Bachelors Medicine Laboratory Science

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Correlation of Cystatin C and Cardiovascular Risk Markers in Type 2 Dibetes Mellitus Patients Attending Mulago Hospital.
(International Health Sciences University., 2014-11) Nyanzi, Faisal.
Introduction: Cardiovascular disease is the main cause of death in Type 2 diabetic patient. Similarly diabetic nephropathy is the major risk factor for morbidity and mortality in diabetes mellitus patients. Cystatin C as a marker of renal function can facilitate the early prediction of cardiovascular risk along with the other classical markers in DM Type 2 patients. Cystatin C is identified as a promising marker of renal dysfunction and has emerged as a biomarker of cardiovascular risk. This study aimed to estimate and correlate the levels of plasma cystatin C with cardiovascular risk markers in type 2 diabetes mellitus patients. Methods: The study population included type 2 diabetes mellitus patients above 18 years of either sex. Among 129 diabetes mellitus type 2 patients, 125 patients were recruited and divided into group A with HbA1c ≤ 6.5% Hb and group B with HbA1c> 6.5% Hb. Fasting blood samples were analyzed for FBG, Total cholesterol, TRIG, HDL and Creatinine by enzymatic method. LDL by direct turbidimetric method. Plasma cystatin C and HbA1c were estimated by immunoturbidimetric method and hs-CRP by particle enhanced immunoturbidimetric method. Cardiovascular risk ratios TC/HDL, LDL/HDL and others were calculated. Results: About 73% of the patients recruited had poorly managed diabetes Patients with poor glycemic control (Group B, n = 91) had significantly higher values of hs-CRP (10.57 ± 4.58 mg/L), Total Cholesterol (4.56 ± 0.25 mmol/L), LDL (4.10 ± 0.25 mmol/L), TC/HDL (4.10 ± 1.39), LDL/HDL (2.56 ± 0.22) and Creatinine (68.52 ± 38.02). The study revealed a positive correlation between cystatin C and the endothelial inflammatory marker hs-CRP (r = 0.93, p = 0.001). Similarly HbA1c, LDL/HDL, Cholesterol and Triglycerides showed positive correlations with cystatin C of (r = 0.92, p = 0.022), (r = 0.81, p < 0.0001), (r = 0.80, p < 0.0001) and (r = 0.80, p = 0.022) respectively. Cystatin C also had a correlation with HDL (r = 0.71, p = 0.018). Creatinine and cystatin C also showed a positive correlation. (r = 0.48, p < 0.0001) Conclusion: Plasma cystatin C, a preclinical marker of renal dysfunction can be used as a predictive marker of diabetic dyslipidemia and cardiovascular risk in poorly controlled Type 2 Diabetes mellitus patients.
Bacterial contamination of Ward Items Predisposing Individuals to Nasocomial Infection at Kiwoko Hospital in Nakaseke District.
(International Health Sciences University., 2014-11) Wabuyi, Patrick.
Background: Contaminated environmental surfaces play an important role in transmission of nosocomial pathogens (Catano et al., 2012). These infections lead to increased rates of morbidity and mortality, staying longer in the hospital, indiscriminate and increased Use Of Antibiotics, And Increases On Hospital Expenses. The Study Was Therefore Carried Out To determine bacterial contamination of ward items predisposing individuals to nasocomial infection at Kiwoko Hospital, Nakaseke District. Methodology: Swabs were collected from 309 ward items (Stethescopes, Blood pressure machines, Bed pans, Examination beds, Nurse stations, Intravenous poles, Curtains and sinks) distributed over 7 wards (male medical, male surgical, female medical, female surgical, paediatric, opd and maternity). A total of 309 swabs collected were cultured on blood agar, Mackonkey agar, and identified using standard microbiological procedures. Antibiotic susceptibility testing was performed for all positive cultures. Results: The results showed that out of 309 items swabbed and cultured, 72(23.3%) were contaminated with bacteria. Staphylococcus. aureus was the highest contaminant 46(63.89%),followed by Pseudomonas species 12(16.67%), Proteus mirabilis 6(8.33%), Staphylococcus epidemidis 4(5.56%), Esherichia coli 2(2.78%) and Salmonella typhi species 2(2.78%). Male surgical ward presented with the highest contamination at 15/72(20.83%), then followed by Paediatric 11/72(15.28%), Maternity ward 10/72(13.89%), Female surgical ward 10/72(13.89%), Male medical ward 9/72(12.50%), OPD 9/72(12.50%) and the least being Female medical ward with 8/72(11.11%). Highly contaminated items were BP machines 26.39% and stethoscopes 25%, while Examination beds, Bedpans and intravenous poles were not contaminated. Conclusion: Ward items are frequently contaminated with bacteria and may be possible sources or reservoirs of pathogens causing nosocomial infection. Items routinely used and often carried by Health workers are frequently contaminated by bacteria for example BP machines and stethoscopes while those assumed to be often soiled like bedpans are always bacteria free. Therefore preventive measures should be followed.
Seroprevalence of Syphilis Among HIV Sero-positive Patients Attending Immuno-supressed Syndrome Clinic at International Hospital Kampala.
(International Health Sciences University., 2014-11) Achieng, Diana Inda.
Background Syphilis has been a persistent public health challenge for developing countries, especially among HIV pandemic regions. The interaction of syphilis and HIV co infection is complex and remains the subject of ongoing research. Studies demonstrate that sexually transmitted diseases (STDs) including syphilis, and particularly genital ulcers, are associated with an increased risk of HIV acquisition (Christopher et al., 2006). The study was carried out to determine the sero-prevalence of syphilis among HIV sero-positive individuals attending the Immune Suppressed Syndrome (ISS) Clinic at International Hospital in Kampala Touch Namuwongo Project (TNP). Methodology A cross-sectional study conducted between January to April 2014. A total of 150 HIV individuals were enrolled for the study. They were screened for syphilis using Rapid Plasma Reagin (RPR) and TPHA as a confirmatory test. Results: The sero-prevalence of syphilis among HIV sero-positive individuals attending the Immune Suppressed Syndrome (ISS) Clinic at International Hospital in Kampala Touch Namuwongo Project (TNP) was 10%(15/150). Conclusion: Prevalence was high 10%, females were more affected than males, and the commonly affected age group was 23-30 years, therefore there is a need for integration of syphilis diagnosis and management in HIV clients more so among the youths.
Knowledge and Attitude of Adolescents Towards Sex Education in Selected Secondary Schools in Gulu Municipal Council, Gulu District.
(International Health Sciences University., 2014-11) Rwotomiyo, Deogratious.
Adolescents' premarital sexual activities are increasing in the countries around the world, many of which are risky, unplanned and unprotected. School-based sex education is a promising medium for reaching many adolescents with fundamental health information and life skills that can prevent unintended pregnancies and sexually transmitted infections (STIs) including HIV/AIDS. The aim of the study was to assess the knowledge and attitudes of adolescents towards school based sex education in selected secondary schools, Gulu district. A descriptive cross sectional study was employed to assess the knowledge and attitudes of adolescents towards school based sex education in selected secondary schools, Gulu district. A total of 125 adolescents from different secondary schools within Gulu district were included in this study using probability, simple random sampling technique. A structured questionnaire was used to collect data. Data were entered in epi-info 3.5.4 which was transferred using Stata transfer into access and analyzed using SPSS version 16. From the assessment done majority of the respondents (69.6%) mentioned that their culture allowed sex education at the age with most of the respondents 83(66.4%) believing that sex education is very useful. Most of the respondents 83(66.4%) reported having sex education in the school, and 56(44.8%) of the respondents mentioned having sex education often. Majority of the respondents 110 (88.8%) knew something about sex education with half of the respondents 63 (50.4%) defining sex education as learning about sex. Most of the respondents 35 (28.0%) mentioned knowing about sex education from the health workers with majority of the students 39 (31.2%) reporting the use of radio as the most reliable source of information about sex education. Most of the respondents 111 (88.8%) think sex education is important, majority of the respondents 91(72.8%) attended sex education offered at the school; most of the respondents 83 (66.4%) mentioned that the schools have teachers who teach sex education, majority of the students 56 (45.8%) were motivated on sex education by their peer/friends. The study showed good knowledge and attitude towards sex education, HIV/AIDS, STIs and family planning and health workers were considered the most source of information and radio as the reliable source of information. Hence, providing constant supply of basic equipments and materials for sex education books, charts to improve on the gap is necessary.
Prevalence and Factors Associated with Positive Tuberculin Skin Test (TST) among Medical Students at International Health Sciences University, Kampala - Uganda.
(International Health Sciences University., 2014-11) Mugumya, Gilbert.
Background: Tuberculosis (TB) is a major public health issue worldwide. Medical students in TB burdened countries are thought to be at unfavorably high risk of acquiring TB since they are always in contact with these TB patients yet their safety precaution measures are minimal. This study therefore, was designed to determine the prevalence and factors associated with positive Tuberculin Skin Test (TST) among International Health Sciences University (IHSU) medical students. Methodology: This was a cross sectional experimental Tuberculin Skin Test (TST) survey involving 174 selected medical students pursuing Bachelors of Medical Laboratory Sciences (BMLS), Bachelors of Sciences in Nursing (BSN), Diploma in Clinical Medicine (DCM) and Bachelors of Sciences in Public Health (BscPH) in the academic year 2013-2014 from the first to the fourth year of their medical school. Questionnaires were given as well as administering TST to students who consented for the study. We used descriptive statistics to assess the significance of predictor variables. Dichotomous and categorical variables were tested using chi-square test and continuous variables were tested using t-tests. Results: The prevalence of positive TST among medical students was 23.1%. In year one, we found a prevalence of 11.8%; year 2 = 24.4%; year 3 = 28.3%; year 4 = 57.1%. Clinical students had a higher prevalence of positive TST (30.48%) compared to pre-clinical students (11.76%) (p = 0.004, OR=8.13). Independent predictors of positive TST were; prior clinical practice (chi = 17.45,p-value <0.0001), and household or hospital TB contact with a case of TB, (Chi = 14.1,p-value =0.0001). Conclusion: A prevalence of 23.1% TST among International Health Sciences University (IHSU) medical students indicates a possible exposure to nosocomial transmission of M. tuberculosis. The study indicated that, clinical students especially those offering Bachelors of Science in Nursing are more at risk of developing Tuberculosis (TB) compared to the pre clinical students though having knowledge or not about tuberculosis infection does not have any effect to TB contraction.
Prevalence and Factors Associated with Cryptosporidium Parvum Among HIV Sero-positive People Attending the HAART Clinic at Seeta Nazigo Health Center III Mukono District.
(International Health Sciences University., 2014-11) Bagonza, Winfred.
Background: Cryptosporidium parvum is one of the most common opportunistic intestinal parasites causing cryptosporidiosis a disease which is commonly found in HIV infected individuals and is currently listed as an AIDS defining illness by US Centers for Disease Control and Prevention (Hunter, 2003). Globally, the prevalence rate of Cryptosporidium infection may account ten to twenty percent (10%to 20%) for the cases of diarrhea in HIV infected patients living in developed countries and as much as forty percent (40%) in under privileged countries (Florez, 2003). It is therefore still a burden in management of HIV patients as shown in this study that was done at the HAART clinic at Seeta-Nazigo Health centre III-Mukono district. Purpose: The study was done to enable us establish the prevalence and associated factors of Cryptosporidium parvum among HIV positive patients attending the ART clinic at Seeta-Nazigo Health centre III-Mukono district. Method: A cross sectional study design was used. The target population was HIV positive patients attending the ART clinic at Seeta-Nazigo Health Centre III. A random sampling method was used under strict ethical consideration and professionalism to achieve a sample size of 300. From these 33 patients were positive for Cryptosporidium and 267 negative by modified Ziehl Nielsen stain. The collected data was analyzed with the help of Microsoft excel displayed in form of texts, bar graphs, and tables. Results: A prevalence of 11% was obtained from the study with 33 of the 300 participants being positive for cryptosporidium oocysts by modified Ziehl Nielsen. The prevalence of Cryptosporidium has then reduced as compared to the 40% by Florez (2003) done in Malaysia. No socio-demographic factor studied was found to be associated with Cryptosporidium oocysts. Among the individual factors it was only history of diarrhea that was found to be associated with cryptosporidium oocysts with a p-value < 0.001. Conclusion: 11% prevalence of Cryptosporidium oocysts still has paramount indication in the management of HIV patients. It was only history of diarrhea that was found to be associated with the prevalence of cryptosporidium oocysts
Intestinal Coccidia among People Living with HIV in Bugembe Health Center IV, Jinja District.
(International Health Sciences University., 2014-11) Bafulwime, Emmanuel.
Introduction: Opportunistic Coccidia parasites amongst other infections frequently complicate human immunodeficiency virus (HIV) infection by causing chronic diarrhea. The magnitude of these parasitic infections in HIV positive patients requires careful attention. However, there has been limited literature addressing this problem in Uganda. Material and methods: Across sectional study was conducted at Bugembe HC/IV Jinja District from January to April 2014 with an aim of determining the prevalence of intestinal Coccidia and asses for immune suppression among people living with HIV/AIDS who were attending Highly Active Anti-Retroviral therapy (HAART) clinic. One hundred and forty stool samples were collected from HIV infected adults and were examined microscopically for presence of intestinal Coccidia parasites using iodine stained wet preparation and modified ZN staining method. CD4 T cell enumeration was done using BD FACS count for each participant. Results: The overall prevalence of intestinal coccidiosis was 2.8% (4/140) with Cryptosporidium species mainly identified. Besides Cryptosporidium species, 18.6% (26/140) had other intestinal parasites, which included the following; 5.7% (8/140) Entemoeba histolytica, 5% (7/140) Giardia lamblia,4.3% (6/140)Schistoma mansoni and 3.6% (5/140)Strongloides stercoralis.All the four (100%) participants who were infected with Cryptosporidium had a CD4 count less than 200 cell/μl. Conclusion: This study shows that there is a significant association between intestinal Coccidia and HIV/ AIDS patients with low CD4 count (p=0.01).Therefore routine examination of the stool samples for Coccidia parasites especially Cryptosporidium species must be not limited to HIV infected individuals with CD4 count less than 200 cell/μl. The prevalence of intestinal coccidios is obtained in this study has an effect on morbidity and mortality especially in HIV infected patients and therefore warrants or suggests routine diagnosis and management of Coccidia parasites be incorporated in the routine HIV care and management. Keywords: Intestinal Coccidia, CD4 count, HIV/AIDS.
Liver Injury Related to Highly Active Antiretroviral Therapy in HIV Patients Attending ISS Clinic from Makerere University Joint AIDS Program.
(International Health Sciences University., 2014-11) Aol, Lilliane.
Background: The Hepatic system carries out numerous synthetic, excretion and detoxification functions, however only a minority of these can be measured by levels of products in the blood (Sulkowski et al., 2000). Patients with chronic viral illnesses such as HIV appear to be more prone to develop hepatotoxicity possibly because of impaired hepatocyte defense mechanisms (Ungo et al., 1998) or due to hepatotoxicity associated with drugs which are given to alleviate the burden of the infection (Bonacini et al., 2000). Several earlier retrospective studies and case reports have associated liver enzyme elevations with HAART regimens. The highest percentages World Health Organization (WHO) grade 3 enzyme elevations (30%) was reported with Ritonavir which manifested with increased liver enzymes (Save et al., 1999). On the other hand, a more specific signal for hepatic injury, serum bilirubin elevation, is rarely present hence affected individuals do not present with jaundice most time (Sulkowski et al., 2000). Purpose: To determine the best liver function marker in detecting drug induced hepatic injury Method: The study was a crossectional study. We consented 150 HIV/AIDS patients attending MJAP clinic in Mulago. Samples were obtained from each participant for hepatitis B and C screening and liver function test analyses (Albumin, total protein, gamma glutamyl transferase, aspartate transaminase, alanine transaminase, alkaline phosphatase, bilirubin). Participants’ baseline information for CD4 count, liver function test results and viral hepatitis status were obtained from medical archives at the clinic. Baseline and follow up results were compared with paired t – test and p value of < 0.05 was considered to be significant. Results: The differences between the baseline mean of Total protein and follow up mean (6 months after initiation of treatment) was not statistically significant; Albumin and alkaline phosphatase also showed a similar trend (p values > 0.05). The rest of the markers gave increased follow up values compared with baseline values with p values < 0.05. Conclusion: According to our study, serum ALT, AST, GGT and Bilirubin are the best markers for detecting drug induced liver injuries in asymptomatic HIV/AIDS patients.
Prevalence of Bacterial Enteric Pathogens among Children Under Five Years in Kampala District.
(International Health Sciences University., 2014-11) Nandala, Michael Wanzila.
Introduction: Diarrhea is the second leading cause of child mortality worldwide and a major problem in developing countries. Though precise data on childhood mortality associated with diarrheal diseases in Uganda is not available, it has been estimated that 19,700 children under 5 years die each year from diarrhea. The purpose of this study was to assess the prevalence of bacterial pathogens causing acute diarrhea in children under 5 years and identify the associated risk factors. Materials and methods: A total of 113 children under 5 years with acute diarrhea in Kisenyi HCIV and Komamboga HCIV were enrolled between January and April 2014. Fecal specimens for culture were sent to Central Public Health Laboratories and cultured on conventional media. The organisms were identified by different biochemical tests and confirmed by serotyping. The bacteria identified were subjected to antimicrobial susceptibility test using Kirby-Bauer‟s disc diffusion method. Results: The prevalence of bacterial enteric pathogens was 23.9% (27/113). The prevalence was greatest in the age group 10 – 29 months (14.2%). Major pathogenic organisms isolated were Escherichia coli 11 (9.7%), Shigella flexneri 7(6.2%), Salmonella typhi 1(0.9%), Salmonella paratyphi 4(3.5%), Shigella boydii 1(0.9%), Shigella dysentriae 2(1.8%) and Enterobacter species 1 (0.9%). Ciprofloxacin (85.2%) was the most sensitive antibiotic followed by Chloramphenical (37%). Among the isolates, 88.9% were resistance to Ampicillin and Sulphamethoxazole, 96.3% resistant to Tetracycline and 85.2% resistant to Nalidixic Acid. The major predisposing factors to enteric bacteria in children under 5 years were; Children drinking un treated water; not exclusively breastfed, not washing hands before eating and after visiting toilet and Children fed on leftover food. Conclusion: The prevalence of bacterial enteric pathogens was 23.9% in the under 5 year children. Commonly isolated pathogens were Escherichia coli and Shigella species. Therefore awareness on prevention of infectious diseases and efforts to improve personal and domestic hygiene should be encouraged. Keywords: diarrhea, bacteria enteric pathogens, children under five.
ABO Blood Group and its Relationship with Malaria among Febrile Outpatients at Mungula Health Center IV Adjumani District.
(International Health Sciences University., 2014-11) Ambayo, William.
Background: Malaria affects over 219 million and kills over 660 000 people every year, 90% of whom are in Africa and 85% of whom are children under five years of age. In endemic regions of Uganda such as the north western, malaria presents with diversity of clinical phenotypes that may be attributed to a number of factors including blood group. In the Ugandan setting, there is limited information on the relation between blood group distribution and malaria. Furthermore, available data on the relationship between blood group and malaria is contradictory. Thus, the aim of this study was to determine the distribution of ABO blood groups and its association with the clinical presentation of malaria among patients seeking medical attention at Mungula Health Centre IV (HCIV) in endemic Adjumani district. Methods: This was a cross sectional study that involved 275 participants of age between 6 months-45 years seeking medical attention at Mungula HCIV in Adjumani district. Blood samples were collected for blood smear microscopic examinations and blood group determination by the direct tiles method. Associations between blood group phenotypes and malaria presentation were determined using Chi square statistics. For all statistical tests, a P value of ˂ 0.05 was considered significant. Results: The predominant phenotype among the study population was blood group A (48.7%), followed by O (32.4%), B (14.2%) and AB (4.7%). The prevalence of uncomplicated malaria was 89.1%, where as 10.9% presented with severe/complicated malaria. Blood group „A‟ were 4.9 times more likely to suffer from complicated/severe malaria than blood group B [OR (95% CI) = 4.887 (1.109-21.53), P-value=0.0283]. None of the participants with blood group O or AB presented with severe malaria. Conclusion: Results indicated that blood group A phenotype may modulate severe disease. Absence of severe malaria among blood groups O and AB may suggest a protective role conferred by these blood groups against severe malaria.
Sero prevalence of hepatitis B among humans immuno deficiency virus infected individuals attending Naguru Hospital.
(International Health Sciences University., 2015-12) Aliguma, Edson
Introduction: Hepatitis B virus (HBV) is a world – wide public health concern with significant morbidity and mortality rates especially in developing countries. Objective: The major objective of this study was to determine the sero prevalence of Hepatitis B virus among HIV infected individuals attending Naguru Hospital. Determination of this prevalence was deemed as critical and important for the timely ninitiation of both drug therapy and proper public health measures like awareness and vaccination programs. Methodology: We conducted a cross-sectional study in which various samples were collected from HIV positive individuals attending Naguru hospital and further tested for Hepatitis B surface antigen and 11 individuals tested positive for this virus hence making a prevalence of 8% in the study. Results: Of these individuals enrolled we had the females with a bigger number than the males 93 and 45 respectively. The females were more infected 7(5.1%) than males 4 (2.1%). The age group between 30-39 having he highest number of Hepatitis B infected individuals with HIV 7(5%) Conclusion: Our study was conducted in an urban setting and at a prevalence of 8% we concluded that this is high and warranted urgent intervention and Heptitis B screening interventions.
Prevalence of Pulmonary Tuberculosis and Associated Risk Factors Among Inmates of Lira Central Prison, Lira Municipality, Mid- Northern Uganda.
(International Health Sciences University., 2015-12) Odyek, Alex
Background: Tuberculosis is caused by Mycobacterium tuberculosis, it is very contagious, airborne and a worldwide pandemic. It ranks as the second leading cause of death from a single infectious agent, after the human immunodeficiency virus (HIV). Each person infected with TB infects 10- 15 people on average yearly. People concentrated in congregated facility such as prison are important but often neglected reservoirs for TB transmission and threaten the entire community. Therefore this study was conducted to determine the prevalence of TB in Lira central prison. Methodology: We conducted a descriptive cross sectional study on the inmates at Lira Central Prison, two hundred and fourty six inmates were enrolled, their sputa was analyzed using the ZN technique. Objective: The main objective of this study was to determine the prevalence of pulmonary tuberculosis among inmates at Lira central prison as at July 2015. All inmates with cough for one or two weeks were included in the study. Results: Out of two hundred and forty six inmates enrolled, Four (04) out of 246 inmates screened were found to have pulmonary TB which translates as a prevalence rate of 1.62%. The infected age groups were 25-29 years (02) and 35-39 years (02) at that time. The prevalence of 1.62% as revealed by this study is lower compared to similar studies done in Mangaung Maximum prison South Africa by Peter Nyasulu et al, 2015 (8.8%). The prevalence of PTB is less common among the female inmates (00%). Recommendations: Improve the ventilation system of most of the wards where these inmates reside. The Uganda Prison Services should consider relocating some inmates to other nearby facilities which are not very congested. Mass screening of inmates and also screening at the entrance should continue to increase the detection rate of PTB.
Detection of Rhesus D (RhD) Variation Phenotype Among RhD Negative Blood Donors at Gulu Regional Blood bank.
(International Health Sciences University., 2015-12) Ojok, Polycarp
BACKGROUND: Rhesus D variant is a phenotypic variation of the Rhesus D antigen that does not show hem-agglutination with monoclonal anti D reagent in the immediate spin (IS). The Rh D variants is able to cause allo-immunisation with its associated risks like hemolytic disease of the foetus and new born (HDFN) , haemolytic blood transfusion reaction, and auto immune haemolytic anaemia when transfused to Rhesus negative individual . Currently there is no documentation on Rhesus D variants at Gulu Regional Blood Bank. To this, the study sought to determine the percentage of RhD variants among blood donors at Gulu Regional Blood Bank. METHODOLOGY: The study used EDTA anticoagulated blood samples collected from voluntary non renumerated blood donors (VNRBD) to screen for RhD status using IgG/IgM monoclonal anti-D grouping antiserum (Rapid Labs and Fortress Diagnostics), for such samples that tested RhD negative, these were analysed with polyspecific Coomb’s serum using indirect antihuman globulin (Coomb’s) test using hem-agglutination tube technique. RESULTS: A total 138 RhD negative samples were tested using indirect antihuman globulin for RhD variant, out of which 0.7% (n=1, 95% CI; 0.5-0.9 ). The RhD variants was detected only in blood group O phenotype. CONCLUSION AND RECOMMENDATION: The study revealed that, 0.7% of blood donors at Gulu Regional Blood Bank are RhD variant and because of the potential risk of allo-immunisation caused by these red blood cells, there is need to include indirect anti-human globulins test as part of routine blood donor typing. To this, the study recommends that Uganda Blood Transfusion Service (UBTS) ought to include routine serological testing of all RhD negative blood units for D variant phenotype to minimise on the potential risk of allo-immunisation imposed by these red blood cells even when monoclonal IgG/IgM is used for typing.
Methicillin Resistant Staphylococcus Aureus Among Patients On The General Wards At Kawolo General Hospital, Uganda.
(International Health Sciences University., 2015-12) Walusimbi, Apollo
Introduction: Over time there has been a global increase of antimicrobial resistances among Staphylococcus aureus (S. aureus) with MRSA persistently becoming rampant especially among hospitalized patients. This has limited the choices for management with increasing treatment costs. Aim: This study aimed at establishing the prevalence of Methicillin Resistant S. aureus among patients admitted in the general wards at Kawolo general hospital, Uganda. Methodology: A cross sectional laboratory based experimental study was done. Samples included nasal and wound swabs from patients on female, male, and the peadiatric wards to isolate S. aureus that colonised the nares or caused wound infections. Drug susceptibility was done by Kirby Bauer method from which Methicillin resistant S. aureus (MRSA) were identified. Also, Multi drug resistant (MDR) and possible Extra drug resistant (XDR) S. aureus were identified. Results: A total of 204 samples were collected from 87 (42.57%) females and 117 (57.43%) males. Samples that grew organisims were 182 (89.2%) while 22 (10.8%) showed no growth. Among those that grew, 102/182 (56.04%) were S. aureus while 80/182 (43.96%) were other organisims. Among the S. aureus isolates, 44/102 (43.14%) were MRSA while 58/102 (56.86%) were MSSA. Samples from the female, male, and the peadiatric wards showed that 8/26 (30.77%), 26/50 (52%), 10/26 (38.46%) participants had MRSA respectively. Susceptibility testing showed that S. aureus was more susceptible to vancomycin > Gentamycin > Clindamycin > Erythromycin > Penicillin G > Trimethoprim sulfamethoxazole. Against the MRSA isolates, only vancomycin showed excellent performance with 100% sensitivity followed by gentamycin with a sensitivity of 24/44 (54.55%) but MRSA was a big predictor of gentamycin resistance (OR: 11.25, P-Value < 0.0001). A total of 92 (90.2%) S. aureus isolates were resistant to at least one antibiotic used among which 46/92 (45.10%) isolates were MDR, while 14/92 (13.73%) isolates were possible XDR. Conclusion: There is a high prevalence of MRSA in Kawolo general hospital. Before treatment, antimicrobial susceptibility should be done or where facilities are unavailable, vancomycin should be the drug of choice in empirical treatment/management of infections with MRSA. Also Trimethoprim sulfamethoxazole and Penicillins should not be used in any presumed MRSA infection in all places with limited isolation facilities.
Prevalence And Associated Risk Factors Of Selected Intestinal Parasites Among Pupils Of Kalongo Town Council, Agago District.
(International Health Sciences University., 2015-12) Rubangakene, Innocent
Intestinal parasitic infestations (IPIs) are among the neglected tropical diseases yet widespread and also regarded as one of the leading causes of disease worldwide. Knowledge of the burden and transmission of these parasites would be important in designing effective approaches in the control and elimination of these parasites in different settings. In this study, the prevalence and factors associated with intestinal parasitic infestations among pupils of Kalongo town council, Agago district was determined. This was a cross-sectional study conducted between February and July 2015, involving 383 school going children. Stool specimens were collected from the children and examined both macroscopically and microscopically. Questionnaires based interviews were conducted to obtain information on factors associated with intestinal worm infestation. The prevalence level of intestinal parasitic infestation was 42.8%. The predominant parasite was Giardia Lamblia. Knowledge of intestinal worm infestation, utilization of health facility, de worming and wearing of shoes were shown to confer protection against intestinal worm infestations. School grade, employment status, handling of fecal matter and hygiene, proximity to water body, playing in water bodies , use well/tap water for home consumption were shown to be associated with increased prevalence of intestinal worm infestations. The high prevalence of intestinal worm infestations among pupils from Kalongo Town Council calls for regular de worming programs to ensure reduction in the prevalence rates. Transfer of effective de worming models from health facilities to schools would not only ensure a wider coverage, but allow for adherence to the regular de worming intervals recommended by the National policy. In addition Health education programs on control and prevention of intestinal worms should be emphasized.
Prevalence And Antimicrobial Susceptibility Pattern Of Bacterial Pathogens Associated With Childhood Septicemia At Lancet Laboratories, Kampala, Uganda.
(International Health Sciences University., 2015-12) Komakech, Christopher
Childhood septicemia remains the leading cause of morbidity and mortality among children aged 0 - 12 years in developing countries. Appropriate choice of antimicrobial agents for treatment and management depends on adequate knowledge of the bacterial agents and their antimicrobial patterns recovered from positive blood culture in the healthcare settings. In this study, the prevalence of septicemia, the microbial profile and antimicrobial susceptibility patterns to the common antibiotics used in treatment of childhood septicemia was determined. This was a cross-sectional study conducted between February and July 2015 at Lancet laboratories, Kampala among 211 children. Antimicrobial susceptibility testing and selected laboratory investigations were carried out on 33 culture positive specimen. Data were cleaned and analysed using Excel. The prevalence of septicemia was 16% (33/211); high bacterial isolation rate was recorded within the age group 0 to 2 years (46%) and lowest among the 9 to 11 year olds. Gram positive isolates accounted for 73% pathogens isolated compared to gram negative isolates 27%. The most common isolates were Coagulase negative staphylococcus (45%), Staphylococcus aureus (15%), Salmonella typhi (12%) and Salmonella species (6%). Other less common pathogens included Listeria Monocytogenes (3.0%), Klebsiella pneumoniae (3.0%), Sphingomonas paucimobilus (3.0%), Acinetobacter (3.0%), Pseudomonas aeruginosa (3.0%) and Streptococcus viridans (3.0%). High antimicrobial sensitivity was observed with Vancomycin, Cloxacillin, Ceftriaxone, Gentamycin, Imipenem and Ciprofloxacin where the least sensitivity was observed with Erythromycin and Tetracyclin. From these findings, there is need for continuous surveillance of the burden of septicemia and antimicrobial susceptibility profiles in different study settings. Erythromycin and tetracycline showed highest resistance, thus not the best choice of drugs for treatment of septicemia in this setting. Ministry of Health should ensure continuous surveillance of the burden of childhood septicemia and the causative organisms in different study settings.
The Effect of Antiretroviral Therapy on Haematological Indicies Among Adults Attending Immunosuppression Clinic at Entebbe General Hospital.
(International Health Sciences University., 2015-12) Ingabire, Gloria
Background: Cytopenias are the most common haematological abnormalities among HIV positive patients, a predictor from HIV infection to AIDS. Cytopenias have become more common with the advent of antiretroviral therapy and related treatments for HIV associated infections and malignancies. The use of antiretroviral therapy (ART) for management of patients infected with HIV has had a positive impact on growth, survival, and general wellbeing of children and adults in both resource-rich and resource-poor settings. Data from limited settings like Uganda about the effects of ART on haematological parameters are limited or non-existent in some health settings. Objective: To assess the effects of different ART regimens on hematological indices among adult HIV positive patients attending ISS clinic at Entebbe General Hospital. Methodology and Results: A total of 307 HIV positive adults were enrolled in the study. The mean age of the participants was 33 years with a median age of 31 years. 53.1% (163/307) were married and 46.9% (144/307) single. 37.8% (116/307) were on Septrin prophylaxis while 62.2% (191/307) were on different ART regimens. Cytopenia was common among ART users than Septrin users with granulocytopenia being the most common form at 64.5% (198/307) especially among those on CBV/NVP regimen (37.9%). Thrombocytopenia was 7.5% (23/307) and common among participants on Septrin and CBV/NVP (47.8%) regimen, anaemia was 20.8% (64/307) and common among those on Septrin (33.3%) while 53.1%(163/307) had CD4 counts below 500cells/ml. Conclusion: Cytopenias were common in the study and highly associated with CBV/NVP regimen, which indicated that the regimen was one factor for cytopenia. Therefore constant monitoring of cytopenia and early intervention may decrease the prevalence of cytopenias among HIV positive patients.
Cryptosporidiosis Among Hiv/Aids Patients Attending The Art Clinic Of International Hospital Kampala.
(International Health Sciences University., 2015-12) Kyagulanyi, Peter
INTRODUCTION: Cryptosporidiosis is an intestinal infection caused by the protozoan parasites, cryptosporidium. In immune-competent individuals; the infection is usually self-limiting and asymptomatic while in patients with the Human Immunodeficiency Virus (HIV), it causes an opportunistic infection resulting into severe, chronic and sometimes fatal diarrhea (Iqbalet al., 2012). OBJECTIVE: The main objective of the study was to establish the magnitude of cryptosporidiosis and associated risk factors among HIV/AIDS patients attending Touch Namuwongo Clinic of International Hospital Kampala. METHODOLOGY: A cross sectional study was carried out on 150 HIV/AIDS patients using a non- probability procedure from April to June 2015. Stool samples were collected from each patient and examined using the Modified ZN method, while the most recent CD4 levels were retrieved from the patients’ medical files. Comparison of the variables was done using odds ratios at 95 % confidence interval to establish which socio- demographic factor was associated with cryptosporidiosis. Data from the questionnaires was entered into an excel spreadsheet and presented in bar charts and pie charts. RESULTS: participants in the study, 14(9.3 %) had cryptosporidiosis while 90.7% were negative for the infection. The infection was more common in the age range of 21-40 years. Majority of the participants, 64.7% (97/140) were females with males accounting for 35.3 % (53/150). From the total participants, only 14% (21/150) presented with diarrhea while the majority 86 % (129/150) presented with no diarrheic stool. Among the positive cases, 64.3% (9/14) presented with diarrhea while 35.7% (5/14) were asymptomatic. Cryptosporidiosis was more evident in patients whose CD4 levels had dropped below 400cells/mm3 and less evident in those with levels above 400cells/mm3 CONCLUSION AND RECOMMENADTIONS: The prevalence of 9.3 % indicates that closely 1 in every 10 attendants at the clinic has cryptosporidiosis infection cryptosporidiosis which exposes them to the life threatening diarrhea. patients with cd4 levels dropping below 400cells/mm3 are equally likely to get the infection and indeed should receive special consideration for cryptosporidiosis diagnosis especially when they present concurrently with diarrhea. I therefore, recommend the inclusion of the diagnosis of cryptosporidiosis in the routine stool analysis and thus management of these patients especially those who present particularly with diarrhea and cd4 below 400cells/mm3.
Antibiotic Susceptibility Profile of Salmonella and Shigella Among Patients Attending Kiswa HC IV - Kampala.
(International Health Sciences University., 2015-12) Nkodyo, Josph M
Background: Diarrheal illnesses continue to pose health challenges, with significant morbidity and mortality among people from such areas where hygiene is substandard. Among enteric pathogens, Salmonella and Shigella species are of particular concern as causes of enteric fevers, food poisoning and gastroenteritis. Antibiotic resistance is an emerging global burden that accelerates rapid colonization of resistant microorganisms which favors rapid global spreading of such strains. Objective: Owing to weaker infection control measures, there has been an increased spread of multi drug resistant (MDR) strains, as seen following outbreaks. Antibiotic resistance to Salmonella and Shigella are emerging global challenges owing to increased wrong usage of antibiotics both in humans and animals of which humans consume as meat, milk and associated products. Despite several reports on outbreaks of Shigella and Salmonella, there is paucity of data in several Kampala suburbs; thus, the study sought to determine the prevalence of Salmonella and Shigella species, and their antibiotic susceptibility patterns to commonly used antibiotics among patients attending Kiswa HC IV. Materials and methods: The study enrolled 120 adult participants after obtaining an informed consent. These were cases with clinical suspicion of Salmonellosis and Shigellosis. Participants‟ stool samples were collected, preserved and immediately analyzed in the Laboratory using culture technique onto Xylose Lysine Deoxycholate (XLD) agar and incubated overnight at 37°C. Positive samples were investigated using biochemical tests, and drug susceptibility testing (DST) using Ceftrioxone (30μg), chloramphenicol (30μg), ciprofloxacin (5μg), gentamicin (10μg), nalidixic acid (30μg), Cotrimoxazole (25 μg) Ampicillin (10 μg) and amoxicillin (20μg). Results: The prevalence of Salmonellosis was found to be 17.2% (95% CI; 14.9-19.1). On the other hand, the prevalence of Shigellosis was 6.8% (95% CI; 2.6-8.9). The overall prevalence of Shigella and Salmonella species was reported at 24.0% (95% CI; 22.6-26.1). The highest prevalence was among men at 16 (55%) while among women, it was at 13(45%). Most of the seropositive were from males, implying that male gender is dependently associated with risk of typhoidal fever (P=0.001). The drug susceptibility pattern to isolated species was Ampicillin: 69% sensitive, Ceftrioxone: 62% sensitive while isolates were resistant to Pefloxacin. Conclusion and recommendation: This study reports high occurrence of Salmonella and Shigella species in a capital city suburb following an outbreak. The study also reveals a high risk of antibiotic resistance to the commonly used agents which may be attributed to low surveillance and weak, or inexistent regulations of the use of antibiotics in the health care systems. We recommend public health awareness campaigns about hand washing, personal hygiene, provision of safe drinking water and regular screening of food handlers to eliminate any risk of transmission. Additionally, antimicrobial use ought to be restricted to the prescription of a health professional, and in to such, it is vital to complete the full prescribed dosage.
Intestinal Schistosomiasis and Associated Risk Factors in Children 6 to 15 years in Bugoto Primary School, Mayuge district.
(International Health Sciences University., 2015-12) Enzaru, Annet
Background: Schistosomiasis, is a parasitic neglected tropical disease (NTD), and is one of the major global public health concerns especially in the tropical and subtropical regions with 90% of the infections coming from Africa. Thus causes loss of productivity due to disability among a fraction of the world’s most disadvantaged population, therefore, causing an estimated 3.3 million disability adjusted life years. For this reason , investigations were done and the prevalence and associated risk factors of intestinal schistosomiasis were determined.among school children of age group 6 to 15 years attending in Bugoto primary school Mayuge district Uganda. Objective: To determine the prevalence and associated risk factors of intestinal schistosomiasis among school children of age group 6 to 15 years attending in Bugoto primary school Mayuge district Uganda. Methodology: A cross sectional study was carried out among the primary school children. A total of 380 randomly sampled study participants provided stool samples for the parasitological examination by the kato_katz technique. Statistical analysis was performed using spss software version 15. Results: From 380 pupils examined, 47.9% were found to be infected with intestinal schistosomiasis, with Schistosoma mansoni being the most prevalent at 100% where low, moderate and heavy infection intensities were observed ranging from as low as 24 eggs per gram to as high as 8064 eggs per gram. Conclusion: Frequent exposure to the lake through playing, carrying out domestic activities like washing clothes and utencils, digging in the swamps and economic activities like fishing and trade in fish, lack of latrines and poor latrine usage are exposing risk factors to acquiring the intestinal schistosomiasis infection.

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