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.
Background: Scarce human resources for health and high injury-related mortality coincide with inequities in accessing quality trauma education programs in low-and middle-income countries. Existing observational studies restrict assessments of trauma training program impacts on providers' knowledge. Evaluation of trauma education programs outside clinical trial settings hinders their effectiveness in influencing clinical practice and policy changes for patient outcomes. Objective: This study aimed to assess the impact of the Rural Trauma Team Development Course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident-related neurological and/or musculoskeletal injuries in selected Ugandan hospitals. Methods: This was a pragmatic 2-arm, parallel, multiperiod, cluster randomized controlled trial. The participants were trauma care frontline personnel and patients aged 2-80 years at 3 intervention and 3 control Ugandan hospitals (1:1 allocation). Hospitals were randomly allocated to intervention or control groups using permuted block sequences. Sequence codes were generated off-site by an independent statistician using Sealed Envelope (version 1.23.1; Sealed Envelope Ltd). Both patient participants and outcome assessors were blinded to allocation. Hospital allocation codes were concealed until the point of assignment. In the intervention arm, 500 trauma care frontliners received RTTDC, whereas patients received standard care. In the control arm, patients received standard care without RTTDC for staff. The primary outcomes were time from accident to admission and from referral to dispatch. The secondary outcomes were all-cause 90-day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT (Consolidated Standards of Reporting Trials) guidelines for reporting cluster randomized trials. Results: We analyzed 1003 participants (501 intervention and 502 control). The intervention arm had a shorter median (IQR) prehospital time of 1 hour (0.50-2) and referral-to-dispatch interval during interfacility transfers of 2 hours (1.25-2.75). This contrasted with 2 hours (1.50-4) and 4 hours (2.50-4.10) in the control arm, respectively (P<.001). The 90-day mortality was more than halved in the intervention (5%, 24/457) vs in the control arm (13%, 58/430) (P<.001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs (20%, 87/430) (P<.001). No difference was found in musculoskeletal injury morbidity outcomes (P=.57). Conclusions: Rural trauma team development training demonstrated potential for improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes. Evidence from this trial supports that locally contextualized, trainee-led rural trauma team development interventional programs are feasible in low-and middle-income countries. However, despite being a multicenter study conducted across 6 geographically distinct hospitals, the research is limited in generalizability due to its focus on a single health care system within 1 country, retrospective trial registration, exclusion of prehospital deaths, and a relatively small number of clusters, which could introduce measurement bias.
QuestionDoes daily zinc supplementation at 20 mg reduce all-cause infection vs placebo in children younger than 5 years with sickle cell anemia?FindingsIn this randomized, double-blind, placebo-controlled clinical trial of 100 children in Uganda younger than 5 years with sickle cell anemia, a daily dose of 20-mg zinc sulfate for 6 months significantly reduced the incidence of all-cause infections compared with placebo (305.7 vs 480.7 infections per 100 person-years; adjusted incidence rate ratio, 0.62).MeaningZinc supplementation at 20 mg daily may be a strategy to reduce infections in children younger than 5 years with sickle cell anemia. ImportanceDespite existing prevention strategies, infections remain a major cause of morbidity and mortality in children in Africa with sickle cell anemia.ObjectiveTo 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 ParticipantsA 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.InterventionsParticipants received zinc sulfate at 20 mg daily or placebo daily for 6 months.Main Outcomes and MeasuresThe primary outcome was all-cause infections per 100 person-years, using standardized clinical criteria to define infections.ResultsAmong 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 RelevanceZinc 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 RegistrationClinicalTrials.gov Identifier: NCT06561061 This randomized clinical trial examines the safety and effectiveness of daily zinc supplementation to prevent all-cause infection in children with sickle cell anemia in Uganda.
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.
