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Nawagi F, Lubega M, Ajambo A, Mukisa J, Nabirye R. "We felt so proud by the president calling us my heroes." An exploration of the nurse's experiences in the management of COVID-19 patients in Uganda. BMC Nurs 2023; 22:352. [PMID: 37789285 PMCID: PMC10548748 DOI: 10.1186/s12912-023-01503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Adequate and intensive nursing care was a key characteristic of recovery of the COVID-19 patients globally and in Uganda. However, there is limited literature on the experiences of nurses who participated in the care of COVID-19 patients in Uganda, East Africa, and Africa at large, yet imperative in designing approaches to increase the efficiency of the health systems' response to future pandemics. To address this gap, this study aimed to explore the experiences of the nurses who managed COVID-19 patients at Mulago National Referral Hospital in Uganda. METHODS This was an exploratory qualitative study that used purposive sampling to identify 21 nurses who treated COVID-19 patients at Mulago National Referral Hospital in Uganda. Focus Group Discussions were used to collect data. Thematic Analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. RESULTS Six themes were identified: 1) Motivation to work on COVID-19 patients, 2 ) Roles performed by nurses, 3) High workload and professional role strain, 4) Challenges with maintaining personal health and relationships, 5) Institutional and government support, 6) Acquired professional knowledge and skills to manage critical patients and epidemics. Most of the nurses faced work burnout, social isolation, stress, and psychological trauma. However, interprofessional collaboration, financial incentives, government recognition, and provision of personal protective equipment, were key motivators for the nurses. The majority reported to have gained new knowledge and skills in the management of pandemics and highly infectious diseases. CONCLUSION The nurses experienced negative scenarios like work burnout due to high workload, social isolation, and psychological stress. Therefore, there is a need for health systems to develop approaches and policies that support nurses' well-being. Nevertheless, key attributes like resilience, adaptability, and diligence to serve enabled them to persevere despite the hardships faced.
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Affiliation(s)
- Faith Nawagi
- College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Martin Lubega
- College of Health Sciences, Department of Nursing, Makerere University, Kampala, Uganda
| | | | - John Mukisa
- School of Biomedical Sciences, Makerere University College of Health Sciences (MaKCHS), Kampala, Uganda
| | - Rose Nabirye
- Faculty of Health Sciences, Department of Nursing, Bustiema University, Kampala, Uganda
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Kwizera A, Kabatooro D, Atumanya P, Tumukunde J, Kalungi J, Mwanje AK, Obua D, Agaba P, Sendagire C, Nakibuuka J, Owachi D, Dünser MW, Alenyo-Ngabirano A, Olaro C, Kyobe-Bosa H, Kirenga BJ, Nakiyingi L, Kiwanuka N, Kateete DP, Joloba M, Sewankambo N, Summers C. Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study. Chest 2023; 164:369-380. [PMID: 36773933 PMCID: PMC9911971 DOI: 10.1016/j.chest.2023.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS. RESEARCH QUESTION Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda? STUDY DESIGN AND METHODS A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses. RESULTS Four hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59 of 79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio2 ratio (OR, 0.99; 95% CI, 0.98-0.99; P < .001) and respiratory rate (OR, 1.07; 95% CI, 1.03-1.12; P = .002) at admission and NIV (OR, 6.31; 95% CI, 2.29-17.37; P < .001) or IMV (OR, 8.08; 95% CI, 3.52-18.57; P < .001) use were independent risk factors for death. INTERPRETATION SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Daphne Kabatooro
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patience Atumanya
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joyce Kalungi
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Arthur Kavuma Mwanje
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Obua
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Agaba
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cornelius Sendagire
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda; Uganda Heart Institute, Kampala, Uganda
| | - Jane Nakibuuka
- Department of Medicine and Intensive Care Unit, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Martin W Dünser
- Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | | | | | - Henry Kyobe-Bosa
- Ministry of Health, Kampala, Uganda; Uganda Peoples Defence Forces, Kampala, Uganda; Kellogg College, University of Oxford, Oxford, England
| | - Bruce J Kirenga
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University Lung Institute, Kampala, Uganda
| | - Lydia Nakiyingi
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Joloba
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Nuwagira E, Mpagama SG, Katusiime A, Natamba B, Baluku JB, Lai PS. Coinfection of COVID-19 and Tuberculosis in Uganda. Am J Trop Med Hyg 2023; 108:1240-1243. [PMID: 37094784 PMCID: PMC10540107 DOI: 10.4269/ajtmh.22-0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
The clinical features and outcomes of tuberculosis (TB) and COVID-19 coinfection are not well established. This short report describes 11 people with TB/COVID-19 coinfection in Uganda. The mean age was 46.9 ± 14.5 years; eight (72.7%) were male and two (18.2%) were coinfected with HIV. All patients presented with cough whose median duration was 71.1 (interquartile range, 33.1, 109) days. Eight (72.7%) had mild COVID-19 whereas two (18.2%) died, including one with advanced HIV disease. All patients were treated with first-line anti-TB drugs and adjunct therapy for COVID-19 using national treatment guidelines. This report presents the possibility of the coexistence of the two diseases and calls for more vigilance, screening, and collective prevention measures for both COVID-19 and TB.
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Affiliation(s)
- Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Stellah G. Mpagama
- Infectious Diseases Unit, Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Asumpta Katusiime
- Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Bobson Natamba
- Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Peggy S. Lai
- Division of Pulmonology, Massachusetts General Hospital, Boston, Massachusetts
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Kyagambiddwa T, Kintu TM, Miiro E, Nabalamba F, Asiimwe GS, Namutebi AM, Abeya FC, Lumori BA, Ijuka I, Muhindo RK, Mutekanga A, Musinguzi R, Natuhwera F, Ngonzi J, Nuwagira E. Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:2923-2932. [PMID: 37197696 PMCID: PMC10184892 DOI: 10.2147/idr.s405256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
Background There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda. Methods We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation <94%, lung infiltrates >50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance. Results Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32-6.82; p = 0.009) and altered mental state (GCS <15) (HR: 6.89, 95% CI: 1.48-32.08, p = 0.014) were significant predictors of 30-day mortality. Conclusion There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.
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Affiliation(s)
- Tonny Kyagambiddwa
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Timothy Mwanje Kintu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Miiro
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Franchesca Nabalamba
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gloria Suubi Asiimwe
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Fardous C Abeya
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Boniface A Lumori
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rose K Muhindo
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Mutekanga
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Joseph Ngonzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
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Olal E, Mukunya D, Oloya JN, Baguma S, Okot C, Alema NO, Acullu D, Ochula DO, Atim PO, Odong PO, Okot GS, Pebolo FP, Oyat FWD, Ikoona EN, Aloyo J, Kitara DL. Prevalence and Factors Associated With Compliance With COVID-19 Presidential Lockdown Measures: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231201258. [PMID: 37803931 PMCID: PMC10559722 DOI: 10.1177/00469580231201258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is one of the most severe global health uncertainties to date. Although significant global effort has been put into implementing COVID-19 pandemic control measures such as lockdowns, travel restrictions, and hygiene precautions, the transmission is expected to resurface once these efforts are discontinued. We aimed to determine the prevalence and factors associated with compliance with presidential 53-day lockdown measures in June-July 2021 in northern Uganda. In this cross-sectional study, 587 adult participants (≥18 years old) from northern Uganda were selected using a systematic sampling method. Data collection involved interviewer-administered questionnaires with an internal validity of Cronbach's α = .72. Socio-demographic characteristics of participants were described, and multivariable modified Poisson regressions were performed to assess prevalence ratios between dependent and selected independent variables, with respective P values at 95% confidence intervals. All analyses were conducted using Stata 17.0. Participants' compliance with the presidential lockdown directives was high at 88%(95% CI: 85%-90%). Compliance with the presidential directives was more likely among participants who agreed to the lockdown measures [adjusted Prevalence Ratio, aPR = 1.28 (95% CI: 1.10-1.49; P = .001)] compared to those who did not, and more likely among those who were afraid of death from COVID-19 [aPR = 1.08 (95% CI: 1.01-1.15; P = .023)] than those who did not. However, compliance was less likely among males [aPR = 0.91 (95% CI: 0.86-0.97; P = .002)] compared to females, those aged 35 to 44 years [aPR = 0.87 (95% CI: 0.79-0.97; P = .013)] compared to those less 25 years; and unmarried [aPR = 0.89 (95% CI: 0.82-0.97; P = .011)] compared to the married. Compliance with the COVID-19 presidential lockdown measures in northern Uganda was high. The factors associated with compliance were the fear of death and agreement with presidential lockdown measures. However, compliance was less likely among males, unmarried persons, and persons aged 35 to 44. The authors recommend more community engagements, participation, sensitization, mobilization, and simultaneous application of multiple public health approaches to improve compliance and control of COVID-19.
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Affiliation(s)
- Emmanuel Olal
- Yotkom Medical Centre, Kitgum, Uganda
- Uganda Medical Association, Gulu City, Uganda
| | - David Mukunya
- Busitema University, Mbale, Uganda
- Nikao Medical Center, Kampala, Uganda
| | - Johnson Nyeko Oloya
- Uganda Medical Association, Gulu City, Uganda
- Moroto Regional Referral Hospital, Moroto, Uganda
| | - Steven Baguma
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | - Christopher Okot
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | | | - Denis Acullu
- Uganda Medical Association, Gulu City, Uganda
- Aga Khan Hospital, Mombasa, Kenya
| | - Denish Omoya Ochula
- Uganda Medical Association, Gulu City, Uganda
- Lamwo District Local Government, District Health Office, Padibe, Uganda
| | - Pamela Okot Atim
- Uganda Medical Association, Gulu City, Uganda
- St. Joseph’s Hospital, Kitgum District, Uganda
| | - Patrick Olwedo Odong
- Uganda Medical Association, Gulu City, Uganda
- Amuru District Local Government, District Health Office, Amuru, Uganda
| | - Godfrey Smart Okot
- Uganda Medical Association, Gulu City, Uganda
- Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | | | | | | | - Judith Aloyo
- Uganda Medical Association, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association, Gulu City, Uganda
- Gulu University, Gulu City, Uganda
- Gulu Centre for Advanced Medical Diagnostics, Research, Trainings, and Innovations (GRUDI BIONTECH), Gulu, Uganda
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James E, Wanume B, Musaba MW, Nantale R, Mutaki V, Nambozo B, Okia D, Soita D, Napyo A, Matovu JKB, Namulondo R, Lubaale J, Okello F, Mulebeke R, Kakuru A, Amejje N, Emojong D, Okolimong C, Ouma S, Okware S, Olupot-Olupot P, Mukunya D. Characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care in Kapelebyong district in Uganda: a mixed-methods study. Trop Med Health 2022; 50:93. [PMCID: PMC9748397 DOI: 10.1186/s41182-022-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda’s health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda.
Methods
We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0
Results
A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2–137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6–145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food.
Conclusion
Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care.
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Mutekanga A, Nuwagira E, Kumbakumba E, Nyaiteera V, Asiimwe S, Gasumuni M, Wandera N, Natumanya R, Akena D, Senoga S, Kyobe Kiwanuka J, Kateregga G, Munyarugero E, Abeya FC, Obwoya PS, Ttendo S, Muhindo R. Factors Associated with 30-Day in-Hospital Mortality Among Patients Admitted with Severe Covid-19 in Mbarara Regional Referral Hospital. Infect Drug Resist 2022; 15:7157-7164. [PMID: 36510588 PMCID: PMC9738092 DOI: 10.2147/idr.s379443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background COVID-19 has created a burden on the healthcare system globally. Severe COVID-19 is linked with high hospital mortality. Data regarding 30-day in-hospital mortality and its factors has not been explored in southwestern Uganda. Methods We carried out a retrospective, single-center cohort study, and included all in-patients with laboratory-confirmed, radiological, or clinical severe COVID-19 admitted between April 2020 and September 2021 at Mbarara Regional Referral Hospital (MRRH). Demographic, laboratory, treatment, and clinical outcome data were extracted from patients' files. These data were described comparing survivors and non-survivors. We used logistic regression to explore the factors associated with 30-day in-hospital mortality. Results Of the 283 patients with severe COVID-19 admitted at MRRH COVID-19 unit, 58.1% were male. The mean age ± standard deviation (SD) was 61±17.4 years; there were no differences in mean age between survivors and non-survivors (59 ± 17.2 versus 64.4 ±17.3, respectively, p=0.24) The median length of hospital stay was 7 (IQR 3-10) days (non-survivors had a shorter median length of stay 5 (IQR 2-9) days compared to the survivors; 8 (IQR 5-11) days, p<0.001. The most frequent comorbidities were hypertension (30.5%) and diabetes mellitus (30%). The overall 30-day in-hospital mortality was 134 of 279 (48%) mortality rate of 47,350×105 with a standard error of 2.99%. The factors associated with 30-day in-hospital mortality were age: 65 years and above (aOR, 3.88; 95% CI, 1.24-11.70; P =0.020) a neutrophil to lymphocyte ratio above 5 (aOR, 4.83; 95% CI, 1.53-15.28; P =0.007) and oxygen requirement ≥15L/min (aOR, 15.80; 95% CI, 5.17-48.25; P <0.001). Conclusion We found a high 30-day in-hospital mortality among patients with severe forms of COVID-19. The identified factors could help clinicians to identify patients with poor prognosis at an early stage of admission.
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Affiliation(s)
- Andrew Mutekanga
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Elias Kumbakumba
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Victoria Nyaiteera
- Department of ENT, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Asiimwe
- Global Health Collaborative, Massachusetts General Hospital, Boston, MA, USA
| | - Medal Gasumuni
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Nelson Wandera
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Robert Natumanya
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Denis Akena
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Siraje Senoga
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Kyobe Kiwanuka
- Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda
| | - George Kateregga
- Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Munyarugero
- Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fardous Charles Abeya
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Stephen Obwoya
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Ttendo
- Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rose Muhindo
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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8
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Muyinda A, Ingabire PM, Nakireka S, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Sserwanja Q, Ainembabazi R, Olum R, Nantale R, Akunguru P, Nomujuni D, Olwit W, Musaba MW, Namubiru B, Aol P, Babigumira PA, Munabi I, Kiguli S, Mukunya D. Survival analysis of patients with COVID-19 admitted at six hospitals in Uganda in 2021: a cohort study. Arch Public Health 2022; 80:233. [PMID: 36380388 PMCID: PMC9666944 DOI: 10.1186/s13690-022-00991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Assessing factors associated with mortality among COVID-19 patients could guide in developing context relevant interventions to mitigate the risk. The study aimed to describe mortality and associated factors among COVID-19 patients admitted at six health facilities in Uganda.
Methods
We reviewed medical records of patients admitted with COVID-19 between January 1st 2021 and December 31st 2021 in six hospitals in Uganda. Using Stata version 17.0, Kaplan Meier and Cox regression analyses were performed to describe the time to death and estimate associations between various exposures and time to death. Finally, accelerated failure time (AFT) models with a lognormal distribution were used to estimate corresponding survival time ratios.
Results
Out of the 1040 study participants, 234 (22.5%: 95%CI 12.9 to 36.2%) died. The mortality rate was 30.7 deaths per 1000 person days, 95% CI (26.9 to 35.0). The median survival time was 33 days, IQR (9–82). Factors associated with time to COVID-19 death included; age ≥ 60 years [adjusted hazard ratio (aHR) = 2.4, 95% CI: [1.7, 3.4]], having malaria test at admission [aHR = 2.0, 95% CI:[1.0, 3.9]], a COVID-19 severity score of severe/critical [aHR = 6.7, 95% CI:[1.5, 29.1]] and admission to a public hospital [aHR = 0.4, 95% CI:[0.3, 0.6]]. The survival time of patients aged 60 years or more is estimated to be 63% shorter than that of patients aged less than 60 years [adjusted time ratio (aTR) 0.37, 95% CI 0.24, 0.56]. The survival time of patients admitted in public hospitals was 2.5 times that of patients admitted in private hospitals [aTR 2.5 to 95%CI 1.6, 3.9]. Finally, patients with a severe or critical COVID-19 severity score had 87% shorter survival time than those with a mild score [aTR 0.13, 95% CI 0.03, 0.56].
Conclusion
In-hospital mortality among COVID-19 patients was high. Factors associated with shorter survival; age ≥ 60 years, a COVID-19 severity score of severe or critical, and having malaria at admission. We therefore recommend close monitoring of COVID-19 patients that are elderly and also screening for malaria in COVID-19 admitted patients.
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Olum R, Baluku JB. Commentary: Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital. Front Public Health 2022; 10:931309. [PMID: 35865243 PMCID: PMC9294281 DOI: 10.3389/fpubh.2022.931309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald Olum
- Department of Internal Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- *Correspondence: Ronald Olum
| | - Joseph Baruch Baluku
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
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Erem G, Ameda F, Otike C, Olwit W, Mubuuke AG, Schandorf C, Kisolo A, Kawooya MG. Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels. BMC Med Imaging 2022; 22:112. [PMID: 35690743 PMCID: PMC9188687 DOI: 10.1186/s12880-022-00838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities. METHODS This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values. RESULTS A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan - the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively. CONCLUSION This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.
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Affiliation(s)
- Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda. .,Clinical Epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda.
| | - Faith Ameda
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Caroline Otike
- Clinical Epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda
| | - William Olwit
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Aloysius G Mubuuke
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
| | - Akisophel Kisolo
- Department of Nuclear Physics, Makerere University, Kampala, Uganda
| | - Michael G Kawooya
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda.,Department of Radiology, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
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Clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 at Case Hospital, Uganda. Interdiscip Perspect Infect Dis 2022; 2022:5477790. [PMID: 35698593 PMCID: PMC9188300 DOI: 10.1155/2022/5477790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023] Open
Abstract
Data on clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in private health facilities in Uganda is scarce. We conducted a retrospective cohort study of patients hospitalized with COVID-19 at Case Hospital, Kampala, Uganda, between June 2020 and September 2021. Data of 160 participants (median age 45 years (interquartile range [IQR]: 37–57) and 63.5% male) was analyzed. Seventy-seven (48.1%) participants had non-severe, 18 (11.3%) severe, and 83 (51.9%) critical COVID-19 illness. In 62 participants with chest computed tomography findings, 54 (87%) had bilateral disease, with 22 (35%) having ground-glass opacities. The median duration of hospitalization was 5 days (IQR: 3–9 days). Overall, 18 (11.3%) participants died. Survival at 14 and 28 days was 89% and 72%, respectively. Factors strongly associated with all-cause mortality were as follows: age >50 years (odds ratio [OR]: 8.6, 95% confidence interval [CI]: 1.1–69.2, and p=0.042), having at least 1 comorbidity (OR: 3.2, 95% CI: 1.1–8.9, and p=0.029), hypertension (OR: 3.2, 95% CI: 1.2–8.6, and p=0.024), diabetes mellitus (OR: 2.9, 95% CI: 1.0–8.5, andp=0.056), and oxygen saturation <92% (OR: 5.1, 95% CI: 1.8–14.4, and p=0.002). In this private health facility, mortality was about 1 in 10 patients, and more people presented with critical illness in the second wave of the pandemic, and most deaths occurred after 2 weeks of hospitalization.
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12
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Ssetaba LJ, Mirembe J, Omega J, Okot J, Kiguli S, Nakwagala FN, Bongomin F. Coronavirus disease–2019 morbidity and mortality among health care workers in Uganda. Ther Adv Infect Dis 2022; 9:20499361221136415. [PMID: 36406814 PMCID: PMC9666413 DOI: 10.1177/20499361221136415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Health care workers (HCWs) are at increased risk of acquiring coronavirus
disease 2019 (COVID-19). This study aimed to determine and compare the
morbidity and mortality rates due to COVID-19 among the HCWs and the general
population (non-HCWs). Methods: We conducted a retrospective chart review. We accessed electronic database of
participants admitted at Mulago National Referral Hospital COVID-19
Treatment Unit (CTU) between March 2020 and September 2021. Participants
with missing occupations were excluded. Results: Of 594 eligible participants, 6.4% (n = 38) were HCWs.
Compared with non-HCWs, HCWs were much younger (48 versus
55 years, p = 0.020). The proportion of participants with
severe disease (73.7% versus 77.6%,
p = 0.442), who had not received COVID-19 vaccine (91.2%
versus 94.7%, p = 0.423), mortality
rate (44.7% versus 54.8%, p = 0.243) and
the median length of hospitalization (6 versus 7 days,
p = 0.913) were similar among HCWs and non-HCWs,
respectively. A higher proportion of HCWs required oxygen therapy (24.3%
versus 9.7%, p < 0.01). At
admission, the presence of cough (p = 0.723),
breathlessness (p = 0.722), fever
(p = 0.19), sore throat (p = 0.133),
comorbidities (p = 0.403) and headache
(p = 0.162) were similar across groups. Rhinorrhoea was
more common among HCWs (34.4% versus 16.6%,
p = 0.017). Among HCWs, nurses had the highest
morbidity (52.6%) and mortality (58.8%). Conclusion: The morbidity and mortality among HCWs in Uganda were substantial, with a low
COVID-19 vaccination rate and a higher requirement for oxygen therapy
despite a younger age.
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Affiliation(s)
- Leoson Junior Ssetaba
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joy Mirembe
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jotham Omega
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Sarah Kiguli
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Felix Bongomin
- Faculty of Medicine, Gulu University, P. O. Box, 166, Gulu, Uganda
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