1
|
Ahabwe OM, Kabanda T, Abesiga L, Mugisha J, Kayondo M, Ngonzi J, Tugume R, Agaba CD, Byamukama O, Tibaijuka L, Lugobe HM. Bacterial isolates and antibiotic susceptibility among women with abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in southwestern Uganda: a cross-sectional study. BMC Womens Health 2023; 23:572. [PMID: 37932705 PMCID: PMC10629097 DOI: 10.1186/s12905-023-02746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Abnormal vaginal discharge is a common complaint among women of reproductive age, affecting about one- third of all women. In resource-limited settings where access to laboratory services is limited, treatment is usually syndromic. This approach may result in ineffective treatment, with high recurrence rates and a potential of developing antibiotic resistance. This study aimed to determine the bacterial isolates and antibiotic susceptibility among women with an abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in Southwestern Uganda. METHODS We conducted a hospital based cross-sectional study among 361 women aged 15-49 years, presenting with abnormal vaginal discharge at the gynecology clinic of Mbarara Regional Referral Hospital from December 2020 to June 2021. Demographic characteristics were collected using a structured questionnaire. We collected cervical and vaginal sterile swabs and subjected them to wet preparation and gram stain. The specimens were cultured for bacterial isolates. Susceptibility testing was performed on samples with bacterial isolates using the Kirby-Bauer disc diffusion method, on the commonly prescribed antibiotics in this setting. We summarized and described the bacterial isolates and antibiotic susceptibility patterns as frequencies and percentages. RESULTS We enrolled 361 women with abnormal vaginal discharge. Bacteria were isolated in 29.6% (107/361) of the women, and the commonest isolates included; Staphylococcus aureus 48.6% (52/107), Klebsiella pneumoniae 29.9% (32/107) and Enterococcus faecalis 15% (16/107). Yeast cells were found in 17.7% (64/361) of the women with abnormal vaginal discharge. Cefuroxime (90.7%) and Ciprofloxacin (81.3%) had a high level of sensitivity while high levels of resistance were observed for Doxycycline (86.0%) and Azithromycin (67.0%). CONCLUSION The common bacterial isolates were Staphylococcus aureus, Klebsiella pneumoniae and Enterococcus faecalis. The isolated bacteria were most sensitive to Cefuroxime and Ciprofloxacin but resistant to Doxycycline and Azithromycin. There is need for routine culture and susceptibility testing of women with abnormal vaginal discharge so as to guide treatment, minimize inappropriate antibiotic use and consequently reduce antibiotic resistance.
Collapse
Affiliation(s)
- Onesmus Magezi Ahabwe
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Taseera Kabanda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lenard Abesiga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julius Mugisha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rodgers Tugume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Collins David Agaba
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Byamukama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
2
|
Kahimakazi I, Tornes YF, Tibaijuka L, Kanyesigye H, Kiptoo J, Kayondo M, Ngonzi J, Adu-Bonsaffoh K, Abesiga L, Lugobe HM. Prevalence of gestational diabetes mellitus and associated factors among women receiving antenatal care at a tertiary hospital in South-Western Uganda. Pan Afr Med J 2023; 46:50. [PMID: 38188887 PMCID: PMC10768552 DOI: 10.11604/pamj.2023.46.50.38355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/05/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION gestational diabetes mellitus is one of the major causes of morbidity and mortality among pregnant women worldwide. We aimed to determine the prevalence and factors associated with gestational diabetes mellitus among women attending the antenatal care clinic at a tertiary care hospital in South-Western Uganda. METHODS this was a hospital-based cross-sectional study conducted among women at ≥24 weeks of amenorrhea attending the antenatal care clinic at Mbarara Regional Referral Hospital between December 2020 and March 2021. We screened all women for gestational diabetes mellitus using the World Health Organization 2013 diagnostic criteria. We obtained socio-demographic, medical, and obstetric data. Multivariable logistic regression was used to determine the factors independently associated with gestational diabetes mellitus. RESULTS we enrolled 343 pregnant women with a mean age of 27.3 (SD ±12.3) years. Of the 343 participants, 35 (10.2%) had gestational diabetes mellitus (GDM) (95% C.I: 7.4%-13.9%) and 7 (2%) had diabetes in pregnancy. The factors significantly associated with gestational diabetes mellitus were; previous history of foetal macrosomia in any of the previous pregnancies (aOR: 5.53, 95% C.I: 1.29-23.65) and family history of diabetes mellitus in the first-degree relatives (aOR: 4.45, 95% C.I:1.48-13.34). CONCLUSION one in every ten pregnant women attending the antenatal care clinic at Mbarara Regional Referral Hospital is likely to have gestational diabetes mellitus in pregnancy. There is a need to strengthen routine testing for gestational diabetes mellitus among women attending the antenatal care clinic, especially pregnant women with a prior history of foetal macrosomia and a family history of diabetes mellitus in first-degree relatives.
Collapse
Affiliation(s)
- Irene Kahimakazi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo Tornes
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Hamson Kanyesigye
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joshua Kiptoo
- Department of Pharmacy, Clinical Pharmacy Unit, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Lenard Abesiga
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
3
|
Twesigomwe G, Migisha R, Agaba DC, Owaraganise A, Aheisibwe H, Tibaijuka L, Abesiga L, Ngonzi J, Tornes YF. Prevalence and associated factors of oligohydramnios in pregnancies beyond 36 weeks of gestation at a tertiary hospital in southwestern Uganda. BMC Pregnancy Childbirth 2022; 22:610. [PMID: 35918640 PMCID: PMC9344782 DOI: 10.1186/s12884-022-04939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oligohydramnios is associated with poor maternal and perinatal outcomes. In low-resource countries, including Uganda, oligohydramnios is under-detected due to the scarcity of ultrasonographic services. We determined the prevalence and associated factors of oligohydramnios among women with pregnancies beyond 36 weeks of gestation at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda. METHODS We conducted a hospital-based cross-sectional study from November 2019 to March 2020. Included were women at gestational age > 36 weeks. Excluded were women with ruptured membranes, those in active labour, and those with multiple pregnancies. An interviewer-administered structured questionnaire was used to capture demographic, obstetric, and clinical characteristics of the study participants. We determined oligohydramnios using an amniotic fluid index (AFI) obtained using an ultrasound scan. Oligohydramnios was diagnosed in participants with AFI ≤ 5 cm. We performed multivariable logistic regression to determine factors associated with oligohydramnios. RESULTS We enrolled 426 women with a mean age of 27 (SD ± 5.3) years. Of the 426 participants, 40 had oligohydramnios, for a prevalence of 9.4% (95%CI: 6.8-12.6%). Factors found to be significantly associated with oligohydramnios were history of malaria in pregnancy (aOR = 4.6; 95%CI: 1.5-14, P = 0.008), primegravidity (aOR = 3.7; 95%CI: 1.6-6.7, P = 0.002) and increasing gestational age; compared to women at 37-39 weeks, those at 40-41 weeks (aOR = 2.5; 95%CI: 1.1-5.6, P = 0.022), and those at > 41 weeks (aOR = 6.0; 95%CI: 2.3-16, P = 0.001) were more likely to have oligohydramnios. CONCLUSION Oligohydramnios was detected in approximately one out of every ten women seeking care at MRRH, and it was more common among primigravidae, those with a history of malaria in pregnancy, and those with post-term pregnancies. We recommend increased surveillance for oligohydramnios in the third trimester, especially among prime gravidas, those with history of malaria in pregnancy, and those with post-term pregnancies, in order to enable prompt detection of this complication and plan timely interventions. Future longitudinal studies are needed to assess clinical outcomes in women with oligohydramnios in our setting.
Collapse
Affiliation(s)
- Godfrey Twesigomwe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Asiphas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Hillary Aheisibwe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Lenard Abesiga
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Yarine Fajardo Tornes
- Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| |
Collapse
|
4
|
Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
Collapse
Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
5
|
Data S, Dubé MM, Bajunirwe F, Kyakwera C, Robinson T, Najjuma JN, Cherop M, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, MacIntosh H, Cheng A. Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda: A Cohort Study. Simul Healthc 2021; 16:e100-e108. [PMID: 33337727 DOI: 10.1097/sih.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students. METHODS We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores. RESULTS One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months. CONCLUSIONS An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.
Collapse
Affiliation(s)
- Santorino Data
- From the Mbarara University of Science and Technology (S.D., F.B., C.K., N.N.J., C.M., L.A., T.N., M.T.), Mbarara, Uganda; KidSIM Simulation Program (M.D., T.R., I.W., A.C.), Alberta Children's Hospital; and Department of Pediatrics (J.L.B., N.S., I.W., A.C.), and Global Health and International Partnerships (H.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Anderson GA, Ilcisin L, Kayima P, Abesiga L, Portal Benitez N, Ngonzi J, Ronald M, Shrime MG. Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital. PLoS One 2017; 12:e0187293. [PMID: 29088302 PMCID: PMC5663485 DOI: 10.1371/journal.pone.0187293] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 10/17/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is Ugandan governmental policy that all surgical care delivered at government hospitals in Uganda is to be provided to patients free of charge. In practice, however, frequent stock-outs and broken equipment require patients to pay for large portions of their care out of their own pocket. The purpose of this study was to determine the financial impact on patients who undergo surgery at a government hospital in Uganda. METHODS Every surgical patient discharged from a surgical ward at a large regional referral hospital in rural southwestern Uganda over a 3-week period in April 2016 was asked to participate. Patients who agreed were surveyed to determine their baseline level of poverty and to assess the financial impact of the hospitalization. Rates of impoverishment and catastrophic expenditure were then calculated. An "impoverishing expense" is defined as one that pushes a household below published poverty thresholds. A "catastrophic expense" was incurred if the patient spent more than 10% of their average annual expenditures. RESULTS We interviewed 295 out of a possible 320 patients during the study period. 46% (CI 40-52%) of our patients met the World Bank's definition of extreme poverty ($1.90/person/day). After receiving surgical care an additional 10 patients faced extreme poverty, and 5 patients were newly impoverished by the World Bank's definition ($3.10/person/day). 31% of patients faced a catastrophic expenditure of more than 10% of their estimated total yearly expenses. 53% of the households in our study had to borrow money to pay for care, 21% had to sell possessions, and 17% lost a job as a result of the patient's hospitalization. Only 5% of our patients received some form of charity. CONCLUSIONS AND RELEVANCE Despite the government's policy to provide "free care," undergoing an operation at a government hospital in Uganda can result in a severe economic burden to patients and their families. Alternative financing schemes to provide financial protection are critically needed.
Collapse
Affiliation(s)
- Geoffrey A. Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lenka Ilcisin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter Kayima
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lenard Abesiga
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mayanja Ronald
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
7
|
Anderson GA, Ilcisin L, Abesiga L, Mayanja R, Portal Benetiz N, Ngonzi J, Kayima P, Shrime MG. Surgical volume and postoperative mortality rate at a referral hospital in Western Uganda: Measuring the Lancet Commission on Global Surgery indicators in low-resource settings. Surgery 2017; 161:1710-1719. [PMID: 28259351 DOI: 10.1016/j.surg.2017.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data. METHODS For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics. RESULTS Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths. CONCLUSION Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data.
Collapse
Affiliation(s)
- Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA
| | - Lenka Ilcisin
- Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA
| | - Lenard Abesiga
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Mayanja
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Kayima
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
| |
Collapse
|