Support mechanisms for research generation and application for postgraduate students in four universities in Uganda.

BACKGROUND: A large proportion of postgraduate students the world over complete a research thesis in partial fulfilment of their degree requirements. This study identified and evaluated support mechanisms for research generation and utilization for masters' students in health institutions of higher learning in Uganda. METHODS: This was a self-administered cross-sectional survey using a modified self-assessment tool for research institutes (m-SATORI). Postgraduate students were randomly selected from four medical or public health Ugandan universities at Makerere, Mbarara, Nkozi and Mukono and asked to circle the most appropriate response on a Likert scale from 1, where the "situation was unfavourable and/or there was a need for an intervention", to 5, where the "situation was good or needed no intervention". These questions were asked under four domains: the research question; knowledge production, knowledge transfer and promoting use of evidence. Mean scores of individual questions and aggregate means under the four domains were computed and then compared to identify areas of strengths and gaps that required action. RESULTS: Most of the respondents returned their questionnaires, 185 of 258 (71.7%), and only 79 of these (42.7%) had their theses submitted for examination. The majority of the respondents were male (57.3%), married or cohabiting (58.4%), and were medical doctors (71.9%) from Makerere University (50.3%). The domain proposal development for postgraduate research project had the highest mean score of 3.53 out of the maximum 5. Three of the four domains scored below the mid-level domain score of 3, that is, the situation is neither favourable nor unfavourable. Areas requiring substantial improvements included priority-setting during research question identification, which had the lowest mean score of 2.12. This was followed by promoting use of postgraduate research products, tying at mean scores of 2.28 each. The domain knowledge transfer of postgraduate research products had an above-average mean score of 2.75. CONCLUSIONS: This study reports that existing research support mechanisms for postgraduate students in Uganda encourage access to supervisors and mentors during proposal development. Postgraduate students' engagement with research users was limited in priority-setting and knowledge transfer. Since supervisors and mentors views were not captured, future follow-on research could tackle this aspect.

A systematic review on academic research productivity of postgraduate students in low- and middle-income countries.

BACKGROUND: While several individual studies addressing research productivity of post-graduate students are available, a synthesis of effective strategies to increase productivity and the determinants of productivity in low-income countries has not been undertaken. Further, whether or not this research from post-graduate students' projects was applied in evidence-informed decision-making was unknown. Therefore, we conducted a systematic review of literature to identify and assess the effectiveness of approaches that increase productivity (proportion published) or the application (proportion cited) of post-graduate students' research, as well as to assess the determinants of post-graduate students' research productivity and use. METHODS: We conducted a systematic review as per our a priori published protocol, also registered in PROSPERO (CRD42016042819). We searched for published articles in PubMed/MEDLINE and the ERIC databases through to July 2017. We performed duplicate assessments for included primary studies and resolved discrepancies by consensus. Thereafter, we completed a structured narrative synthesis and, for a subset of studies, we performed a meta-analysis of the findings using both fixed and random effects approaches. We aligned our results to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: We found 5080 articles in the PubMed (n = 3848) and ERIC (n = 1232) databases. After excluding duplicates (n = 33), we screened 5047 articles, of which 5012 were excluded. We then retrieved 44 full texts and synthesised 14, of which 4 had a high risk of bias. We did not find any studies assessing effectiveness of strategies for increasing publication nor citations of post-graduate research projects. We found an average publication proportion of 7% (95% CI 7-8%, Higgins I-squared 0.0% and Cochran's Q p < 0.01) and 23% (95% CI 17-29%, Higgins I-squared of 98.4% and Cochran's Q, p < 0.01) using fixed effects and random effects models, respectively. Two studies reported on the citation of post-graduate students' studies, at 17% (95% CI 15-19%) in Uganda and a median citation of 1 study in Turkey (IQR 0.6-2.3). Only one included study reported on the determinants of productivity or use of post-graduate students' research, suggesting that younger students were more likely to publish and cohort studies were more likely to be published. CONCLUSIONS: We report on the low productivity of post-graduate students' research in low- and middle-income countries, including the citation of post-graduate students' research in evidence-informed health policy in low- and middle-income countries. Secondly, we did not find a single study that assessed strategies to increase productivity and use of post-graduate students' research in evidence-informed health policy, a subject for future research.

Use of post-graduate students' research in evidence informed health policies: a case study of Makerere University College of Health Sciences, Uganda.

BACKGROUND: World over, stakeholders are increasingly concerned about making research useful in public policy-making. However, there are hardly any reports linking production of research by students at institutions of higher learning to its application in society. We assessed whether and how post-graduate students' research was used in evidence-informed health policies. METHODS: This is a multiple case study of master's students' dissertations at Makerere University College of Health Sciences (MakCHS) produced between 1996 and 2010. In a structured review, we applied a theoretical framework of 'research use' and used content analysis to map how research was used in public policy documents. We categorised content of these documents according to the health-related Millennium Development Goals (MDG). We defined a case of 'use' as citation of research products from a master's student's dissertation in a public policy-related document. RESULTS: We found 22 cases of research use in policy-related documents (0.5%) out of a total 4230 citations from 16 of 1172 total dissertations (1.4%). Additionally, research was mostly cited in primary studies (95.4%), systematic reviews (3%), narrative reviews (0.8%) and cost-effectiveness analyses (0.2%). Research was predominantly used instrumentally, to either frame the problem (burden of disease or health condition) or select an intervention (treatment or diagnostic option) and rarely symbolically to justify strategies already selected. The bulk of the cases of research use addressed child health (MDG 4), focusing on infectious diseases (MDG 6), mainly in international clinical or public health guidelines, working papers, a consensus statement and a global report. We distilled 'synergistic relationships' among organisations or interest groups, 'globalisation of local evidence', 'trade-offs' in the use of research and use of 'negative results' from the documents and text content. CONCLUSIONS: Research from dissertations of post-graduate students at MakCHS is used in evidence-informed health policies, particularly for infectious diseases in child health. Further, we have delineated pathways of research use in the global arena and highlighted the importance of 'negative results' from dissertations of post-graduate students at MakCHS.

Academic research productivity of post-graduate students at Makerere University College of Health Sciences, Uganda, from 1996 to 2010: a retrospective review.

BACKGROUND: Research is a core business of universities globally, and is crucial in the scientific process as a precursor for knowledge uptake and use. We aimed to assess the academic productivity of post-graduate students in a university located in a low-income country. METHODS: This is an observational retrospective documentary analysis using hand searching archives, Google Scholar and PubMed electronic databases. The setting is Makerere University College of Health Sciences, Uganda. Records of post-graduate students (Masters) enrolled from 1996 to 2010, and followed to 2016 for outcomes were analysed. The outcome measures were publications (primary), citations, electronic dissertations found online or conference abstracts (secondary). Descriptive and multivariable logistic regression analyses were performed using Stata 14.1. RESULTS: We found dissertations of 1172 Masters students over the 20-year period of study. While half (590, 50%) had completed clinical graduate disciplines (surgery, internal medicine, paediatrics, obstetrics and gynaecology), Master of Public Health was the single most popular course, with 393 students (31%). Manuscripts from 209 dissertations (18%; 95% CI, 16-20%) were published and approximately the same proportion was cited (196, 17%; 95% CI, 15-19%). Very few (4%) policy-related documents (technical reports and guidelines) cited these dissertations. Variables that remained statistically significant in the multivariable model were students' age at enrolment into the Masters programme (adjusted coefficient -0.12; 95% CI, -0.18 to -0.06; P < 0.001) and type of research design (adjusted coefficient 0.22; 0.03 to 0.40; P = 0.024). Cohort studies were more likely to be published compared to cross-sectional designs (adjusted coefficient 0.78; 95% CI, 0.2 to 1.36; P = 0.008). CONCLUSIONS: The productivity and use of post-graduate students' research conducted at the College of Health Sciences Makerere University is considerably low in terms of peer-reviewed publications and citations in policy-related documents. The need for effective strategies to reverse this 'waste' is urgent if the College, decision-makers, funders and the Ugandan public are to enjoy the 'return on investment' from post-graduate students research.

Where is students' research in evidence-informed decision-making in health? Assessing productivity and use of postgraduate students' research in low- and middle-income countries: a systematic review.

BACKGROUND: Investing in research that is not accessible or used is a waste of resources and an injustice to human subject participants. Post-graduate students' research in institutions of higher learning involves considerable time, effort and money, warranting evaluation of the return on investment. Although individual studies addressing research productivity of post-graduate students are available, a synthesis of these results in low-income settings has not been undertaken. Our first aim is to identify the types of approaches that increase productivity and those that increase the application of medical post-graduate students' research and to assess their effectiveness. Our second aim is to assess the determinants of post-graduate students' research productivity. METHODS: We propose a two-stage systematic review. We will electronically search for published and grey literature in PubMed/MEDLINE and the ERIC databases, as well as contact authors, research administration units of universities, and other key informants as appropriate. In stage one, we will map the nature of the evidence available using a knowledge translation framework adapted from existing literature. We will perform duplicate screening and selection of articles, data abstraction, and risk of bias assessments for included primary studies as described in the Cochrane handbook for systematic reviews. Our primary outcome is publication output as a measure of research productivity, whilst we defined research use as citations in peer-reviewed journals or policy-related documents as our secondary outcome. In stage two, we will perform a structured narrative synthesis of the findings and advance to quantitative meta-analysis if the number of studies are adequate and their heterogeneity is low. Adapting the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach, we will assess the overall quality of evidence for effects, and report our results in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. DISCUSSION: We will share our findings with universities, other training institutions, civil society, funders as well as government departments in charge of education and health particularly in low- and middle-income countries.

Difference in Risk Factors for Breast Cancer by ER Status in an Indigenous African Population.

Introduction. Breast cancer is the commonest cancer among women globally. In Uganda, it is on the rise, projected at a 4.5% annual ASR increase (age standardized incidence rate). The reasons for this steep increase are not fully established. In the recent past, gene profiling in tumor tissues suggests that breast cancers are divided into subtypes dependent on the presence or absence of oestrogen receptor, progesterone, and human epidermal growth factor receptor 2 (HER 2). These subtypes do have distinctive clinical outcomes and perhaps risk factors from past studies. There is paucity of data on hormonal receptor status and the traditionally known risk factors in sub-Saharan Africa. The purpose of this study therefore was to establish the differences between ER status and the traditionally known risk factors for breast cancer in Uganda. Methods. An observational analytical hospital, based study, carried out at Makerere University, College of Health Sciences. Formalin fixed and paraffin imbedded sections were prepared for haemotoxylin and eosin (H&E) stains and immunohistochemistry (IHC). Ethical approval was obtained. Results. A total of 113 women were recruited. Mean age was 45 years (SD14). There were no significant differences in selected risk factors (setting, age, contraceptive use, parity, breast feeding, or menarche) by ER status although ER negative tumors had significantly higher grade tumors (by a factor of two) compared to ER positive tumors. Conclusion. There were no significant differences among risk factors by ER status contrary to what several other studies suggest. The manifestation of breast cancer in Africa warrants further extensive inquiry.

The diagnosis of childhood tuberculosis in an HIV-endemic setting and the use of induced sputum.

SETTING: A hospital in the capital city of Uganda. OBJECTIVES: To determine the proportion of positive induced sputum cultures among probable childhood tuberculosis (TB) cases, to describe the laboratory and radiological features of childhood TB in the context of human immunodeficiency virus (HIV), and to determine the prevalence of HIV infection in these patients. DESIGN: Cross-sectional descriptive study. METHOD: Seven hundred and fifty children with suspected TB were evaluated clinically, by chest radiography and by tuberculin test (Mantoux). Probable cases underwent sputum induction or lymph node biopsy, HIV testing and RNA-PCR tests. RESULTS AND CONCLUSION: The Mantoux test was positive in 55/121 (45%) of the patients; low sensitivity to Mantoux was associated with HIV infection (P = 0.000). Induced sputum yielded 12/101 (12%) positive smears of Mycobacterium tuberculosis and 30/101 (30%) positive cultures. Six of the eight lymph node biopsies were culture-positive, and the histology of seven samples was supportive of TB. Most of the children with probable and confirmed TB presented with similar signs, symptoms and chest radiography patterns, irrespective of HIV status. Elevated ESR had no significant role in the diagnosis of TB in children and even more so in the presence of HIV infection. The HIV infection rate was high among children with TB (49%).

Hydroquinone neuropathy following use of skin bleaching creams: case report.

A 30-year old black woman presented with gradual onset of weakness of the legs associated with burning sensation in the feet for two months. She had been using two hydroquinone based skin bleaching creams (MGC by M. G. C. International, MEKAKO by Anglo Fabrics BOLTON Ltd) for about four years. Her BP was 80/40 mm Hg supine with un-recordable diastolic pressure on standing. She had decreased power (Grade 3/5), loss of deep tendon reflexes and impairment of deep sensation in the lower limbs. A complete blood count, urinalysis, serum electrolytes, serum creatinine and uric acid were all normal. Oral GTT, VDRL and brucella tests were negative. Chest and abdominal radiographs did not show any abnormalities. A diagnosis of peripheral neuropathy with autonomic neuropathy possibly due to hydroquinone toxicity was made and she was advised to stop using hydroquinone based skin bleaching creams. Four months later she was asymptomatic, her BP was 120/80 mmHg supine and standing, and neurological examination was normal. The case raises the question of whether hydroquinone based skin bleaching creams could be a cause of peripheral neuropathy and underscores the need for research on hydroquinone based skin bleaching creams and neuropathy particularly in black women involved in the sale and/or use of skin bleaching creams.

Maternal diagnosis and treatment of children's fever in an endemic malaria zone of Uganda: implications for the malaria control programme.

A mother's ability to suspect malaria in the presence of fever has important consequences for child survival in malaria-endemic areas. This paper presents results of a clinic-based study of mothers' abilities to suspect malaria in the event of recognizing fever and other physiological and behavioral changes associated with the disease. The study population consisted of all (439) women or mothers who had accompanied children 5 years and below to the Old Mulago Hospital, Kampala, Uganda over a 10 day period during the malaria season of 1992. The children were those who had fever as a major complaint at the time of the visit or those who had fever in the last 7 days and were visiting the clinic for the first time for the current illness. The children were physically examined and their blood tested for malaria parasites. Mothers' diagnosis was compared with clinical and laboratory diagnosis of malaria. Mothers associated the presence of fever with several types of illness and malaria was often not suspected. Only 40% of the mothers suspected malaria in their children. The mothers were poor at recognizing malaria when, in fact, it was present. The sensitivity of the mothers' diagnosis of malaria was found to be 37%; 63% of malaria cases were misclassified as other conditions. The doctors classified most (92%) of the cases presenting with fever as having malaria, but laboratory tests indicated that only 64% of the children really had malaria. The sensitivity of clinical diagnosis was 98%, but the specificity was only 18%. Ninety percent of the mothers gave some medicines before visiting the health centre; and, of these, 76% gave modern drugs exclusively, including antimalarials, antipyretics, antibiotics and other drugs. Among the modern drugs given to children suspected of having malaria, 50% were antimalarials. The most commonly used antimalarial was chloroquine tablets. Mothers indiscriminately administered antimalarials to children irrespective of the perceived cause of the fever. There is need to educate mothers to suspect malaria first in every case of febrile illness, just like the doctors do, and about the first line drugs for the treatment of malaria.

PIP: Maternal ability to suspect malaria in the presence of fever and behavioral changes was investigated in a study of all 439 mothers who had brought febrile children 5 years of age and under to Old Mulago Hospital in Kampala, Uganda, during a 10-day period in the 1992 malaria season. The mothers' diagnosis of malaria was compared with clinical and laboratory diagnoses. Laboratory tests indicated that 64% of these children actually had malaria. Only 40% of mothers suspected malaria in their children. The sensitivity of mothers' diagnosis of malaria was 37%; 63% of malaria cases were misclassified as other conditions. Physicians diagnosed 92% of cases presenting with fever as malaria. The sensitivity of clinical diagnosis was 98%, but the specificity was only 18%. 90% of mothers indiscriminately administered some medication--primarily antimalarials such as chloroquine--before bringing their child to the clinic. In malaria-endemic areas, mothers' inability or delay in relating fever to malaria may have adverse effects on child survival. These findings indicate a need to educate mothers to suspect malaria first when fever is present and to administer appropriate treatment.