Bachelors Medicine Laboratory Science

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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.
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.
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.
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.
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.
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 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
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 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.
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 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.
Prevalence and Selected Risk Factors Associated With Hepatitis B Virus Infection in Pregnant Women Attending Antenatal Clinic at Arua Regional Referral Hospital.
(International Health Sciences University., 2015-12) kabaka, Angurini
Background: The study was conducted at Arua regional referral hospital on pregnant women who were attending antenatal services with the aim of determining prevalence and selected risk factors associated with hepatitis B infections from July to August 2015. Methodology: Blood samples were collected from the participants and tested for HBsAg antibodies using specific HBsAg test strips [plasmatec] and those tested positive were retested using ELISA [Murex] for confirmation. Results Out of 140 pregnant women who participated in the study, 12 (8.6%) tested positive and 128 (92.4%) tested negative. None of the selected risk factors; age, level of education and knowledge of pregnant women towards hepatitis B infections all did not show positive significance towards hepatitis B sero-status as all their p-values were > 0.05 and to consider a given risk factor to show positive significance p-values was considered to be < 0.05 at 95% Confidence Interval. Participants were categorized in age group as 15 – 25 with total of 79 (56.4%) of these 9 (11.4%) tested positive and 70 (88.6%) tested negative, 26 – 35 with total of 49 (35%) of these 3 (6.1%) tested positive and 46 (93.9%) tested negative and 36 – 45 with total of 12 (8.6%) of these none tested positive and 12 (100%) tested negative and the study results reveal a non-significant positive relationship (r = 0.121, P = 0.155) between hepatitis B sero status and age. In assessing the levels of education , 15 (10.7%) did not attend formal education and of these 2 (13.3%) tested positive and 13 (86.7%) tested negative, 59 (42.1%) attended primary education and of these 5(8.5%) tested positive and 54 (91.5%) tested negative, 43 (30.7%) attended secondary education and of these 2 (4.7%) tested positive and 41 (95.3%) tested negative, 20 (14.3%) attended tertiary education and of these2 (10%) tested positive and 18 (90%) tested negative and 3 (2.1%) were students of these 1(33.3%) tested positive and 2 (66.7%) tested negative and the results indicate a non-significant positive relationship (r = 0.007, P = 0.938) between hepatitis B sero status and level of education. Participants’ knowledge were also assessed where 51 (36.4%) did not have any knowledge at all and of these 4 (7.8%) tested positive and 47 (92.2%) tested negative, 53 (37.9%) had scanty knowledge and of these 3 (5.7%) tested positive and 50 (94.3%) tested negative and 36 (25.7%) had adequate knowledge and of these 5 (13.9%) tested positive and 31 (86.1%) tested negative and the findings showed a non-significant positive relationship (r = -0.074, P = 0.388) between hepatitis B sero status and Knowledge on Hepatitis B infection. Conclusion: The prevalence of hepatitis B among pregnant women attending antenatal services at Arua Regional Referral Hospital is high (8.6%) with age group 15 – 25 mostly affected and high in participants who did not attend formal education and those who attended primary education as the highest education level. Therefore as a recommendation, pregnant women should be screened for hepatitis BsAg antibodies and routine sensitization of the pregnant women about hepatitis B infections to continue during antenatal visits at Arua Regional Referral Hospital.
Determination of Glycosylated Haemoglobin Levels in Type II Diabetes Mellitus Patients on Different Drug Regimens at Mengo Referral Hospital.
(International Health Sciences University., 2015-12) Emou, Frederick
Introduction: Glycosylated haemoglobin has been known for some time as a critical marker in monitoring compliance to treatment by diabetic patients. With a single measurement, glycosylated haemoglobin can quantify average glycaemia over weeks and months, thereby complementing day to day testing. Glycosylated haemoglobin reflects a mean glycaemia over the preceding 2 to 3 months, measurement approximately every 3 months is required to determine whether a patient‟s metabolic control has reached and maintained within the target range. Glycosylated haemoglobin is not routinely used to monitor patients on treatment in MRH. Objectives: The main objective of the study was to determine the glycosylated haemoglobin levels in diabetic patients taking different drugs. Methodology: A cross-sectional study to measure glycosylated haemoglobin levels in diabetic patients who attended Diabetic clinic at Mengo Referral Hospital in Namirembe Rubaga division was carried out between August-October 2015 and 135 patients participated in the study. The method used to determine their HbA1c levels was using the Cobas Integra ® 400 Plus. In the Ethical consideration, the study was submitted to the; faculty, ethics, IHSU and MRH research committees for approval. Results: Out of the 135 participants, 57 (42.2%) were males and 78 (57.8%) were females. Only 26 (19.3%) of the participants had good glycaemic control (HbA1c <7.0%) and the rest had poor glycaemic control. Using multiple regression model, our study found out that, diabetic drugs had similar efficacy in achieving glycaemic control. Metformin was a better drug in achieving glycaemic control compared to insulin and glibenclamide. Conclusion: Most diabetic patients in Mengo hospital have poor glycaemic control. Metformin is a better drug in controlling hyperglycaemia and FBS is related to HbA1c Recommendation: HbA1c level should be adopted in monitoring diabetic patients on treatment as to detect and control their hyperglycaemia. A study with a bigger sample size from different diabetic clinics should be done to assess for the best drug to use in diabetic patients.
Uropathogens among diabetic patients with urinary tract infections attending the diabetic clinic in Jinja regional referral hospital.
(International Health Sciences University., 2015-12) Nabaigwa, Barbara Irean
Introduction: Urinary tract infections (UTIs) are a major problem among the diabetic patients with a higher risk of acquiring the infection than their non-diabetic counterparts. This may be due to both host and local risk factors in diabetic patients. The predisposing factors for UTIs in diabetic patients includes invasion of the urinary tract with different microorganisms, glycosuria and impaired functioning of the granulocytes. UTIs in diabetes mellitus can lead to cystitis, pyelonephritis, impaired functioning of the leucocytes, recurrent vaginitis, emphysematous complications and renal abscesses when there is poor glycemic control. Objective: The study was conducted to establish the uropathogens causing UTI among diabetic patients attending the diabetic clinic at Jinja Regional Referral Hospital. Methodology: A cross sectional study was conducted from May to August 2015, where midstream urine samples from a total of 210 consented diabetic patients were obtained for analysis. The urine samples were transported to the laboratory. CONCLUSION: All the urine samples were subjected to routine urinalysis to determine their suitability for culture test. One hundred and fifty nine (159) urine samples had more than 10 pus cells per high power field of a light microscope (x 40 objective) and were cultured on blood agar, MacConkey and CLED. Forty one (41) urine samples were not cultured as they did not qualify for it. Growths were inspected after 18 – 24 hours of incubation and colony counts performed. Cultures with significant growth were identified using biochemical identification techniques. The data were entered in excel and exported to STATA version 11. Chi square test was used to show associations between two categorical variables and results were presented with 95% confidential interval was used to report the mean. Results: The mean age of the participants was 51 years with a 95% confidence interval of 25 – 77 years. Out of the 159 samples 35/159 (22.01%) showed significant bacterial growth and of the isolates Staphylococcus areaus, (18/35, 51.43%) was the commonest, (12/35, 34.3%) were E. coli, (3/35, 8.6%) were Klebsiella spp and the rest were either Citrobacter or Moganella morgani (1/35; 2.86% respectively). Significant bacteria was associated with hyperglycaemia (Pearson [chi] 2; 74.6 p value 0.0001) and symptoms such as fever, painful urination (dysuria), lower abdominal pain and heamaturia (Pearson chi [1], 3.95 p value 0.047) RECOMMENDATION: This study highlighted that the occurrence of the uropathogens causing UTIs are high especially among the diabetic women. This calls for periodic screening of diabetic patients both in symptomatic and asymptomatic patients.
Microbial Contaminants Isolated From Items And Work Surfaces In The Post- Operative Ward At Kawolo General Hospital, Uganda.
(International Health Sciences University., 2015-12) Sserwadda, Ivan
Introduction: Medical care equipment and hospital work surfaces play a major role in the accommodation of pathogenic bacteria. As such, they act as modes of transmission of these organisms among patients giving rise to nosocomial infections. Consequences of such infections include morbidity and mortality of the patients and increased antibiotic resistances amongst others. Objective: This research was aimed at determining the microbial contaminants present on medical items and work surfaces in the post-operative surgical ward at Kawolo general hospital and their susceptibility patterns to antibiotics. Methodology: A cross sectional and laboratory based study was conducted for the research. Sterile swabs were used to collect samples from medical equipment including scissors, infusion stands, beds and work surfaces which were composed of tables, sinks and taps. The samples were processed and the antimicrobial susceptibility patterns of the identified isolates were assessed and further classified as MDR, XDR and PDR. Results: Out of the total 138 swabs that were collected and processed, the overall prevalence of bacterial contaminants was 44.2% (61/138). The Gram positive organisms constituted of 75.4% (46/61) while the Gram negative organisms accounted for 24.6% (15/61). All the Gram positive organisms isolated were Staphylococcus aureus, while the Gram negative bacteria isolated had Klebsiella pneumoniae with 7(11.5%), Proteus vulgaris, Enterobacter species and Serratia merscescans representing 5(8.2%), 2(3.3%) and 1(1.6%) respectively. The items that had the highest level of bacterial contaminants that were isolated were infusion stands and patient beds from which 12 swabs (19.67%) had isolates followed by tables and sinks represented by 10 (16.39%), scissors with 9 (14.75%) and light switches with 8 (13.11%). Statistically, contaminated patient beds were the most likely medical care equipment that were capable of transmitting organisms to the patients with OR: 20.1 and p value 0.0008. Antibiotic susceptibility patterns for Gram positive isolated revealed that vancomycin was the most effective antibiotic with 100% while ciprofloxacin and ceftriaxone were the most effective antibiotics for Gram negative isolates both with 80% sensitivity. MDR for Staphylococcus aureus accounted for 52% (24/46) with 4% (1/24) classified as a possible XDR. Gram negat ive isolates had 27% (4/15) MDR strains out of which 50 %( 2/4) were classified as possible PDR. Conclusion: The high prevalence of bacteria present on the medical equipment at Kawolo hospital is an indicator of ineffective decontamination. A microbiology unit should be put in place for routine isolation and susceptibility testing of bacteria before antibiotic treatment to combat increasing drug resistance trends together with an infection control surveillance system.

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