Mulago National Specialised Hospital, also known as Mulago National Referral Hospital, is a component of Mulago Hospital Complex, the teaching facility of Makerere University College of Health Sciences. It is the largest public hospital in 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/Objectives: Transitions to new vaccines or antigen schedules represent complex system changes requiring coordinated governance, reliable data systems, domestic financing, and multisectoral collaboration. In 2025, African countries were moving toward a switch from separate pentavalent and inactivated poliovirus vaccines to the combined hexavalent vaccine. This project report describes the Hexavalent Vaccine Switch Early Adopters Workshop in Dakar, Senegal, which included ten African countries, and its implications for future vaccine introductions. Methods: We conducted a practice analysis drawing on structured documentation of plenary presentations, country case studies, interactive problem-solving sessions, and national roadmap exercises. A thematic framework aligned to ten process points for the hexa switch guided synthesis. Results: Countries reported shared system vulnerabilities, including coexistence risks of legacy and new vaccine stocks, inconsistent data completeness, under-resourced vaccine safety surveillance, and financing uncertainties. Early adopter countries demonstrated operational feasibility, logistical efficiencies, and opportunities for reducing injection burden. Outputs included a Health System Adaptation Checklist, a Switch Risk Mitigation Catalog, and 12-month national roadmaps. Conclusions: Regional peer-learning mechanisms can accelerate decision-making, improve operational quality, and strengthen accountability for vaccine introductions. Structured cross-country collaborations can transform a product switch into a scalable system-strengthening opportunity.
Background: Kounis syndrome is an acute coronary syndrome triggered by allergic or hypersensitivity reactions, mediated by inflammatory cascades and mast cell activation. It can manifest as coronary vasospasm, plaque rupture, or stent thrombosis. Electrocardiographic presentations vary and may mimic ST-elevation myocardial infarction, occasionally with atypical features such as atrial fibrillation or extreme ST-segment elevation patterns. Case Presentation: We report a case of an adult African patient who developed acute chest pain, hypotension, and localized allergic manifestations (pruritus and soft tissue swelling at sting sites) following multiple bee stings. Notably, no generalized urticaria or angioedema was observed. Electrocardiography revealed atrial fibrillation with a "shark-fin" ST elevation pattern, a combination not previously reported in an African patient with Kounis syndrome suggestive of extensive myocardial ischemia. Emergent management included hydrocortisone, diphenhydramine, epinephrine infusion, and intracoronary nitroglycerin. Coronary angiography and clinical evolution supported a diagnosis of coronary vasospasm highly consistent with type I Kounis syndrome, in the absence of confirmatory biomarker testing. Discussion: Kounis syndrome remains underrecognized, particularly in low-resource settings. The coexistence of atrial fibrillation and shark-fin ST elevation is rare and represents the distinguishing novelty of this case; it may lead to misdiagnosis as primary myocardial infarction or ventricular tachycardia. The confounding role of exogenous epinephrine administered during resuscitation must be acknowledged in interpreting the angiographic findings. Allergic mediators such as histamine and leukotrienes can induce coronary vasospasm and electrical instability. Early recognition is critical, as management requires simultaneous treatment of both allergic and cardiac components. Conclusion: Kounis syndrome should be considered in patients presenting with acute coronary syndromes in the context of allergic triggers such as bee stings. The simultaneous occurrence of atrial fibrillation and shark-fin ST elevation is a rare, diagnostically challenging presentation. Prompt recognition and dual-pathway management can improve outcomes.
We document a 43% reduction in rotavirus-associated hospitalizations among Ugandan children following introduction of the monovalent rotavirus vaccine (Rotarix). Declines were evident each year after Rotarix introduction and at each surveillance site, predominantly among infants. Continued monitoring for long-term impact is warranted given changes in the vaccine formulation in Uganda.
