Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa.

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.

Developing an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa.

BACKGROUND: With funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice. METHODS: Ten faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula. RESULTS: Between April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020. CONCLUSIONS: To our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, cross-institutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.

Mammographic breast density patterns among a group of women in sub Saharan Africa.

INTRODUCTION: Mammographic breast density is a measure of parenchymal breast patterns on film and in part a marker of cumulative exposure to oestrogen. The risk of breast cancer for women with increased density is up to six fold more than in women with less dense tissues. The pattern of mammographic breast density among Ugandan women is not known. OBJECTIVE: To establish these as a contribution to baseline data. METHODS: A cross sectional descriptive study that enrolled women presenting for mammography at the national referral hospital radiology department. Breast densities were scored using the BI-RADS categories. IRB approval was obtained. RESULTS: Of the 190 women enrolled, 178 were scored, of those scored 10 (5.3%) had extremely dense breasts (grade IV) and 39 (20.5%) had heteregenous ones (grade III). The rest 129 (67.9%) had scattered fibroglandular or fat densities (Grades I & II). Most of the women were young 45.8 ± 12.5 years The majority had normal or benign mammographic findings and all were non pregnant. CONCLUSION: Mammographic densities in this Ugandan population appear to be of low grade. The pattern established here is markedly different from findings in other studies that indicated much higher proportions for high dense tissues in other races. Mammographic interpretation of films could therefore be easier.

Rethinking breast cancer screening strategies in resource-limited settings.

The incidence of breast cancer in sub-Saharan nations is increasing. There is a worsening scarcity of Human Resource for Health in Uganda in particular and Sub Saharan Africa in general. Resources available for health care are predominantly spent on infectious disease care such as (HIV/AIDS, Tuberculosis and Malaria). These factors and more make the future of breast cancer care including screening in Sub Saharan African grim.Although mass breast cancer screening by mammography has been proved to be efficacious in the developed nations of the world, this has not been replicated in the developing nations because mass screening is not yet possible for the reasons stated. This paper proposes an alternative to mammography mass screening.Breast health programs for the most part are adhoc or non-existent in Uganda. The challenge of mass screening is not only limited to less readily available mammogram machines and trained human resources but also to the fact that the targeted population is of relatively young women in their 30s, implying that screening should commence earlier than it is practiced in nations where breast cancer peaks among women in their 50s. Mammography is not efficacious in young women with dense breast tissue. Ultra sound scans are not only up to 10 fold more available than mammography machines but are half the cost per examination.Although using ultra sound Scan for screening for non-palpable lumps is not up to par with standard breast cancer care mammography. It may be better than nothing, may be beneficial in aiding early cancer diagnosis. This concept is akin to the 'task shifting' advocated by WHO. It is worth investigating use of ultra sound scan for mass screening for breast cancer in resource-limited environments. This is not in any way lowering standards of oncologic diagnosis but filling the otherwise unattended to gap, the unmet need.

Sonography and risk factors for lower limb deep venous thrombosis at Mulago Hospital, Uganda.

BACKGROUND: Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have made it the imaging modality of choice in the diagnosis of lower limb DVT. OBJECTIVES: To determine the sonographic pattern, and identify the risk factors of lower limb DVT. DESIGN: Cross sectional, descriptive study carried out between April 2002 and March 2003. SETTING: Mulago Hospital, Uganda. SUBJECTS: Eighty six consecutive patients (92 limbs), with clinically suspected DVT, were studied by duplex sonography after a thorough risk factor evaluation. RESULTS: Out of a total of 86 patients clinically suspected to have lower limb DVT, 38 (44.2%) were found to have DVT after sonography. The gender incidence was similar. The left limb was affected in 60% of cases and the right in 40%. Bilateral DVT was noted in two patients. Most of the patients had acute and extensive DVT. CONCLUSION: Duplex ultrasonography is a very useful modality for assessing lower limb DVT, even in a low resource country like Uganda. It demonstrates the wealth of information obtained from sonography.

Problem Based Learning, curriculum development and change process at Faculty of Medicine, Makerere University, Uganda.

INTRODUCTION: The faculty of Medicine, (FOM) Makerere University Kampala was started in 1924 and has been running a traditional curriculum for 79 years. A few years back it embarked on changing its curriculum from traditional to Problem Based Learning (PBL) and Community Based Education and Service (COBES) as well as early clinical exposure. This curriculum has been implemented since the academic year 2003/2004. The study was done to describe the steps taken to change and implement the curriculum at the Faculty of Medicine, Makerere University Kampala. OBJECTIVE: To describe the steps taken to change and implement the new curriculum at the Faculty of Medicine. METHODS: The stages taken during the process were described and analysed. RESULTS: The following stages were recognized characterization of Uganda's health status, analysis of government policy, analysis of old curriculum, needs assessment, adoption of new model (SPICES), workshop/retreats for faculty sensitization, incremental development of programs by faculty, implementation of new curriculum. CONCLUSION: The FOM has successfully embarked on curriculum change. This has not been without challenges. However, challenges have been taken on and handled as they arose and this has led to the implementation of new curriculum. Problem based learning can be adopted even in a low resourced country like Uganda.

Comparison between sonographic and plain radiography in the diagnosis of small bowel obstruction at Mulago Hospital, Uganda.

OBJECTIVE: To evaluate the role of sonography compared to plain radiography in the diagnosis of patients with suspected small bowel obstruction as well as to determine their specificity, sensitivity and accuracy in the Ugandan setting. DESIGN: Prospective comparative study. SETTING: Mulago Hospital, Uganda's main referal Hospital and Makerere University Medical School. SUBJECTS: Seventy patients with suspected small bowel obstruction (SBO) were evaluated at Mulago Hospital between December 1998 and January 2000, 42 patients were males and 28 females. Patients were aged three days to two years and had a clinical suspicion of SBO. RESULTS: Of the 70 patients, 55 were confirmed to have had SBO. Four had ileus and 11 had no SBO. Sixty four per cent were managed surgically while 36% were managed conservatively. Sonography made a diagnosis of SBO in 92.7% and detected strangulation in 71% of patients. Plain radiography made a diagnosis in 85.5% of patients and did not detect strangulation. Specificity was 100% for both, sensitivity 93%, PPV 100%, NPV 73% for sonography. Sensitivity was 85%, PPV 100%, NPV 58% for plain radiography. MAIN OUTCOME MEASURES: The accuracy of sonography was 93% as compared to 87% for plain radiography. The level of obstruction was correctly predicted in 81% by sonography and 64% with plain radiography. CONCLUSION: It was concluded that sonography is as accurate, specific and sensitive as plain radiography in the diagnosis of SBO as well as determining the level of obstruction in a Ugandan setting. Sonography was found to be more accurate at determining the cause of obstruction and detecting strangulation. It is recommended that sonography should be the initial imaging modality for patients presenting with suspected SBO and plain radiography should only be used as a complimentary investigation.

Tumoral calcinosis: report of nine cases.

Radiological observations of nine cases of tumoral calcinosis are reported. CT appearances of intracranial lesions in one patient are described. All patients were confirmed by histopathology. After complete excision no recurrence was seen in eight of the patients after a mean follow up of 24 months. Incomplete excision led to recurrence in one case.

Radiological presentation of pulmonary calcinosis: case report.

A 64-year old man presented to the Department of Radiology for evaluation. He had a seven year history of chronic cough. The chest x-ray (CXR) done showed high density diffuse cotton wool parenchymal opacities in both lungs sparing the pleura and broncho vascular bundles. These were also demonstrated on CT. This type of pulmonary calcinosis did not fit in with the classical appearances.

Congenital diaphragmatic hernia: report of three cases.

Three cases of congenital diaphragmatic hernia (CHD) are presented with special emphasis on a neonate with an unusual combination of abnormalities. It was noted that in all three the hernias were of the Bochdaleck's type. CDH may not always be a single isolated failure of closure of the pleural peritoneal hiatus but a more complex multi organ anomaly.

Bilateral massive galactoceles. An atypical presentation.

Two cases of atypical presentation of galactoceles are reported. Both young women were referred to Mulago Hospital, Department of Radiology for breast imaging because of painful enlargement of both breasts. Both were found to be young lactating mothers. Ultrasound and aspiration was done on both of them. Ultrasound showed cystic lesions in both women. A milky solution was aspirated in both cases.

Choledochal cyst: an atypical presentation of Caroli's disease.

An unusual case of a four month old baby girl with obstructive jaundice due to a choledochal cyst is reported. Pertinent clinical history, ultrasound and computerized tomography allowed accurate pre-operative diagnosis.