Kabale Regional Referral Hospital, commonly known as Kabale Hospital, is a hospital in the town of Kabale in Kabale District, in south-western Uganda. It is the referral hospital for the districts of Kabale, Kanungu, Rubanda, Rukiga, Kisoro and Rukungiri. It is proposed that the hospital will become the teaching hospital of Kabale University once its medical school is established..
Malignant bowel obstruction (MBO) is a known, devastating complication of advanced intra-abdominal malignancy. International management guidelines are derived from high-income settings and rely on resources: computed tomography, self-expanding metal stents, total parenteral nutrition, specialist palliative care, that are inconsistently available in low- and middle-income countries (LMICs). Clinicians in LMICs therefore manage MBO within a fundamentally different diagnostic and therapeutic landscape, usually without context-specific guidance. Surgery dominates management but carries high morbidity and mortality, particularly in patients with ECOG performance status ≥3, serum albumin <30 g/L, ascites and peritoneal carcinomatosis. Emerging LMIC-based data confirm these patterns: a prospective Kenyan series reported 30-day postoperative mortality of 10.8% for malignant obstruction, while a South African review of 510 obstructed colorectal cancer patients found stomas were used twice as frequently as stents, the reverse of high-income country practice. No prognostic tool has been validated in LMIC populations. MBO care in LMICs demands a recalibration of international evidence to local realities. Our proposed context-adapted decision framework offers a structured, evidence-informed approach to rational surgical decision-making that can be applied immediately, even in settings lacking advanced imaging or endoscopic services.
Background: Linear IgA Dermatosis of Childhood (LAD of childhood) is a rare autoimmune sub-epidermal blistering disorder classically confirmed by direct immunofluorescence demonstrating linear IgA deposition along the basement membrane zone. However, in resource-limited settings, access to immunopathological diagnostics is often restricted, posing significant challenges to timely diagnosis and management. Case Presentation: We report the case of a 12-year-old girl from rural South-Western Uganda with a history of recurrent vesiculobullous eruptions beginning at 2 years of age, with subsequent episodes at 7 years and a current severe presentation at 12 years. The disease demonstrated a progressive increase in severity with each recurrence. On examination, she had multiple large, tense bullae arranged in annular and polycyclic patterns over the trunk, limbs, thighs, and groin, with a characteristic "string-of-pearls" configuration and no mucosal involvement. Due to unavailability and unaffordability of histopathology and immunofluorescence studies, a clinical diagnosis of LAD of childhood was made based on history, morphology, distribution, recurrence pattern, and exclusion of close differentials. The patient was treated with dapsone, systemic corticosteroids, antibiotic prophylaxis, and local wound care. Within one week of initiating therapy, there was marked clinical improvement, with cessation of new blister formation, resolution of existing bullae, and progressive re-epithelialization. Conclusion: This case underscores the critical role of clinical acumen in diagnosing LAD of childhood in resource-constrained settings where gold-standard investigations are inaccessible. It highlights that a thorough history, careful physical examination, recognition of characteristic lesion patterns, and therapeutic response to dapsone can provide sufficient diagnostic confidence. Importantly, lack of advanced diagnostic tools should not delay initiation of appropriate treatment. This report also emphasizes the need to strengthen diagnostic capacity in low-resource settings while reinforcing the value of clinical judgment in managing rare dermatological conditions.
Background Medical oxygen is an essential medicine that is often unavailable for patients when they need it. We explored if ‘outsourced oxygen to the bedside’ (O2B) pilots, where private providers deliver a package of services, were successful in ensuring reliable oxygen access at the patient bedside.Methods We conducted a sequential explanatory mixed-methods assessment of O2B pilots in Kenya, Nigeria, India, Tanzania and Uganda from September 2024 to January 2025. A quantitative cross-sectional facility audit described facility contexts, tested equipment functionality and assessed healthcare worker (HCW) oxygen knowledge. Qualitative interviews with HCWs and managers explored experiences of O2B pilots.Results We studied 28 of the 80 facilities participating in the pilots, 179 HCWs completed the knowledge survey and 59 qualitative interviews were conducted. In the audit, we found O2B provided oxygen equipment more functional and usable than non-O2B equipment: 64.5% vs 40.9%, p<0.001 for cylinders, 95.0% vs 25.7% (p<0.001) for concentrators and 84.0% vs 70.0% (p value=0.172) for pulse oximeters. Overall, 21.8% (39/179) of HCWs had received training from O2B providers, and their oxygen knowledge was slightly higher than those who had not (mean score 15.3/24 vs 13.9/24, p value=0.002). Qualitative interviews highlighted positive changes in oxygen access and the ability to treat patients, but also mixed understandings of the O2B services being provided, and requests for additional services.Conclusion O2B pilots appear to improve medical oxygen access, with effective maintenance and repair services being a key mechanism. However, tailoring to local needs and remaining gaps in HCW capacity need to be addressed.
Introduction: Access to medical oxygen remains a challenge, with 60% of the worlds population lacking access to quality oxygen services. We explored whether "outsourced oxygen to the bedside" (O2B), where private providers offer bundles of oxygen services, could be adopted and scaled across diverse health systems, to improve patient access to oxygen. Methods: Qualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeria, Tanzania, Kenya and Uganda, who had taken part in an O2B pilot. Interviews were conducted between 19th November 2024 and 25th January 2025, and explored the feasibility, fidelity, acceptability, perceived benefits and weaknesses of five O2B models. Analysis used a pragmatic codebook approach, with inductive and deductive coding, informed by implementation science frameworks. Results We conducted 59 interviews, with managers and HCWs from 20 health facilities. We identified five themes relating to the potential for O2B pilots to be adopted within the health system: effect on oxygen culture, feasibility of whole of facility solutions, promotion of local ownership, being willing but unsure about the ability to pay, and the desire for hybrid tailored service models. HCWs and facility staff raised several positive factors within these themes but highlighted that understanding local facility needs and tailoring the services to embed within existing structures were important for sustainability. Conclusion Overall, the O2B service approach shows potential for implementation beyond the pilots, but more understanding of how to optimize service delivery packages to different facility needs, while also prioritizing affordability is needed. ### Competing Interest Statement TB declares technical consultancies with UNICEF, the World Bank, USAID, and PATH, and is Board member of the non-profit organisation EECC Global, all outside the submitted work. HG has provided unpaid technical advice on oxygen therapy to FREO2 Foundation (one of the O2B providers). ### Funding Statement The research was funded by Brink through a grant from the UK FCDO. The views expressed in this report are those of the authors. This material has been funded by UK International Development as a part of the Oxygen CoLab; however, the views expressed do not necessarily reflect the UK governments official policies, nor those of any of the individuals and organisations referred to in the report. ### 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: Ethical approvals were obtained from ethical review boards in each country: Monk Prayogshala Institutional Review Board, India (reference: #156-024); Maseno University Scientific and Ethics Review Committee, Kenya (reference: MSU/DRPI/MUSERC/01361/23); National Commission for Science, Technology and Innovation, National Commission for Science, Technology and Innovation, Kenya (license number: NACOSTI/P/24/37427, reference: #673262); Health Research and Ethics Committee, LASUTH, Lagos State, Nigeria (reference: LREC/06/10/2498); Health Research Ethics Committee, Ogun State, Nigeria (reference: OGHREC/467/2024/290/APP); National Institute for Medical Research, Tanzania (reference: NIMR/HQ/R.8a/Vol.IX/4743); Ugandan National Council for Science and Technology, Uganda (reference: HS5437ES); Makerere University School of Health Sciences REC, Uganda(reference: MAKSHSREC-2023-600). Approval was granted by the Swedish Ethics Review Authority for the processing of personal data (reference: DNR 2024-00868-01). 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 Given the qualitative nature of the data, transcripts cannot be sufficiently anonymised for Open Data Access. Data can be requested for the purposes of further academic research, by contacting Carina King (carina.king{at}ki.se) and Freddy Eric Kitutu (kitutufred{at}gmail.com). Requests will be reviewed and discussed with the site qualitative leads, and approval from local ethical committees will need to be sought.
OBJECTIVE:To explore the lived experiences of community health workers (CHW) engaged in efforts toward the elimination of vertical transmission (EVT) of HIV and to assess the impact of a capacity-building training intervention. DESIGN:The study consisted of (1) a qualitative assessment of lived experiences of CHWs; (2) a capacity-building training intervention responsive to identified needs; and (3) assessment of the training intervention using pre- and postintervention questionnaires. METHODS:Focus group discussions and semistructured key informant interviews in addition to CHW training sessions for HIV/EVT were held in 1 rural and 1 semiurban setting in Uganda, based on training materials developed by the World Health Organization and the United States Agency for International Development (USAID). We used standardized pre- and postintervention questionnaires to assess comprehensive knowledge and accepting attitudes toward HIV. RESULTS:Qualitative exploration of the lived experience of 152 CHWs in 10 focus group discussions and 4 key informant interviews revealed several themes: (1) CHWs as bridges between health system and community; (2) CHW assets (tacit knowledge and shared social networks); (3) CHW challenges (stigma, secrecy, and ethical quandaries); (4) favorable community reception; and (5) need for continuing education and reinforcement of skills. In response to identified needs, a capacity-building intervention was designed and implemented with 143 CHWs participating in 10 sessions. The proportion of participants with comprehensive knowledge of HIV increased from 45% to 61% ( P = 0.006), and the proportion endorsing accepting attitudes increased from 63% to 76% ( P = 0.013). CONCLUSION:CHWs are potentially valuable players in global EVT efforts. Ongoing training is needed to support community-level initiatives.
