Bachelors Medicine Laboratory Science

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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.
Antibiotic Resistance Patterns Among Gram Negative Bacteria Isolated In Urine Samples Received At Lancet Laboratories Uganda
(International Health Sciences University., 2018-12) Bogere, Alan
There has been increasing resistance of Gram negative bacteria causing UTI to several antibiotics over years around the globe and has complicated management of UTI especially in under developed World. Study was carried out at Lancet Laboratories to assess the antibiotic resistance patterns so that effective antibiotics are identified especially for empirical management of UTI. A cross sectional study was conducted on a total of 200 urine samples received at Lancet Laboratories Buganda Road from February to May 2015 to determine antimicrobial resistance pattern on Gram Negative bacteria. Mid-stream Urine was received and Cultured using standard Microbiology procedures, sensitivity was done using Kirby Bauer method. The overall prevalence of Gram Negative bacteria that caused UTI were at30.5 %( 61/200),E. coli as the most prevalent with (80.3%: 49/61) followed by Proteus mirabilis (4/61, 6.71%), Serratia Species (3/61:4.9%), Raoultella ornithinolytica (2/61:3.2%), KlebsiellaPneumoniae (2/61:3.3%) and Kluyvera Species (1/61:1.6%).ESBL had a prevalence of 44.3% out of the 61 E. Coli were ESBL producer at a rate of 85.45% followed by Serratia species(7.2%), Proteus Mirabilis(3.7%) and Klebsiella pneumoniae (3.7%).ESBL producing organism are more responsible to the production of XDR compared to MDR, XDR were noted more prevalent with 42.6% more than MDR (13.1 %.). Fosfomycin, Ertapenem, Meropenem, and Imipenemwere the most effective antibioticsfollowed by Amikacin and Nitrofurantoin, the least effective were Ampicillin and Cephazolin.
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.
Assessment Of Anticoagulation Control Among Adult Patients On Warfarin Therapy Attending Uganda Heart Institute.
(Clarke International University., 2022-02) Bamwange, Beatrice
Background: Warfarin is an oral anticoagulant prescribed worldwide with a narrow therapeutic index and wide interindividual variability in dose requirement. Due to its difficult in predicting an accurate dose for an individual, it predisposes patients to risks of thromboembolism or even hemorrhagic events associated with underdoing or overdosing respectively. Thus, Time in Therapeutic Range (TTR) is recommended to monitor warfarin anticoagulation control with TTR >60% considered as well controlled. This study assessed the performance of warfarin and associated patients’ and institutional factors on anticoagulation control among adult at UHI, Mulago Hospital from July to October 2021. Methodology: In this study, 157 patients were enrolled, aged 18 to 80 years on warfarin as an anticoagulant control for not less than six months and had a minimum of three INR results. Consecutive and convenient sampling of all patients was done. Patients’ previous three INR results were retrieved from their respective files plus the INR test done on the review date and these were used to calculate the TTR using the Rosendaal’s method of linear interpolation. Quantitative data was entered into MS excel and later exported to the STATA SE13 for analysis while qualitative data was coded manually to generate themes. A TTR >60% was considered good control. Results: The average TTR among the study participants as 45.97% (95% CI=41.51-50.44) and a median of 43% (IQR=24-67). Only 31.21% had a TTR >60. The association between controlled TTR was assessed with; gender, education, comorbidity, comorbidity medication, missed taking warfarin, vitamin K food substance use, use of non–prescribed substances, indication for warfarin, accessing warfarin, paying for warfarin and knowledge regarding warfarin use. Using chi square test and a p value of 0.05, none of the factors was associated with the poor warfarin anticoagulation control. Participants had their views about the services offered at UHI including; appreciation of the cheaper services and quality time with health workers. There were reports on inadequate doctors and long clinic distance. Conclusion and recommendation: There was inadequate anticoagulation control among adult patients on warfarin therapy attending Uganda Heart Institute, Mulago Hospital with a TTR of 45.97 %.The anticoagulation performance of Warfarin was thought to be intrinsic, not affected by the external factors. Therefore, a need to change individuals who are not responding on warfarin to a superior anticoagulant.
Assessment Of The Tuberculin Skin Test Positivity Rate Among Students Of International Health Sciences University
(International Health Sciences University, 2018-12) Kabera, Michael
Back ground: TB latency has created a serious hindrance to Global TB control. The Tuberculin skin test (TST) can be used to detect Latent tuberculosis infection (LTBI) and appropriately inform TB control programs. The main objective of this study was to at assess the Tuberculin skin test (TST) positivity rate among all IHSU students. Methods: A cross sectional research study design was used to assess the positivity rate of tuberculin skin among students at International Health Sciences University (IHSU) in August 2018. 0.1ml of Purified protein derivative (PPD) was intradermally introduced on long axis of the fore arm. An induration of ≥5 mm diameter was taken to be positive. Univariate and multivariate method were used to assess the risk factors associated with LTBI. Results: A total of 205 participants were sampled for TST test. The TST positivity rate was years (Z= 2.96, P=0.023) courses of Laboratory (Z= 3.12, P=0.002) and Nursing (Z= 2.21, P=0.027) long time of clinical placement for more than four months (Z= 3.81, P=<0.001) and smoking (Z= 3.97, P=<0.001). Conclusion and recommendations: Tuberculin skin test positivity rate among IHSU students was lower than the studies around Kampala and male students were more affected than girls. The risky factors were associated with a positive LTBI were age, course, duration of placement and smoking. This suggests that health care providers should put on protective equipment like N95 masks, work under Bio safety cabinets and carry out routine screening test for LTBI. Those found positive be advised to do further tests like Zeihl Neelsen, Chest X-ray and culture and sensitivity Keywords: Latent tuberculosis infection, Tuberculin skin test and TB control.
Assessment Of Truehb ® Point-Of-Care Hemometer Among Patients Attending International Hospital Kampala
(International Health Sciences University., 2018-12) Ndeze, Ivan
Background: Accurate determination of hemoglobin (Hb) levels is vital to elucidate the extent of anemia, and thus a guide to clinical and research care in harnessing timely diagnosis. This study assessed the diagnostic performance of TrueHb ® point-of-care hemometer at International Hospital Kampala, Uganda. Methods: We analyzed ethylene-di-amine tetra acetic acid (EDTA) blood samples to estimate Hb levels using parallel testing with TrueHb® hemometer and Sysmex i3 analyzer. Data was analyzed using STATA 12 (College Station, TX, USA) to ascertain diagnostic performance of the test assays using the Bland and Altman method. Sensitivity, specificity, positive and negative predictive values were calculated. Results: We analyzed 402 EDTA blood samples, the mean difference of the two methods was 2.2219 (SD 1.07915),p-value 0.017 The accuracy of the two assays as measured by the intra- class correlation coefficients (ICC), the average measure was 0.793, which indicated a substantial correlation between the two assays. The average performance TAT for the machine was 2.46 minutes (95% CI= 2.37-2.55) Conclusion: The TrueHb® point-of-care hemometer could be an accurate point of care tool for screening anemia with recalibration done positively by 2.22g/dl. The TAT for the TrueHb® meter is convenient.
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.
Bacterial Pathogens Isolated From Drinking Water Sources In Different Homes In Namugongo-Janda Village, Wakiso District .
(Clarke International University., 2021-11) Banana, Afia
ABSTRACT Background: Availability of healthy drinking water sources is a main concern world over. In Uganda, 80% of all infections have been directly linked to poor-quality drinking water due to contaminants arising from unsanitary conditions. This study isolated bacterial pathogens from different homes' drinking water sources in Namugongo-Janda village, Wakiso district, and determined their antimicrobial susceptibility patterns as well as the factors associated with bacterial contamination in drinking water. Methods: A total of 20 drinking water samples were collected using 300 ml sterile glass bottles. Samples were cultured using Muller Hinton and MacConkey agar, identification was done using the biochemical tests and drug sensitivity testing (DST) was done using Muller Hinton Agar. Additionally, a questionnaire was used to assess the associated factors for water contamination. Results: The analysis of the water samples collected from the four sources indicates that only 75% (15) of water samples had observable bacterial counts, whereas the remaining 15% (5) had no growth. The highest total plate count was 1.8 x 105 CFU/ml whereas the lowest total plate count was 480 CFU/ml, both of which were obtained from taps 1 and 2 respectively. All the observed microbial contaminants ranges were above WHO reference standards for drinking water, which are 0 CFU/ml. The biochemical characterization of the possible bacteria in the 15 positive water samples indicated the presence of only Bacillus subtilis, which suggests that 75% of the water sources contain biofilms inside them and so they need to be cleaned regularly. Ciprofloxacin together with Tetracycline, Gentamicin and Erythromycin were the most effective antibiotics from the results. The main factors for contamination of the drinking water sources discovered by this study were absence of a perimeter fence, presence of other potential contaminants, presence of cracks or dirt draining channels, using water source for washing of legs, clothes, containers, animal access to the water source and presence of a toilet nearby. Conclusion and recommendation: The main bacterial contaminant that was isolated from the drinking water samples is Bacillus subtilis, which suggests that 75% of the water sources in Namugongo-Janda village contain biofilms inside them. I highly recommend that there should be regular microbiological assessment of all drinking water sources, and erecting of perimeter fence around all water points in the area in order to prevent animal droppings, debris near water points.
Bacteriological Profile, Risk Factors And Susceptibility Patterns In Non-Tuberculosis Lower Respiratory Tract Infections Among Patients Attending Kisugu Health Centre III
(International Health Sciences University, 2018-12) Mujanama, Barnabas
Background: Non-Mycobacterium tuberculosis bacterial lower respiratory tract infection (LRTI) is among the most prevalent diseases affecting humans across the globe. There is an increased antimicrobial drug resistance by bacteria causing LRTI. The main objective of this study was to investigate the bacteriological profile, risk factors and susceptibility patterns in non-tuberculosis lower respiratory tract infections among patients attending Kisugu Health Centre III Methodology: A cross-sectional study design was used to recruit 236 participants at Kisugu Health Centre III by consecutive sampling. Sputum samples were collected and analyzed for Non-MTB bacterial causes of lower respiratory tract infections using microbiological standard procedures. Antimicrobial susceptibility tests were performed using disc diffusion technique following Kirby-Bauer method. Data was cleaned and analyzed using SPSS (version 16.0). Ethical approval was sought from the IHSU-REC Results: The study yielded a prevalence of Non-MTB bacterial causes of LRTIs of 31.78% (75/236) [95%, CI=25.89-38.13]. The commonest Non-MTB bacterial isolates in the study were P. aeruginosa (38.67%), S. aureus (21.33%) and K. Pneumoniae (17.33). Others included S. Pyogenes (9.33%), S. pneumonia (6.67%), M. catarrhalis (5.33%) and H. influenza (1.33%). The study revealed that poor social behaviors like smoking (X2=20.86, P- value<0.001), excessive consumption of alcohol (X2=20.20, P-value<0.001) and HIV infection (X2=15.52, P-value<0.001) predispose one to contracting bacterial Non-MTB LRTIs. Also young and elderly people stand higher chances of contracting these infections. Conclusion and recommendations: The prevalence of Non-MTB bacterial lower respiratory tract infections was high with a relatively high rate of antibiotic resistance among bacteria like P. aeruginosa. Continuous surveillance of antibiotic susceptibility patterns of bacteria to different antimicrobials and introduction of PCR for other bacteria other than TB alone is recommended. The Government of Uganda should introduce policies to prevent use of drugs across the counter without prescription from doctors. Key words: Prevalence, Non-MTB bacterial LRTIs, Antimicrobial susceptibility pattern, Kisugu Health Centre III.
Correlation Between Venous Plasma Glucose Measurements And Glycated Hemoglobin In Type 2 Diabetes Patients Attending Doctors Plaza Consultation Clinic, Nsambya
(International Health Sciences University., 2018-12) Byarugaba, Francis
Background: The HbA1c test for monitoring diabetes is expensive and robust to carry out which limits its uptake in many health facilities in low and middle income countries. As a result, health facilities have resorted to use of fasting blood sugar and random blood sugar to monitor diabetes, hence a need to evaluate the performance of the former tests using HbA 1 c. Methods: This cross sectional study recruited 240 participants. Questionnaires were used to obtain data on socio demographic characteristics of the participants and risk factors of type 2 diabetes. About 4mls of anti- coagulated blood in a fluoride bottle collected for the estimation of glycated Hemoglobin as a gold standard, fasting and random blood glucose levels. Results: We recruited 240 adult, 98 males (40.8%) and 142 females (59.2%) with type 2 diabetes mellitus (T2DM). In the study, 155(64.6%, 95% CI=58.17-70.63) had HbA1c level greater than 7% (poor diabetes control). With regression, there an association between HBA1c and fasting plasma glucose together with random plasma glucose (t=10.53; p. Value<0.001 and t=5.85; p. Value<0.001 respectively). Still a correlation existed between HBA1c and fasting plasma glucose (0.66) and random plasma glucose (0.52). Gender (X 2 =0.04, p.V=0.8), Health education on glycemic control (X 2 =1.4, p.V=0.2), Place of residence(X 2 =3.4, p. V=0.9) and smoking (X 2 =1.9, p.V=0.2) were not associated with poor glycemic control while Fat consumption (X 2 =41.01, p.V=<0.001), lack of fruit intake (X 2 =10.4, p.V=0.001), High blood pressure (X 2 =24.5, p.V<0.001) and Alcohol intake (X 2 =14.6, p.V=0.002) were associated with poor glycemic control. Conclusion: The incidence of poor glycemic control is high among our study participants. The factors associated with poor glycemic control includes high fat intake, heavy alcohol intake and low fruit intake. Both fasting blood glucose and random blood glucose correlate with HbA1c level Recommendation: More elaborate with big sample size or another study design be conducted to ascertain the relationship between fasting, random plasma glucose and HbA1c level. Patient’s management and education on glycemic control be emphasized to improve on their glycemic control.
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.
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.
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.
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.
Determination of local reference values for random blood glucose levels in young adults at victoria medical centre, Kampala.
(International Health Sciences University., 2015-12) Lutaaya, James Kiganda
Background: Clinical chemistry reference ranges vary due to factors such as sex, ethnicity, diet, climate, genetics, geographical location, analytical methods, sample type and analytical instruments. Objective: The aim of this study was to determine reference ranges for random glucose for healthy adults in Uganda. This was important in the diagnosis and treatment of diabetes and also provided more scientific knowledge on our local glucose reference ranges for further use by other scientists. The local glucose reference ranges were important to be established in our society as stated by the (IFCC, 2000) because this would help with the interpretation of locally obtained results. Methodology: The study was cross sectional, blood samples were collected from healthy non fasting young adults aged 18 up to 39 years. Capillary blood samples were collected and analyzed using a glucometer. Urine samples collected to detect for glycosuria as exclusion criteria. Data was analyzed using STATA version 11 software and the Chi square test to study the significance. Results: A total of 288 participants were enrolled in the study. The mean age of the participants was 29 years with a median age of 32 years, of the male participants (62/142; 43.66%) had RBS in the range of 3.0-4.9 mmo1/L, (66/142; 46.48%) had RBS in the range of 5.0 – 6.9 mmol/L and the rest had RBS of 7.0 – 8.9 mmol/L. Up to (84/146; 57.53%) of the female participants had their RBS ranging from 3.0 – 4.9 mmol/L, (36/146; 24.66%) had RBS from 5.0 – 6.9 mmol/L and the rest of females had RBS ranging from 7.0 – 8.9 mmol/L. (1/74; 1.35%) of participants aged between 35 – 39 years had their RBS between 3.0 – 4.9mmol/L, (33/74; 44.59%) had their RBS between 5.0 – 6.9 mmol/L and (40/74; 54.05%) had their RBS between 7.0 – 8.9mmol/L. This difference is statistically significant at p value less than 0.05 (p value 0.0001). Conclusion: The refernce range obtained in the sudy was different from that quoted by WHO. This means our study population where characteristically different and required different reference range for glucose.
Distribution Of Abo Blood Group Types And Their Association With Malaria Among Children Under 5 Years Attending Outpatients Clinic At Bundibugyo Hospital, Western Uganda
(International Health Sciences University., 2018-12) Ejoku, Emmanuel
Background: Infection with malaria under five remains a burden in sub Saharan African, and is associated with numerous preventable deaths. The clinical outcome of Plasmodium infection in endemic areas is influenced by erythrocyte polymorphisms including the ABO blood groups. This study reports the association of Malaria with the ABO blood group in children under 5years attending the outpatient‟s clinic at Bundibugyo hospital. Methods: This was a cross-sectional prospective study that carried out during the months of July to August, 2018, in Bundibugyo hospital. The study population comprised of children 7 months-5 years presenting with a febrile condition. Clinical and laboratory investigations were done using malaria rapid diagnostic tests and microscopy; Blood grouping was done by hemagglutination methods. Statistical analysis was done at bivariate and multivariate levels using SPSS Version 23.0 and P-values less than 0.05 were considered significant. Results: The prevalence of malaria was 14%. The most predominant blood group type were Rhesus (D) positive „O‟ at 54%; A‟ at 26.2%, B‟ at 18.6% and AB‟ at 1.3%;. Blood group A were 1.24 times more susceptible to have positive malaria test than those with blood group O (OR= 1.24, 95%C.I (1.01 – 2.48) ; P-value =0.003. B were 1.29 times more susceptible to have positive malaria test than those with blood group O blood (OR= 1.29, 95% C.I (0.88 – 3.23 ); P-Value = 0.011). The statistically outcome indicated that: blood groups A and B patients are more likely to have a positive malaria test compared to blood group O
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.
Establishment Of Hematological Reference Ranges For Pregnant Women Attending Antenatal Care At Nakaseke Hospital
(International Health Sciences University, 2018-11) Kyakulaga, Philip
Background: Measurement of haematological parameters is key to the diagnosis, treatment and monitoring of many infectious diseases and pregnancy related conditions. However, less effort has been put in establishment of these parameters in developing countries where clinical care strongly relies on laboratory diagnosis. This study reports on the haematological reference ranges among pregnant attending antenatal care in Nakaseke Hospital. Methods: A cross sectional study was conducted during the months of August and November, 2018 among pregnant women attending antenatal care in Nakaseke hospital. Ethylene di-amine tetra acetic acid (EDTA) venous blood were collected and a full blood count (FBC) was run. Data was presented in tabular form as mean ± SD in reference to 95 % reference intervals. Results: Overall, 135 consented pregnant women were enrolled. The red blood cells (RBCs) showed a gradual decrease in haemoglobin and RBCs counts as the pregnancy progressed from 1 st to 2nd and then became constant 3rd trimester as 4.04-5.02, 3.77-4.67 and3.92- 4.7 respectively. The haematocrit value decreases from the1st to the 2nd trimesters and then remains constant in the 3rd trimester as 36.94- 45.3, 34.67-41.35 and 32.47-44.79 respectively. There was no significant change in MCV. For the white blood cells (WBCs), there was no significant change in the total count from the 1 st to the 2nd trimesters, but there is significant rise in the 3 rd trimester as 4.57-8.75 , 4.41-8.85 and 4.8-9.2 respectively. The granulocytes were affected by the increase in numbers. The total platelet count decreased from the 1 st to the 2nd to the 3 rd trimesters as 152.38-267.24, 145.41-224.59 and 128.48-220.94 respectively. Conclusion: This study has explored a variance in the blood cell parameters across the different gestational stages. To this, gestation- and age-based reference values for haematological parameters are key to their clinical care and management.
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.
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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