Jinja Regional Referral Hospital, commonly known as Jinja Hospital, is a hospital in the city of Jinja, in the Eastern Region of Uganda. It is the largest hospital in eastern Uganda, with a bed capacity of 600, although many more patients are admitted, with many sleeping on the floor.
Importance Despite existing prevention strategies, infections remain a major cause of morbidity and mortality in children in Africa with sickle cell anemia. Objective To determine the safety and effectiveness of daily zinc supplementation to prevent all-cause infection in children with sickle cell anemia in Uganda. Design, Setting, and Participants A randomized, double-blind, placebo-controlled trial of children aged 1.00 to 4.99 years with sickle cell anemia at Jinja Regional Referral Hospital in Jinja, Uganda, from February 10, 2025, to April 30, 2025, with 6 months of follow-up through November 7, 2025. Interventions Participants received zinc sulfate at 20 mg daily or placebo daily for 6 months. Main Outcomes and Measures The primary outcome was all-cause infections per 100 person-years, using standardized clinical criteria to define infections. Results Among 118 children screened for eligibility, 100 were randomly assigned to receive zinc supplementation (n = 50) or placebo (n = 50) (mean [SD] age, 36.0 [13.2] months; 45 female [45%]). At enrollment, 45 participants (45%) were receiving hydroxyurea therapy. All participants initiated or continued receiving hydroxyurea after enrollment. During the 6-month follow-up, there was complete ascertainment for all participants and no loss to follow-up. There were 80 all-cause infections in the zinc group and 124 in the placebo group, corresponding to a significantly lower infection rate in the zinc group than the placebo group (305.7 [95% CI, 242.4-380.4] infections per 100 person-years vs 480.7 [95% CI, 399.8-573.1] infections per 100 person-years; rate difference, −176.0 [95% CI, −300.8 to −51.3]; incidence rate ratio after adjustment for baseline age, sex, and hydroxyurea use, 0.62 [95% CI, 0.45-0.86]). No adverse events requiring discontinuation of the study intervention were observed in either group. Conclusions and Relevance Zinc supplementation at 20 mg per day reduced all-cause infection in children with sickle cell anemia younger than 5 years in Uganda. Multisite clinical trials are needed to validate these findings and to assess effectiveness in older children. Trial Registration ClinicalTrials.gov Identifier: NCT06561061
Background: Many children under five die post hospital discharge in low-and middle–income countries (LMICs), particularly after treatment for severe infections. While some models exist, evidence on risk prediction for post-discharge mortality remains limited, with most relying solely on admission characteristics, overlooking in–hospital disease progression and discharge features. Methods: We used secondary data from prospective cohort studies in six Ugandan hospitals (2012–2021) to update models at discharge. Of 8,810 children included, 3,665 were aged <6 months and 5,145 were aged 6-60 months. Models were developed utilizing an elastic net regression approach, with admission variables selected a priori and discharge variables selected based on variable importance ranking. Performance was evaluated by applying 10–fold cross–validation, area under the receiver operating characteristic curve (AUROC), Brier score, and Net Reclassification Index (NRI). Results: Models augmented with discharge characteristics outperformed admission-only models. For children aged <6 months, the model AUROC improved by 5.1% (95% CI 3.0 – 7.3, P<0.001), achieving an AUROC of 0.81 and a Brier score of 0.06. In the 6–60m cohort, the model AUROC increased by 4.4% (95% CI 2.0 – 6.9, P<0.001), with an AUROC of 0.79 and a Brier score of 0.04. The NRI was 10.41% for children <6 months and 14.51% for those 6-60m and was achieved primarily through a reduction of false positive rates. Conclusion: Adding only three discharge characteristics to the post-discharge mortality model based on admission characteristics enhanced prediction accuracy, including model calibration, discrimination and risk stratification compared to admission–only models. Keywords: Post-discharge mortality, Risk prediction model, Elastic Net regression, Low-and middle-income countries, Child mortality, Critical illness. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Mitacs through the Mitacs Accelerate Fellowship to T.A. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study involved a secondary analysis of a deidentified dataset. The parent study (Smart discharges to improve post-discharge health outcomes in children: A prospective before after study with staggered implementation) was approved by the Mbarara University of Science and Technology (MUST) Research Ethics Committee (REC) (15/10-16, approved November 28, 2017), the Uganda National Council for Science and Technology (HS 2207, approved April 12, 2017), and the University of British Columbia/Children & Women's Health Centre of British Columbia (UBC/C&W) Research Ethics Board (REB) (H16-02679, approved May 9, 2017). Written informed consent was obtained from parents or guardians of participating children in the parent study, and verbal assent was obtained from children where appropriate. As part of the consent process, participants were informed that their data would be deidentified and may be used for future research studies. The dataset used in this analysis was fully deidentified prior to secondary use. All procedures were conducted in accordance with the ethical standards of the MUST REC and UBC/C&W REB and with the Helsinki Declaration of 1975. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying this article are available from the Smart Discharge Dataverse within the Borealis Dataverse repository. Access to the data can be granted upon request to the study investigators, in accordance with institutional data-sharing polices. [https://borealisdata.ca/dataverse/SD\_Processed\_Data][1] [1]: https://borealisdata.ca/dataverse/SD_Processed_Data
Importance:Despite existing prevention strategies, infections remain a major cause of morbidity and mortality in children in Africa with sickle cell anemia. Objective:To determine the safety and effectiveness of daily zinc supplementation to prevent all-cause infection in children with sickle cell anemia in Uganda. Design, Setting, and Participants:A randomized, double-blind, placebo-controlled trial of children aged 1.00 to 4.99 years with sickle cell anemia at Jinja Regional Referral Hospital in Jinja, Uganda, from February 10, 2025, to April 30, 2025, with 6 months of follow-up through November 7, 2025. Interventions:Participants received zinc sulfate at 20 mg daily or placebo daily for 6 months. Main Outcomes and Measures:The primary outcome was all-cause infections per 100 person-years, using standardized clinical criteria to define infections. Results:Among 118 children screened for eligibility, 100 were randomly assigned to receive zinc supplementation (n = 50) or placebo (n = 50) (mean [SD] age, 36.0 [13.2] months; 45 female [45%]). At enrollment, 45 participants (45%) were receiving hydroxyurea therapy. All participants initiated or continued receiving hydroxyurea after enrollment. During the 6-month follow-up, there was complete ascertainment for all participants and no loss to follow-up. There were 80 all-cause infections in the zinc group and 124 in the placebo group, corresponding to a significantly lower infection rate in the zinc group than the placebo group (305.7 [95% CI, 242.4-380.4] infections per 100 person-years vs 480.7 [95% CI, 399.8-573.1] infections per 100 person-years; rate difference, -176.0 [95% CI, -300.8 to -51.3]; incidence rate ratio after adjustment for baseline age, sex, and hydroxyurea use, 0.62 [95% CI, 0.45-0.86]). No adverse events requiring discontinuation of the study intervention were observed in either group. Conclusions and Relevance:Zinc supplementation at 20 mg per day reduced all-cause infection in children with sickle cell anemia younger than 5 years in Uganda. Multisite clinical trials are needed to validate these findings and to assess effectiveness in older children. Trial Registration:ClinicalTrials.gov Identifier: NCT06561061.
Objective: This study aimed to identify gaps and barriers to the use of antimicrobial resistance (AMR) surveillance data in Uganda and to recommend enhancements to improve policy and intervention outcomes.Design: A comprehensive assessment was conducted within a framework of infrastructural and system analysis, stakeholder engagement, and data management simulations.Methods: The assessment consisted of three components: (1) assessing data utilization through stakeholder engagement to identify barriers in data translation and use; (2) evaluating the existing infrastructure and surveillance system supporting AMR data flow; and (3) simulating processes of data management and flow to contextualize identified gaps.Results: Findings revealed deficiencies in the AMR data governance structure and informatics capabilities. Stakeholders highlighted limited access to data and analytical capacity as barriers to effective decision-making. The existing infrastructure lacks the capability for real-time data analysis, which limits the ability to inform national and health facility policies. Strengthening data management processes, enhancing analytical tools, and fostering stakeholder collaboration at all levels are recommended for efficient data utilization.Conclusions: Addressing these gaps is crucial for strengthening AMR surveillance in Uganda, enabling more effective data use to guide intervention and policies, and ultimately improving public health outcomes.
Introduction Maternal and newborn morbidity and mortality are a global concern. Understanding the epidemiology of post-discharge complications could identify opportunities for interventions. We aimed to quantify mortality, care-seeking events and readmission among mothers and newborns in Uganda following facility-based delivery.Methods This prospective observational study (Apr 2022-Sep 2023) enrolled women presenting for delivery at two regional referral hospitals in Uganda. Data were collected during admission and 6 weeks after delivery by phone.Results Overall, 7131 women delivered 7359 newborns, of whom 7129 (99%) women and 6968 (94%) newborns were discharged alive. The newborn mortality rate was 2.7% and 32% of deaths occurred post-discharge. Following discharge, 230 (3%) women and 287 (4%) newborns were readmitted. Suspected sepsis and infections were the most common reasons for readmission among mothers (62.2%) and newborns (89.9%). Caesarean delivery (OR:2·26 (1·75-2·93)) and perinatal death (OR:3·18 (2·09-4·69)) were associated with post-discharge maternal readmission. Both maternal and newborn readmission were associated with household food insecurity during pregnancy (maternal OR:1·56 (1·15-2·08); newborn OR: 1·73 (1·31-2·25)). Newborn resuscitation with oxygen was associated with maternal readmission (OR:2.24 (1.24–3·78)), newborn readmission (OR: 2·74 (1·54-4·56)) and newborn death (OR: 4·01 (1·73-8·21)). Although >99% of women had ≥1 antenatal care visit, only 511 (7%) had ≥1 routine postnatal care visit. There were no routine postnatal care visits among 211 (91·7%) readmitted mothers, 276 (96·2%) newborns and 57 (91·9%) newborns who died.Conclusion Post-discharge complications occur in a context of low routine postnatal care use. Risk-informed discharge planning, postnatal care and health education strategies may improve outcomes in mothers, newborns and their families.
