Mbale Regional Referral Hospital, commonly known as Mbale Hospital is a hospital in Mbale, Eastern Uganda. It is the referral hospital for the districts of Busia, Budaka, Kibuku, Kapchorwa, Bukwa, Butaleja, Manafwa, Mbale, Pallisa, Sironko and Tororo. The hospital also serves many more patients from outside the hospital's catchment area.
BACKGROUND:Extraintestinal pathogenic Escherichia coli (ExPEC) are a leading cause of human bloodstream infections (BSIs) in sub-Saharan Africa, yet few studies have characterized African strains implicated in BSI or explored their potential reservoirs. METHODS:We enrolled febrile patients at 2 hospitals in Moshi, Tanzania, 2007-2019, and performed blood cultures. Whole-genome sequencing was conducted on E. coli originating from the bloodstream to characterize sequence types (STs), serotypes, and theoretical coverage of a 9-valent ExPEC polysaccharide conjugate vaccine (ExPEC9V). Separately, we evaluated 601 E. coli whole-genome sequences from humans, animals, and environmental sources in nearby communities. We assessed genetic relatedness between bloodstream and community isolates based on single-nucleotide polymorphisms and allele differences. FINDINGS:Of 3046 participants receiving blood culture, 48 (0.2%) had BSI yielding 48 E. coli isolates. The median (range) age of participants with E. coli BSI was 40.7 (0.3-89.0) years, and 32 (68.1%) were female. We identified 16 STs including ST131 (n = 16, 33.3%), ST73 (n = 10, 20.8%), and ST69 (n = 6, 12.5%) and 19 O groups including O25 (n = 13, 27.1%), O6 (n = 10, 20.3%), O17 (n = 4, 8.3%), and O18 (n = 4, 8.3%). Theoretical coverage for an ExPEC9V was 72.9%. None of the bloodstream and community E. coli pairs were closely related. CONCLUSIONS:We found a high diversity of STs among E. coli human bloodstream isolates in Tanzania. Despite this diversity, we observed that an EXPEC9V in development would provide good coverage. Reservoir-attribution studies at finer spatial and temporal scales may better identify transmission networks and reservoirs of ExPECs.
Background National ICU registries are increasingly being implemented in low- and middle-income countries (LMICs) to support resource mapping, patient care evaluation, and data-driven quality improvement. The Intensive Care Registry of Uganda (ICRU) was launched in 2020 to strengthen critical care services through standardized data collection, benchmarking, and research facilitation. This article describes the implementation of ICRU, its contributions to critical care in Uganda, and lessons learned during operationalization. Methods ICRU was established as a cloud-based registry using standardized nomenclature (SNOMED-CT) to ensure interoperability. Participating ICUs employed dedicated data collectors supported by centralized training, IT assistance, and quality assurance mechanisms. Data were collected across admission, daily care, and discharge domains. Challenges, including staffing constraints, ethical approvals, and internet limitations, were addressed through targeted mitigation strategies. Results Between 2020 and 2024, ICRU expanded from 5 to 11 ICUs, capturing nearly 3,800 consecutive admissions and achieving >95% completeness across 33 core variables. The registry enabled real-time tracking of ICU occupancy and critical resource utilization, supported benchmarking with risk-adjusted outcome measures (including e-TROPIcs), and embedded context-appropriate quality indicators. Registry data have informed national quality improvement initiatives, site-level process monitoring, and have supported observational and interventional studies such as MOTIVATE-ICU and ARISE-Africa. Conclusion ICRU demonstrates the feasibility of implementing a national ICU registry in a low-resource setting. By enabling benchmarking, quality improvement, and research, it provides a scalable model for LMICs seeking to strengthen critical care through data-driven approaches. Future priorities include nationwide expansion, integration with the national Health Management Information System (HMIS), and participation in multinational benchmarking and adaptive trials.
Background Genital trauma is common in gynaecologic practice and causes tend to diff er depending on the age of the patient. Although more common in obstetrics with an incidence of 1-2 per 1000 deliveries, there are a rare occurrence in Gynaecology with incidence of 3.7% and constitute 0.8% of all gynaecological emergencies. We present a rare case of post-coital vulva haematoma with acute urinary retention in pregnancy that was successfully surgically managed with subsequent positive pregnancy outcome. Methods We present a case of a 19year old, NA. She was a black African Ugandan, primigravida at 21 weeks of amenorrhoea. She presented with a 16hours history of post-coital painful genital swelling and acute failure to pass urine. On examination, abdominal fi ndings revealed a symphysis-fundal height corresponding to 22 weeks of amenorrhoea, distended urinary bladder and a tender cystic left vulvar swelling extending to involve the labia minora on the right. On day two, the mass was noted to have increased in size with necrotic edges. Management: Involved surgical evacuation of the haematoma with insertion of the catheter drain. She healed well and had Cul de sac catheter drain removed on day 6 and urethral catheter removed on day 8. She was enrolled into antenatal care. Conclusions Gynaecology emergency attendees must be suspicious of the rare causes of vulvar haematomas such as coitus and exclude them from common ones such as Bartholin’s abscess and cysts, vulva varicosities and folliculitis. Although vulva haematomas can be managed conservatively, those that are tender, increasing in size and debilitating need surgical intervention and the procedure is safe in pregnancy.
Background Metabolic syndrome (MetS) is a growing public health burden associated with increased cardiovascular morbidity and mortality, particularly among patients with hypertension (HTN). Comprehensive cardiometabolic risk profiling, including estimation of 10-year cardiovascular (CVD) risk, provides an estimate of overall cardiovascular risk. However, data on MetS and cardiovascular risk profiles among HTN patients in Uganda are limited. Understanding the prevalence, associated factors, and cardiovascular risk profile is critical for designing preventive and management strategies. Objective To determine the prevalence and factors associated with MetS and to describe the 10-year cardiovascular risk profile among patients with HTN attending the Chronic Care Clinic at Mbale Regional Referral Hospital in Eastern Uganda. Methods A cross-sectional study that involved 384 patients with HTN was conducted between December 2024 and April 2025, using a structured questionnaire modified from the WHO STEPwise instrument®. Physical measurements and laboratory investigations were systematically collected. MetS was defined using the harmonized 2009 criteria. Ten-year CVD risk was estimated using three published algorithms: QRISK3, the ASCVD Pooled Cohort Equation, and the Framingham Risk Score. Data were summarized as proportions, means, and standard deviations. Adjusted prevalence ratios (APR) and their 95% confidence intervals (CI) were calculated using modified Poisson regression. Results Of 384 participants, 74.5% (286/384) had MetS. Independent factors associated with MetS were female sex (APR 1.44; 95% CI 1.25–1.66; p < 0.001) and increasing age (APR 1.004 per year; 95% CI 1.001–1.008; p = 0.027). Central obesity (81.3%), low HDL-C (59.4%), and hypertriglyceridemia (44.5%) were the most prevalent components. The proportion of participants classified as high 10‑year cardiovascular risk was 17.8% by QRISK3, 19.6% by ASCVD, and 43.8% by Framingham. Conclusion MetS was highly prevalent in this hypertensive population and was associated with female sex and increasing age. A substantial proportion of participants were classified as having elevated 10-year cardiovascular risk. Routine assessment and management of MetS components in HTN clinics is warranted for early risk stratification and intervention.
Abstract Background Vasectomy remains one of the most underutilized contraceptive methods in Uganda, with a prevalence of only 0.2% despite its safety, effectiveness, and potential contribution to fertility reduction. Understanding the factors influencing awareness, knowledge, and attitudes toward vasectomy acceptance is crucial for developing effective promotion strategies in the Ugandan context. Methods A cross-sectional study was conducted among 617 men aged 20-60 years, selected through simple random sampling of participants attending Kapchorwa General Hospital. Data were collected using a structured questionnaire. Results Knowledge scores showed a negative association with age (β = -0.044, p < 0.001) and varied significantly by marital status, with married participants demonstrating higher knowledge than single (β = -0.624, p < 0.001) and widowed (β = -0.950, p < 0.001) individuals. Counterintuitively, higher knowledge was associated with more negative attitudes (β = -1.729, p < 0.001). Age demonstrated the strongest negative effect on attitudes (β = -0.249, p < 0.001), and 99.9% of participants believed contraception is primarily women’s responsibility. Behavioral data revealed that 75.0% desired more children, with 51.2% preferring a family size of 3-4 as the ideal. Conclusion The study shows a disconnect between knowledge, attitudes, and behaviors regarding vasectomy. While general awareness is high, deep-seated misconceptions, cultural norms around masculinity and contraceptive responsibility, and fertility preferences present significant barriers to acceptance.
