Soroti Hospital

Oxygen supplementation is a recommended treatment for children with severe pneumonia or hypoxaemia. The open, fractional-factorial Children's Oxygen Administration Strategies Trial (COAST) recruited Kenyan and Ugandan children with severe pneumonia and hypoxaemia. Participants in the severe hypoxaemia stratum (SpO2 < 80%) were randomised to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO), and in the hypoxaemia stratum (SpO2 80-91%) to HFNT, LFO or permissive hypoxaemia (ratio 1:1:2). The trial stopped early and there is ongoing uncertainty about the clinical benefits of the alternative strategies. There is a lack of evidence about the relative costs, of alternative oxygen delivery for critically-ill children in low- and middle- income countries. We used data from COAST to conduct a cost-consequence analysis of the treatment strategies. We measured resource use for 28 days post-randomisation (n = 1,842). Resources included oxygen delivery, medications, blood and fluid products, diagnostic tests, point of care tests, hospital admission and length of stay. We calculated the total costs and reported the incremental costs as the difference in the mean total costs between groups, adjusting for baseline differences. In the severe hypoxaemia stratum, the mean total cost was $393.04 for HFNT and $218.73 for LFO. In the hypoxemia stratum, the mean total costs were $391.95 (HFNT), $198.26 (LFO) and $167.80 (permissive). The adjusted cost difference between HFNT versus LFO and liberal versus permissive was $184.43 (95% CI l: $127.90, $240.95), and $124.01 (95% CI: $99.53, $148.49), respectively. The differences of HFNT and LFO versus permissive were $216.22 (95% CI: $160.77, $271.68) and $31.80 (95% CI: $11.49, $52.11), respectively. For children with severe hypoxaemia, HFNT is more costly than LFO. For children with hypoxaemia, either of HFNT or LFO were more costly than permissive hypoxaemia. The main driver of costs for HFNT is the high cost of equipment and consumables; other costs were similar across treatment groups in both strata, as were health outcomes.

Background: In 2016, Uganda adopted the WHO HIV drug resistance (HIVDR) monitoring strategy to track treatment outcomes following the introduction of a dolutegravir (DTG) based regimen as first line among people living with HIV (PLHIV). However, despite widespread transition to DTG-based regimens, evidence on acquired DTG resistance and its determinants remains limited. Objectives: To determine the prevalence of acquired DTG resistance among PLHIV with virologic failure and identify associated factors in North-Eastern Uganda. Design: We conducted a retrospective cross-sectional study from 24 accredited antiretroviral therapy health facilities in North-Eastern Uganda by 28th February 2025. Methods: The study included eligible PLHIV on DTG-based regimens with at least 2 viral loads >1000 copies/mL and a documented HIV genotypic resistance testing result between April 2022 and July 2024. Clinical data were extracted from the national drug resistance dashboard and verified against facility electronic medical records. Logistic regression via generalised estimating equations (GEE) was used to identify factors associated with DTG resistance. A p -value < 0.05 was considered statistically significant. Results: Of 225 participants, the median age was 19 years (interquartile range: 15–39), and 55.1% ( n = 124) were male. The prevalence of high-level to intermediate DTG resistance was 18.7% ( n = 42), with 14.2% ( n = 32) having high-level resistance to DTG and 4.4% ( n = 10) intermediate resistance. Most participants were unemployed (60.0%, n = 135) and had not disclosed their HIV status (74.2%, n = 167). DTG resistance was associated with presence of nucleoside reverse transcriptase inhibitor (NRTI) drug resistance mutations (DRMs) (adjusted odds ratio (aOR); 12.14, 95% confidence interval (CI): 4.14–35.65, p < 0.001), poor adherence (aOR; 6.19, 95% CI: 2.54–15.11, p = 0.001), DTG use ⩾ 3 years (aOR; 9.19, 95% CI: 1.60–52.74, p = 0.013), and alcohol/substance abuse (aOR; 3.94, 95% CI: 1.74–8.91, p = 0.001). Conclusion: Nearly one in five PLHIV with virologic failure exhibited DTG resistance, predominantly high-level. Key associated factors included poor adherence, being on DTG for ⩾3 years, alcohol/substance abuse, and the presence of relevant NRTI DRM. Strengthening family and peer support, integrating substance abuse screening and management in HIV care, and improving adherence may help reduce the risk of DTG resistance. These findings highlight the urgent need for enhanced HIVDR monitoring and tailored interventions to sustain progress toward HIV epidemic control by 2030.

BACKGROUND:International guidelines for treatment of children with severe acute malnutrition advise against giving standard oral rehydration solutions (ORS) for dehydration secondary to diarrhoea. Instead, they recommend exclusive use of low-sodium rehydration solution for malnutrition (ReSoMal), due to concerns about both sodium and fluid overload. Supportive evidence is lacking, warranting reappraisal of this guidance. We aimed to assess the safety and superiority of standard WHO-ORS versus ReSoMal. METHODS:GASTROSAM was a phase 2, factorial, open-label, superiority randomised controlled trial conducted at six hospitals in four African countries (Kenya, Niger, Nigeria, and Uganda). Children aged 6 months to 12 years with severe acute malnutrition who were admitted to hospital with severe (stratum A) or moderate (stratum B) dehydration and diarrhoea were randomly assigned in a 1:1 ratio to receive ReSoMal or low-osmolarity WHO-ORS. A simultaneous randomisation in stratum A compared two intravenous strategies versus an oral control rehydration strategy (results reported elsewhere). Children with severe dehydration (stratum A) received their allocated ORS as soon as possible. The primary endpoint was change in sodium concentration at 24 h from baseline in all randomised participants and analysed on an intention-to-treat basis. Children with lived experience were not involved in the study design. The trial is registered on the ISRCTN registry (ISRCTN76149273) and the Pan-African Clinical Trials Registry (PACTR202103852542919). FINDINGS:Between Sept 2, 2019, and Oct 27, 2024, 415 eligible children were enrolled (218 [53%] male; 197 [47%] female); 272 were enrolled into stratum A (137 to ReSoMal and 135 to WHO-ORS) and 143 were enrolled into stratum B (69 to ReSoMal and 74 to WHO-ORS). Children were followed up for 28 days; 11 (3%) were lost to follow-up or withdrew. The primary endpoint was assessed in 387 (93%) of 415 participants. The increase in sodium concentration was similar in both groups (5·3 mmol/L [SD 8·1] with ReSoMal vs 5·0 mmol/L [7·6] with WHO-ORS; mean difference for WHO-ORS vs ReSoMal -0·6 [95% CI -1·9 to 0·7], p=0·37). There was no difference in day 28 mortality between the WHO-ORS and ReSoMal groups (19 [9%] vs 24 [12%]; adjusted hazard ratio 0·76 [95% CI 0·41 to 1·41], p=0·39). Fluid overload events (pulmonary oedema and cardiac overload) were actively monitored: none was observed. INTERPRETATION:WHO-ORS resulted in similar outcomes to ReSoMal, and neither strategy led to fluid overload. This finding informs the simplification of guidelines supporting the use of WHO-ORS for the management of dehydration in children regardless of nutritional status. FUNDING:Joint Global Health Trials Scheme of the UK Medical Research Council, UK Department for International Development, Wellcome, and Médecins Sans Frontières.

Background:Obstetric fistula remains a debilitating maternal health condition, particularly in low-income countries. The Mainz II pouch, a continent urinary diversion, is a last-resort surgical option for irreparable fistulas. Despite surgical success, little is known about long-term psychosocial outcomes in such settings. This study aimed to explore the long-term lived experiences and quality of life outcomes of women in rural Uganda who underwent the Mainz II pouch procedure for incurable obstetric fistula, with a focus on post-surgical equity and adaptation. Methods:This qualitative study, informed by biopsychosocial and feminist political economy frameworks, utilized in-depth interviews guided by a culturally adapted World Health Organization Quality of Life (WHOQOL-BREF) tool. Six women with obstetric fistula and one with a non-obstetric urological condition were purposively sampled and interviewed 5-14 years post-surgery. Thematic analysis using NVivo 12 followed a rigorous six-phase approach, with intercoder reliability (κ=0.82) ensuring analytical rigor. Results:Participants reported restored continence and improved physical functionality. However, ongoing nocturnal incontinence, psychological distress, and social stigma persisted. Younger women (23-33 years) adapted better compared to older counterparts (52-70 years), who faced challenges such as social isolation. Conclusion:Mainz II pouch surgery offers physical relief but insufficient psychosocial recovery. To address systemic inequities in post-fistula care, health systems in low-income countries must prioritize integrated, context-sensitive rehabilitation services that include mental health, sexual health, and long-term follow-up.

Two rapid assessments of avoidable blindness (RAAB) surveys were conducted in the Karamoja subregion, Uganda, in 2015 and 2023. This paper reports the observed changes in prevalence, causes of visual impairment and coverage of cataract services and examines how the trends differ for males and females. Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity (VA) exam, a lens exam, and a posterior segment exam using a direct ophthalmoscope for all participants with presenting VA < 6/18. Data was analyzed using an inbuilt command prtesti, and the regression models were developed using Stata v15 statistical software. In 2015, 3,833 participants were enrolled, and 96.8% (3,727) examined. In 2023, 3,450 were enrolled and 91.6% (3,159) examined. The prevalence of all-cause blindness was 6.0% in 2015 and 4.9% in 2023 (p-value = 0.05). The Cataract Surgical Coverage (CSC) for persons with visual acuity threshold of <3/60, < 6/60, and <6/18 was 41.6%, 34.2% and 20.5% in 2015 and 71.6%, 56.6% and 41.5% respectively, in 2023. The effective Cataract Surgical Coverage (eCSC) for the same vision category was 20.0%, 16.2%, and 9.2% in 2015 and 22.5%, 17.1% and 12.4% in 2023 The eCSC was consistently lower among females than males with the gap widening over the years: 15.9%, 12.1%, and 9.1% in females vs 28.4%, 21.6%, and 15.7% in males respectively. The CSC levels differed across assessments while eCSC values remained low. Targeted interventions are needed to improve post-surgical visual outcomes and ensure equity in access for women and individuals with moderate visual impairment.