-inflammatory activity of the extract. Twenty eight animals were divided into 7 groups each with 4 rats and two (2) sets of data were obtained from each animal per group as per guidance of the refinement rule of 3Rs. For analgesic activity, Group I was dosed with 1.0ml of normal saline (negative control), group II, III, IV, V, VI were dosed with 1000.0, 600.0, 150.0, 40.0 and 5.0 mg/kg bwt of extract respectively. Group VII was dosed 10.0 mg/kg bwt diclofenac sodium (Na) drug (positive control). For anti-inflammatory activity, Group I was dosed with 1.0ml of normal saline (negative control), Group II, III, IV, V, VI were dosed with 1000.0, 600.0, 300.0, 40.0 and 5.0 mg/kg bwt of extract respectively. Group VII was dosed 10.0 mg/kg bwt diclofenac Na. The percentage mean paw volume inhibition and percentage writhing protection were determined. Results: The mean percentage paw volume inhibitions were 29.1%, 74.2% and 32.3% at doses of 5.0, 40.0 mg/kg bwt and 10.0 mg/kg bwt diclofenac Na respectively. The mean percentage writhing protection was 8.9%, 10.4%, 78.5% and 98.7% at doses of 150.0, 600.0, 1000.0 mg/kg of extract and 10.0 mg/kg bwt diclofenac Na respectively. Conclusions: Total crude leaf extracts of P. dodecandra has analgesic and anti-inflammatory activity that may be attributed to the presence of polyphenolic, saponins and many others phytochemicals that are present in the plant.

Quality of Sputum Specimen Samples Submitted for Culture and Drug Susceptibility Testing at the National Tuberculosis Reference Laboratory-Uganda, July-October 2013

Setting: The Uganda National Tuberculosis Reference Laboratory (NTRL) in Kampala. Objective: The proportion of poor quality specimens received for drug susceptibility testing (DST) at the NTRL and factors contributing to poor specimen quality were assessed. Design: A cross-sectional study was conducted of sputum samples received at the NTRL from patients at high risk for multi-drug-resistant tuberculosis (MDR TB) during July-October 2013. Demographic, clinical, and bacte-riological data were abstracted from laboratory records. A poor quality sample failed to meet any one of four criteria: ≥3 milliliter (ml) volume, delivered within 72 hours, triple packaged, and non-salivary appearance. Results: Overall, 365 (64%) of 556 samples were of poor quality;89 (16%) were not triple packaged, 44 (8%) were <3 mls, 164 (30%) were not delivered on time, and 215 (39%) were salivary in appearance. Poor quality specimens were more likely to be collected during the eighth month of TB treatment (OR = 2.5, CI = 1.2 - 5.1), from the East or Northeast zones (OR = 2.2, CI = 1.1 - 4.8), and from patients who previously defaulted from treatment (OR = 1.9, CI = 1.1 - 3.2). Conclusion: The majority of sputum samples had poor quality. Additional efforts are needed to improve quality of samples collected at the end of treatment, from East and Northeast zones, and from patients who had previously defaulted.

COVID-19 and HIV Treatment Interruption: A Case Study of the AIDS Support Organization (TASO) Mbale Clinic

Introduction: COVID-19 pandemic caught many HIV programs completely unprepared, leading to massive interruptions in HIV treatment. Fear and anxiety caused by another infectious and potentially deadly virus kept many PLHIV away from accessing ART services. Besides, the COVID-19 control measures imposed by the Government of Uganda, such as restrictions on movement due to the ban on both private and public transport, shortened travel hours due to the curfew imposed from 7 p.m. local time and limited resources at The AIDS Support Organization (TASO) Mbale clinic further frustrated access to ART services. The actual burden of treatment interruption in Uganda remains unclear. As such, this paper provides the magnitude of treatment interruption in TASO Mbale clinic during the April-June 2020 quarter—the COVID-19 pandemic peak period in Uganda. Methodology: We analyzed secondary and routine program data for all PLHIV on scheduled appointment in the quarters of January-March 2020 and April 2020-June 2020. We abstracted data from Uganda Electronic Medical Records (EMR) and linked with that from TASO Management Information system to make one dataset. This was then exported for final analysis in STATA version 15. Results: Out of 6744 PLHIV scheduled on appointment during April-June 2020 quarter, 1710 (25.3%) individuals missed their appointments, with the facility-based clients more affected than community-based (56.1% vs 43.9%) (p < 0.001), individuals with up-to-date viral load (VL) status were less likely to miss their appointment (p < 0.001) while sex was not associated with missed appointment (p-value = 0.269). Overall, there was a 356% increase in rate of missed appointment compared with that of January-March 2020 quarter (25.3% vs 7.1%) before COVID-19 pandemic hit Uganda. Moreover, PLHIV who received six-month’s drug refills were less likely to miss their appointment (p < 0.001) compared to those who received less. Conclusions: The COVID-19 pandemic significantly disrupted provision of ART services, leading to increased rate of missed appointment from 7.1% in the pre-COVID-19 quarter to 25.3%.

Surgical Site Infection Prevention Practices and Associated Factors among Nurses Working in Government Hospitals of Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia

背景:手术部位感染是可预防的医院获得性感染中最常见的类型,其不良的手术结果与发病率,死亡率,住院时间,再入院和费用增加有关。预防手术部位感染是提供最佳护理的最重要挑战之一。研究表明,护士预防手术部位感染的方法未得到很好的解决。此外,在非洲包括研究地区显然缺乏研究。目的:本研究的目的是评估2019年3月1日至28日在埃塞俄比亚东部哈拉里地区州政府和迪里达瓦市政府的政府医院工作的护士的手术部位感染预防措施及相关因素。方法和材料:共515名护士参与机构的横断面研究设计。使用简单的随机抽样方法来选择研究参与者。使用通过观察补充的预先测试的结构化自我管理调查表收集数据。使用Epi-data 3.1版检查,编码,输入和清除数据,然后将其导出到SPSS 20版进行分析。研究进行了双变量和多变量分析,在95%置信区间内的P值小于0.05被认为具有统计学意义。结果:手术部位感染预防实践的总体自我报告水平为40.8%(95%CI:36.9%,45.4%)。学士学位及以上的护士[调整后的优势比[(AOR)=2.52,95%CI(1.14,5.54)],接受过感染预防培训[AOR=2.22,95%CI(1.29,3.82)],良好的知识[AOR=2.21,95%CI(1.32,3.71)],良好的态度[AOR=5.11,95%CI(3.05,8.57)],已获得个人防护用品的供应[AOR=2.57,95%CI(1.46,4.49)],管理支持[AOR=3.41,95%CI(1.90,6.12)],5至10年的经验[AOR=5.38,95%CI(2.82,10.27)]和≥11年[AOR=3.48,95%CI(1.47,8.25)]被发现与护士手术部位感染预防实践在统计上正相关。结论:在这项研究中,预防手术部位感染的水平很差。拥有学士学位及以上学历,知识渊博,态度良好,拥有个人防护设备,有管理支持,服务≥5年并接受过感染预防培训,这与手术部位感染的预防措施有很大关联。建议通过在职教育和最新循证实践培训,定期提供个人防护设备,制定医院政策和预防手术部位感染实践的方法来更新护士的知识和实践。