Prevalence of gastrointestinal bleeding and frequency of selected predictors of mortality on the medical emergency ward at Mulago hospital.

Background: There was no data on the prevalence of Gastrointestinal bleeding (GI) among patients admitted on the emergency ward at Mulago hospital. This was partly because the medical records were not adequately completed as designed. Objective: To estimate the prevalence of gastrointestinal bleeding and the frequency of selected predictors of mortality on the emergency ward. Methods: This was a chart review incorporating quality improvement methods in the process of data collection. The health care team was educated on documentation of gastrointestinal bleeding while being assessed weekly for knowledge and practice of completion of the Casualty Assessment form (CAF) from which a documented diagnosis of GI bleeding and selected predictors of mortality were looked for. Results: Of the 1881 CAF assessed, 278 had a documented diagnosis of GI bleeding, resulting in a prevalence of 6.8%. Of the patients with GI bleeding, 14.1% had age greater than 60 years, 24.0% had a systolic blood pressure less than 100mmHg and 44.5% had a heart rate greater than 100 beats per minute. Conclusion: The prevalence of GI bleeding on the medical emergency ward of Mulago hospital is high. This calls for strategies for resuscitative management of this life-threatening medical emergency. Among the selected predictors of mortality, tachycardia was most frequent followed by hypotension. These should always be assessed in a patient with GI bleeding and resuscitative measures with blood transfusion and intravenous fluids undertaken to correct them.

Safety and efficacy of hydroxychloroquine for treatment of non-severe COVID-19 among adults in Uganda: a randomized open label phase II clinical trial.

BACKGROUND: Several repurposed drugs such as hydroxychloroquine (HCQ) have been investigated for treatment of COVID-19, but none was confirmed to be efficacious. While in vitro studies have demonstrated antiviral properties of HCQ, data from clinical trials were conflicting regarding its benefit for COVID-19 treatment. Drugs that limit viral replication may be beneficial in the earlier course of the disease thus slowing progression to severe and critical illness. DESIGN: We conducted a randomized open label Phase II clinical trial from October-December 2020. METHODS: Patients diagnosed with COVID-19 using RT-PCR were included in the study if they were 18 years and above and had a diagnosis of COVID-19 made in the last 3 days. Patients were randomized in blocks, to receive either HCQ 400 mg twice a day for the first day followed by 200 mg twice daily for the next 4 days plus standard of care (SOC) treatment or SOC treatment alone. SARS COV-2 viral load (CT values) from RT-PCR testing of samples collected using nasal/orapharyngeal swabs was performed at baseline, day 2, 4, 6, 8 and 10. The primary outcome was median time from randomization to SARS COV-2 viral clearance by day 6. RESULTS: Of the 105 participants enrolled, 55 were assigned to the intervention group (HCQ plus SOC) and 50 to the control group (SOC only). Baseline characteristics were similar across treatment arms. Viral clearance did not differ by treatment arm, 20 and 19 participants respectively had SARS COV-2 viral load clearance by day 6 with no significant difference, median (IQR) number of days to viral load clearance between the two groups was 4(3-4) vs 4(2-4): p = 0.457. There were no significant differences in secondary outcomes (symptom resolution and adverse events) between the intervention group and the control group. There were no significant differences in specific adverse events such as elevated alkaline phosphatase, prolonged QTc interval on ECG, among patients in the intervention group as compared to the control group. CONCLUSION: Our results show that HCQ 400 mg twice a day for the first day followed by 200 mg twice daily for the next 4 days was safe but not associated with reduction in viral clearance or symptom resolution among adults with COVID-19 in Uganda. TRIAL REGISTRATION:  NCT04860284.

A Preliminary Report on Herbal Medicine Use Among Patients Hospitalized at Two-Large COVID-19 Treatment Centers in Uganda.

INTRODUCTION: Herbal medication use among patients with COVID-19 imposes a significant risk of drug-herbal interactions and adverse events. This study aimed to assess the prevalence and factors associated with herbal medicine use among patients hospitalized with COVID-19 attending two large COVID-19 Treatment Units (CTU) in Uganda. METHODS: A hospital-based descriptive cross-sectional study was conducted recruiting patients with COVID-19 hospitalized at the Mulago National Referral Hospital and Namboole Stadium CTUs. Chi-square or Fishers' exact test for categorical and Mann-Whitney U-test for numerical were used to determine the association between dependent and independent variables. RESULTS: The study was terminated early because of significant reduction in the number of patients hospitalized with COVID-19 and the closure of Namboole CTU. Of the anticipated 422 participants, we recruited 108 (25.6%). Of this, 58 (53.7%) were female, with a median age of 38 (range: 20-75) years. Forty-nine (45.4%) had received at least one dose of the COVID-19 vaccine. Fifty-eight (57.3%) of the participants had ever used herbal medicine and the majority had used them in the past 12 months (71.9%, n = 41) either before the diagnosis of COVID-19 (85.4%, n = 35) or after (36.6%, n = 15). Being vaccinated for COVID-19 (adjusted odds ratio (aOR): 3.1, 95% confidence interval (CI): 1.4-6.8, p = 0.005) and having attained tertiary level of education (aOR: 6.2, 95% CI: 1.7-23.1, p = 0.006), as well as the accessibility to herbalists (aOR: 31.2, 95% CI: 3.7-263.2, p = 0.002) were significantly associated with herbal medication use. The majority of participants reported some improvement after using herbal medicine (80.7%, n = 46) and their doctors or nurses asked almost half of the participants about herbal medicine use (49.5%, n = 53). CONCLUSION: The use of herbal medicines to treat or prevent COVID-19 among hospitalized patients is a widespread practice in Uganda amidst unpublished evidence of their safety and efficacy.

Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda.

BACKGROUND: Mothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming. METHOD: The study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late. RESULTS: Four hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit. CONCLUSION: Pregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care.