Mengo Hospital, also known as Namirembe Hospital, is a private, faith-based, community, teaching hospital in Kampala, the capital and largest city of Uganda.
INTRODUCTION:This study examined the factors linked to all-cause mortality and morbidity from neurological and musculoskeletal injuries during motorcycle accidents in Uganda. METHODS:The study was part of a two-armed, parallel, multi-period, cluster-randomised controlled trial of 1003 motorcycle crash victims. Morbidity was assessed using various scoring systems, and mixed effects regression models were employed for analysis. RESULTS:Ninety-day all-cause mortality was 9.2% (82/887). Factors associated with mortality included referral-to-dispatch >1 hour (OR 4.215 (1.802-9.858), p=0.001), Kampala Trauma Score (KTS) ≤6 (OR 7.696 (1.932-30.653), p=0.004), GCS 9-12 (OR 3.432 (1.194-9.870), p=0.022), GCS ≤8 (OR 6.919 (2.212-21.645), p=0.001), intra-axial lesions (OR 78.647 (9.871-626.587), p<0.001), extra-axial lesions (OR 11.933 (1.386-102.750), p=0.024), skull fracture (OR 11.366, (1.197-107.977), p=0.034) and craniotomy (OR 0.260 (0.095-0.706), p=0.008).A percentage of 14.5% had unfavourable Glasgow Outcome Scale (1-3); associated factors included increasing age (OR 1.02 (1.013-1.045, p<.001), multiple injuries (OR 4.559 (1.185-17.531), p=0.027), KTS 7-8 (OR 2.755 (1.285-5.906), p=0.009), KTS ≤6 (OR 7.551 (2.815-20.255), p=0.001), GCS 9-12 (OR 4.07 (1.901-8.719), p=0.001), GCS ≤8 (OR 13.779 (5.643-33.645), p<0.001) and craniotomy (OR 0.149 (0.075-0.295), p<0.001).Factors associated with unfavourable patient-reported musculoskeletal outcomes included being married (OR 1.984 (1.322-2.976), p=0.001), multiple injuries (OR 1.762 (1.001-3.100), p=0.049) and enrolment after the onset of the COVID-19 pandemic (OR 2.095 (1.199-3.659), p=0.009]. CONCLUSIONS:The key determinants of mortality and adverse neurological and musculoskeletal injury outcomes observed in this study are essential for establishing core outcome sets in future research and predictive models. TRIAL REGISTRATION NUMBER:Pan African Clinical Trial Registry (PACTR202308851460352).
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.
Background Burnout is a widely recognised occupational phenomenon, with emergency department (ED) healthcare workers globally facing a heightened risk. Despite this, data on the burden of burnout among ED healthcare workers, especially in low-resource settings, are limited. Our study sought to establish the prevalence and factors associated with burnout and workplace stressors among ED healthcare workers in Uganda.Methods An online-based survey was conducted among ED professionals across four private and public hospitals. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey tool. Data were analysed using univariable and multivariable logistic regression analyses.Results Data from 82 participants were analysed (response rate of 88%), with approximately equal numbers of males and females, just over half providing care to both adult and paediatric patients and 61% working in public facilities. Overall, 9.7% of participants met the criteria for burnout. In total, 48.7% (n=40) reported high emotional exhaustion, 21.9% (n=18) reported high depersonalisation and 35.4% (n=29) reported low personal accomplishment. At least 80% of participants identified key ED stressors including work-related fatigue, patients' financial problems, work overload, equipment shortages and challenges in balancing professional and personal responsibilities. After adjusting for covariates such as overload of health professional literature needed to be read, patients' financial problems, educational issues, lack of sufficient clinical skills and ED violence, burnout was positively associated with poor communication with colleagues in the ED (adjusted OR (AOR) 9.90; 95% CI 1.60 to 61.17; p=0.014) and with caring for the old and terminally ill patients (AOR 7.54; 95% CI 1.38 to 41.29; p=0.020). These associations were consistent with the high depersonalisation domain of burnout.Conclusion Burnout, particularly in the emotional exhaustion domain, is notably prevalent among ED healthcare workers in Uganda. There is a pressing need for context-specific interventions aimed at improving early recognition of burnout and addressing persistent ED stressors. Such measures are essential to enhance ED healthcare workers' well-being, and ultimately improve in-hospital emergency care in Uganda.
Background: The study aims to determine the prevalence of malaria and associated factors among pregnant women attending antenatal care at Gogonyo Health Centre III, Pallisa District. Methodology: The study adopted a descriptive cross-sectional design using quantitative data collection methods. study was conducted at Gogonyo Health Centre III located in Gogonyo County in Pallisa District, in the Eastern Region of Uganda. The study population was pregnant women attending antenatal care. A Systematic random sampling technique was used to select participants. Results: Most participants were aged 20–29 years (39.2%), while the majority were married (74.2%). Regarding education level, 43.3% had attained primary education, followed by 33.0% with secondary education. More than half of the participants resided in rural areas (59.8%), and 64.9% were multigravida. In addition, most respondents were in the second trimester of pregnancy (46.4%), followed by those in the third trimester (32.0%). 18.6% (18/97) of pregnant women tested positive for malaria infection. The analysis demonstrated statistically significant associations between malaria infection and non-use of ITNs (p = 0.018), rural residence (p = 0.030), primigravidity (p = 0.025), and low education level (p = 0.013). Pregnant women who did not use ITNs were approximately three times more likely to test positive for malaria compared to ITN users (OR = 3.2). However, although women in the first trimester showed higher malaria prevalence, the association was not statistically significant (p > 0.05). Conclusions: The study further emphasises the need for healthcare providers and district health authorities to adopt context-specific prevention approaches that address behavioural and sociodemographic vulnerabilities. Recommendations Healthcare workers should scale up community sensitization on the importance of early ANC attendance and IPTp-SP uptake for all pregnant women in the community, in order to mitigate the burden of MIP.
