Factors associated with peptic ulcer perforations in Uganda: a multi-hospital cross-sectional study.

INTRODUCTION: Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. However, there is paucity of published data on the patterns of perforated peptic ulcer in the region. The aim of this study was to determine the factors associated with anatomical patterns of peptic ulcer perforation, as well as the clinical, socio-demographic, and anatomical patterns among patients in Uganda. METHODS: This was a cross sectional study that enrolled 81 consecutive patients with perforated peptic ulcers. Using a structured pretested questionnaire the social demographic and clinical characteristics were obtained. At surgery, the patterns of the perforations were determined. Logistic regression was done in SPSS version 22 to determine the factors associated with the anatomical patterns. RESULTS: Perforated peptic ulcer disease was more prevalent among males (79.5%), peasants (56.8%) and those from rural areas (65.4%). Majority of study participants were of blood group O (43.2%). Gastric perforations were more common (74.1%). Majority of the perforations were found anteriorly (81.5%). Being a casual laborer was independently associated with lower odds of having a gastric perforation compared to being a peasant farmer (P < 0.05). CONCLUSION: Public health campaigns aimed at prevention of peptic ulcer perforations should prioritize the males, peasants and those living in rural areas. When a patient in our setting is suspected to have a peptic ulcer perforation, the anterior part of the stomach should be considered as the most likely site involved more so in peasant farmers.

Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda.

INTRODUCTION: Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. MATERIAL AND METHODS: This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. CLINICAL TRIAL: Pan African Clinical Trial Registry 202006793783148. RESULTS: Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). CONCLUSIONS: There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.

Pre-pregnancy obesity among immigrant and non-immigrant women in Norway: Prevalence, trends, and subgroup variations.

INTRODUCTION: This study assessed prevalence and time trends of pre-pregnancy obesity in immigrant and non-immigrant women in Norway and explored the impact of immigrants' length of residence on pre-pregnancy obesity prevalence. MATERIAL AND METHODS: Observational data from the Medical Birth Registry of Norway and Statistics Norway for the years 2016-2021 were analyzed. Immigrants were categorized by their country of birth and further grouped into seven super regions defined by the Global Burden of Disease study. Pre-pregnancy obesity was defined as a body mass index ≥30.0 kg/m2, with exceptions for certain Asian subgroups (≥27.5 kg/m2). Statistical analysis involved linear regressions for trend analyses and log-binomial regressions for prevalence ratios (PRs). RESULTS: Among 275 609 pregnancies, 29.6% (N = 81 715) were to immigrant women. Overall, 13.6% were classified with pre-pregnancy obesity: 11.7% among immigrants and 14.4% among non-immigrants. Obesity prevalence increased in both immigrants and non-immigrants during the study period, with an average yearly increase of 0.62% (95% confidence interval [CI]: 0.55, 0.70). Obesity prevalence was especially high in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India (20.3%-26.9%). Immigrant women from "Sub-Saharan Africa" showed a strong association between longer residence length and higher obesity prevalence (≥11 years (23.1%) vs. <1 year (7.2%); adjusted PR = 2.40; 95% CI: 1.65-3.48), particularly in women from Kenya, Eritrea, and Congo. CONCLUSIONS: Prevalence of maternal pre-pregnancy obesity increased in both immigrant and non-immigrant women from 2016 to 2021. Several immigrant subgroups displayed a considerably elevated obesity prevalence, placing them at high risk for adverse obesity-related pregnancy outcomes. Particular attention should be directed towards women from "Sub-Saharan Africa", as their obesity prevalence more than doubled with longer residence.

Prevalence and factors associated with rotavirus diarrhea among children aged 3-24 months after the introduction of the vaccine at a referral hospital in Uganda: a cross-sectional study.

BACKGROUND: Rotavirus has a significant morbidity and mortality in children under two years. The burden of rotavirus diarrhea 4 years post introduction of rotavirus vaccine in Uganda is not well established. This study aimed to determine the prevalence, severity of dehydration and factors associated with rotavirus diarrhea among children aged 3 to 24 months after the introduction of the vaccine at Fort Portal Regional Referral hospital. METHODS: This was a cross-sectional hospital-based study in which children with acute watery diarrhea were included. A rectal tube was used to collect a stool sample for those unable to provide samples. Stool was tested for rotavirus using rapid immunochromatographic assay. Data was analysed using SPSS version 22 with logistic regression done to determine the factors. RESULTS: Out of 268 children with acute watery diarrhea, 133 (49.6%) were females. Rotavirus test was positive in 42 (15.7%), majority of whom had some dehydration 28(66.7%). The factors that were independently associated with rotavirus diarrhea were; age < 12 months (AOR = 8.87, P = 0.014), male gender (AOR = 0.08, P = 0.001), coming from a home with another person with diarrhea (AOR = 17.82, P = 0.001) or a home where the water source was a well (AOR = 50.17, P = 0.002). CONCLUSION: The prevalence of rotavirus diarrhea was three times less in the post rotavirus vaccination period compared to pre-rota vaccination period. Majority of the participants with rotavirus diarrhea had some dehydration. There is need for provision of safe water sources to all homes. Surveillance to determine the cause of the non rota diarrhea should be done.

Reasons for implementation success despite health system constraints: qualitative insights on 'what worked' for cotrimoxazole preventive therapy.

BACKGROUND: Although Cotrimoxazole preventive therapy (CPT) has shown to be highly efficacious in reducing morbidity and mortality among people living with Human immunodeficiency virus (HIV) under 'ideal world' study conditions, operational challenges are limiting its effectiveness when implementing in countries most affected by the HIV epidemic. The fact that Mozambican authorities reported high coverage of CPT among patients with HIV, has led to this qualitative case study aimed at exploring possible factors responsible for the successful implementation of CPT in the Province of Maputo. METHODS: Between February and April 2019, we individually interviewed nine governmental stakeholders, including the person responsible for the HIV Program, the person responsible for the TB Program and the person responsible for Pharmaceutical management at three administrative levels (central, provincial and district level). Interviews were recorded, transcribed, and analysed thematically using MAXQDA Analytics Pro. Findings were translated from Portuguese into English. RESULTS: Five themes iteratively emerged: (a) Role of governance & leadership, (b) Pharmaceutical strategies, (c) Service delivery modifications, (d) Health care provider factors, and (e) Patients' perspectives. Interviews revealed that continuous supply of cotrimoxazole (CTZ) had been facilitated through multiple-source procurement and a push-pull strategy. One part of CTZ arrived in kits that were imported from overseas and distributed to public health facilities based on their number of outpatient consultations (push strategy). Another part of CTZ was locally produced and distributed as per health facility demand (pull strategy). Strong district level accountability also contributed to the public availability of CTZ. Interviewees praised models of differentiated care, the integrated HIV service delivery and drug delivery strategies for reducing long queues at the health facility, better accommodating patients' needs and reducing their financial and organisational burden. CONCLUSIONS: This study presents aspects that governmental experts believed to be key for the implementation of CPT in the Province of Maputo, Mozambique. Enhancing the implementation outcomes - drug availability and feasibility of the health facility-based service delivery - seemed crucial for the implementation progress. Reasons for the remarkable patient acceptability of CPT in our study setting should be further investigated.

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings.

PURPOSE: Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organization. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings. METHODS: The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation. The resultant GAPS Version 2 underwent international pilot testing. Construct validation categorized institutions into providing basic or advanced surgical care. GAPS was further refined to Version 3 to include only questions with a > 75% response rate and those that significantly discriminated between basic or advanced surgical settings. RESULTS: GAPS Version 1 included 139 items, which, after expert panel feedback, was expanded to 168 items in Version 2. Pilot testing, in 65 institutions, yielded a high response rate. Of the 168 questions in GAPS Version 2, 64 significantly discriminated between basic and advanced surgical care. The refined GAPS Version 3 tool comprises 64 questions on: human resources (9), material resources (39), outcomes (3), accessibility (3), and education (10). CONCLUSION: The GAPS Version 3 tool presents a validated instrument for evaluating pediatric surgical capabilities in low-resource settings.

Injury characteristics and mortality in an emergency department in Ethiopia: a single-center observational study.

INTRODUCTION: An injury is described as any damage to the body that impairs health, and its severity can span from mild to life-threatening. On a global scale, injuries account for approximately 4.4 million deaths annually and are anticipated to become the seventh leading cause of death by 2030. In Ethiopia, injuries account for 7% of all deaths, with one of the world's highest rates of road traffic injuries. This study, undertaken at a primary trauma centre in the capital of Ethiopia, aimed to explore the characteristics of injured patients and emergency department mortality as the patient outcome. Understanding the patterns and outcomes of injuries helps to anticipate needs, prioritize patients, and allocate resources effectively. METHODS: A retrospective single-center observational study utilised patient records from September 2020 to August 2021 at Addis Ababa Burn Emergency and Trauma Hospital, located in Ethiopia. A structured checklist facilitated the data collection. All patients arriving in the ED from September 2020 to August 2021 were eligible for the study while incomplete records (missing > 20% of wanted data elements) were excluded. RESULT: Of the 3502 injured patients recorded during the study period, 317 were selected. The mean patient age was 30 years, with 78.5% being male. About 8% arrived the emergency department within an hour after the injury. Ambulances transported 38.8% of patients; 58.5% of these were referred from other facilities. The predominant mechanism of injury both in and outside Addis Ababa was pedestrian road traffic injuries (31.4% and 38%). The predominant injury type was fractures (33.8%). The mortality rate was 5%, of which half were pedestrian road traffic incidents. CONCLUSION: Pedestrian road traffic injuries were the main cause of injury in and outside of Addis Ababa. A small proportion of patients arrived at the emergency department within the first hour after an injury event. A significant proportion of ambulance-transported patients were referred from other facilities rather than directly from the scene. The overall mortality rate was high, with pedestrian road traffic injury accounting for half of the proportion.

Building a predictive model of low birth weight in low- and middle-income countries: a prospective cohort study.

BACKGROUND: Low birth weight (LBW, < 2500 g) infants are at significant risk for death and disability. Improving outcomes for LBW infants requires access to advanced neonatal care, which is a limited resource in low- and middle-income countries (LMICs). Predictive modeling might be useful in LMICs to identify mothers at high-risk of delivering a LBW infant to facilitate referral to centers capable of treating these infants. METHODS: We developed predictive models for LBW using the NICHD Global Network for Women's and Children's Health Research Maternal and Newborn Health Registry. This registry enrolled pregnant women from research sites in the Democratic Republic of the Congo, Zambia, Kenya, Guatemala, India (2 sites: Belagavi, Nagpur), Pakistan, and Bangladesh between January 2017 - December 2020. We tested five predictive models: decision tree, random forest, logistic regression, K-nearest neighbor and support vector machine. RESULTS: We report a rate of LBW of 13.8% among the eight Global Network sites from 2017-2020, with a range of 3.8% (Kenya) and approximately 20% (in each Asian site). Of the five models tested, the logistic regression model performed best with an area under the curve of 0.72, an accuracy of 61% and a recall of 72%. All of the top performing models identified clinical site, maternal weight, hypertensive disorders, severe antepartum hemorrhage and antenatal care as key variables in predicting LBW. CONCLUSIONS: Predictive modeling can identify women at high risk for delivering a LBW infant with good sensitivity using clinical variables available prior to delivery in LMICs. Such modeling is the first step in the development of a clinical decision support tool to assist providers in decision-making regarding referral of these women prior to delivery. Consistent referral of women at high-risk for delivering a LBW infant could have extensive public health consequences in LMICs by directing limited resources for advanced neonatal care to the infants at highest risk.

Barriers to using postpartum family planning among women in Zanzibar, Tanzania.

BACKGROUND: Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. METHODS: Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. RESULTS: Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. CONCLUSIONS: The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.

Prevalence and characteristics of unipolar mania in a low-income country setting: population-based data from the Butajira cohort, rural Ethiopia.

PURPOSE: Previous research suggests unipolar mania, i.e., bipolar disorder without depression, to be more common in low-income countries. However, longitudinal population-based studies on unipolar mania from low-income countries are lacking. This study therefore examined unipolar mania, in Butajira, Ethiopia, and associations with possible determinants. METHODS: Key informants and 68,378 screenings with the Composite International Diagnostic Interviews (CIDI 2.1) identified suspected cases of bipolar disorder. Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) (n = 2,285). 315 participants with bipolar disorder were recruited and followed up for an average of 2.5 years. Unipolar mania was defined when illness episodes consisted of at least two manic relapses. 240 cases had sufficient data to ascertain course of disorder. RESULTS: 41.7% (100 of 240 cases) of participants had unipolar mania. Unipolar mania was associated with less suicidal ideation (0% vs. 26.4%, p < 0.001), less suicidal thoughts (occasionally/often: 1%/3% vs. 19.6%/21%, p < 0.001), and less history of suicide attempt (2% vs. 11.6%, p = 0.01). The participants with unipolar mania tended to have better social functioning (OR = 2.05, p = 0.07) and less alcohol use (20.8% vs. 31.4%, p = 0.07). The study was partly based on retrospective data liable to recall bias. Some cases defined as unipolar mania in our study may later develop depression. CONCLUSION: Previous cross-sectional studies finding high proportions of unipolar mania in low-income countries appear supported. Unipolar mania trended towards better social functioning and was associated with lower suicidality. Future unipolar mania specifications could inform treatment and prognostic estimates of bipolar disorder.

24 h mortality and its predictors among road traffic accident victims in a resource limited setting; a multicenter cohort study.

INTRODUCTION: The incidence of road traffic accidents (RTAs) is on the rise contributing to the global burden of mortality as a major global health threat. It has been estimated that 93% of RTAs and more than 90% of the resulting deaths occur in low and middle income countries. Though death due to RTAs has been occurring at an alarming rate, there is paucity of data relating to incidence and predictors of early mortality. This study was aimed at determining the 24 h mortality and its predictors among RTA patients attending selected hospitals in western Uganda. METHODS: This was a prospective cohort that consecutively enrolled 211 RTA victims admitted and managed in emergency units of 6 hospitals in western Uganda. All patients who presented with a history of trauma were managed according to the advanced trauma life support protocol (ATLS). The outcome regarding death was documented at 24 h from injury. Data was analyzed using SPSS version 22 for windows. RESULTS: Majority of the participants were male (85.8%) aged 15-45 years (76.3%). The most common road user category was motorcyclists (48.8%). The 24 h mortality was 14.69%. At multivariate analysis, it was observed that a motorcyclist was 5.917 times more likely to die compared to a pedestrian (P = 0.016). It was also observed that a patient with severe injury was 15.625 times more likely to die compared to one with a moderate injury (P < 0.001). CONCLUSION: The incidence of 24 h mortality among road traffic accident victims was high. Being motorcycle rider and severity of injury according to Kampala trauma score II predicted mortality. Motorcyclists should be reminded to be more careful while using the road. Trauma patients should be assessed for severity, and the findings used to guide management since severity predicted mortality.

Gastroschisis in Mozambique: current status and priorities for improving care from Hospital Central de Maputo, the largest and referral hospital of the country.

PURPOSE: Historically, gastroschisis was considered a death sentence in Mozambique. The purpose of this study was to evaluate the current state of gastroschisis management and outcomes in our facility and to identify potential areas of improvement in neonatal and surgical care. METHODS: A retrospective study was performed of all gastroschisis patients admitted to Hospital Central Maputo located in Maputo City/ Mozambique from 2019 to 2020. Demographic, perinatal, operative, and mortality data were obtained from neonatal and surgical logbooks. Descriptive analysis was performed. RESULTS: A total of 62 gastroschisis patients were admitted to the Hospital Central Maputo. No patients had a prenatal diagnosis. Many of the infants were born preterm (48%), and 68% had low birth weight. Only 15 (24%) patients underwent operative intervention (73% primary fascial closure and 27% sutured silo). There were only three survivors (5%) all of whom underwent primary closure. However, the overall survival rate for patients undergoing an attempt at surgical closure was 20%. CONCLUSION: While the mortality rate remains high for gastroschisis patients in Mozambique, there have been a few survivors when surgery is performed. Improvements in neonatal care are needed. Given the high mortality rates and limited resources, we plan to focus our surgical efforts on bedside closure techniques.

Stressful life events among women living homeless in Nicaragua, a low-income country.

Nicaragua is one of the lowest income countries in Latin America, where there is a shortage of data on women living homeless. This paper analyses the types, timing and perceived causality of stressful life events (SLE) suffered both during childhood and adolescence and throughout life by women living homeless (n = 30). A structured interview was used to collect the data. Findings showed that women living homeless in Nicaragua suffered a very high number of SLEs, and that these were extremely severe and from very early ages. Most of the SLEs took place before the women became homeless. The SLEs suffered by the women interviewed in Nicaragua were largely similar to those seen in women living homeless in other cultural contexts with higher incomes, although it should be noted that those interviewed in Nicaragua had suffered a higher number of SLE during their childhood and adolescence. The women interviewed mainly attributed finding themselves homeless to having suffered SLEs in the family environment. The suffering of multiple and severe SLEs, largely leading to living in socioeconomically disadvantaged situations, seem to present a significant vulnerability factor both for becoming homeless and remaining homeless over time.

Lack of Access to Coronavirus Disease 2019 Vaccines Could Be a Greater Threat than Vaccine Hesitancy in Low-Income and Conflict Nations: The Case of Yemen.

BACKGROUND: Vaccine hesitancy and vaccine inequity are 2 major hurdles toward achieving population immunity to coronavirus disease 2019 (COVID-19). Although several studies have been published on vaccine hesitancy among numerous populations, there is inadequate information on any potential correlation between vaccine acceptance and lack of access to vaccines. Our cross-sectional study in a low-income country aimed to fill this gap. METHODS: We conducted a nation-wide cross-sectional survey among the general population in Yemen, a low-income conflict country. Participants from all provinces in Yemen were included in the study. We evaluated factors that influence agreement to accept a COVID-19 vaccine and any potential correlation between vaccine hesitancy and lack of access to vaccines. RESULTS: Overall, 50.1% of the 5329 respondents agreed to accept a COVID-19 vaccine. Only 39.9% of participants agreed that they had access to a COVID-19 vaccine, with females indicating lower access than males. Potential determinants of vaccine acceptance included being male, updating self on the development of vaccines against COVID-19, opinion about severity of COVID-19, anxiety about contracting COVID-19, concerns about the safety of COVID-19 vaccines, and lack of access to vaccines. CONCLUSIONS: Our results indicate that the immediate threat in Yemen toward achieving population immunity is the severe shortage and lack of access to vaccines, rather than vaccine hesitancy.

Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting.

INTRODUCTION: The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM: The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS: Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS: Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION: Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.

The association of cognitive impairment with quality of life and functional impairment in Ugandan first-episode psychosis patients: a cross sectional study.

INTRODUCTION: Cognitive impairment is common in first-episode psychosis patients and often associated with poor quality of life and functional impairment. However, most literature on this association is from high income countries and not low resource countries like Uganda. We aimed to determine the association between cognitive impairment with quality of life and functional impairment in Ugandan first-episode psychosis patients. METHODS: At Butabika national psychiatric hospital of Uganda, we enrolled 94 first-episode psychosis patients aged 18-60 years with a confirmed first-episode of psychosis and no previous treatment with antipsychotic medication. Neuropsychological assessment was performed using the MATRICS consensus cognitive battery (MCCB). Quality of life and functional impairment were assessed using the brief version of the World Health Organisation Quality of Life scale (WHOQOL-BREF) and the MINI International Neuropsychiatric Inventory (MINI) respectively. Linear regression analyses determined the association between impairment in different cognitive domains with various quality of life and functional impairment domains while controlling for age, gender and level of education. RESULTS: High scores in the reasoning and problem solving cognitive domain were associated with better quality of life in the psychological domain of WHOQOL-BREF (p = 0.029). For functional impairment, high cognitive scores in the domains of speed of processing (p = 0.018), reasoning and problem solving (p = 0.015), working memory (p = 0.017) and visual learning and memory (p = 0.002) were associated with psychosis "having a greater impact on other members of the family" on the MINI. Higher scores in the social cognition domain were associated with "less aggressive and disruptive behaviour" (p = 0.003). CONCLUSION: Cognitive impairment in Ugandan first-episode psychotic patients is associated with both poorer quality of life and functional impairment. Remediation of cognitive function may be a plausible intervention to improve outcomes in Ugandan first-episode psychosis patients.

Paediatric nephrology in under-resourced areas.

BACKGROUND: Nearly 50% of the world population and 60% of children aged 0 to 14 years live in low- or lower-middle-income countries. Paediatric nephrology (PN) in these countries is not a priority for allocation of limited health resources. This article explores advancements made and persisting limitations in providing optimal PN services to children in such under-resourced areas (URA). METHODS: Medline, PubMed and Google Scholar online databases were searched for articles pertaining to PN disease epidemiology, outcome, availability of services and infrastructure in URA. The ISN and IPNA offices were contacted for data, and two online questionnaire surveys of IPNA membership performed. Regional IPNA members were contacted for further detailed information. RESULTS: There is a scarcity of published data from URA; where available, prevalence of PN diseases, managements and outcomes are often reported to be different from high income regions. Deficiencies in human resources, fluoroscopy, nuclear imaging, immunofluorescence, electron microscopy and genetic studies were identified. Several drugs and maintenance kidney replacement therapy are inaccessible to the majority of patients. Despite these issues, regional efforts with support from international bodies have led to significant advances in PN services and infrastructure in many URA. CONCLUSIONS: Equitable distribution and affordability of PN services remain major challenges in URA. The drive towards acquisition of regional data, advocacy to local government and non-government agencies and partnership with international support bodies needs to be continued. The aim is to optimise and achieve global parity in PN training, investigations and treatments, initially focusing on preventable and reversible conditions.

Why a large percentage of Tunisian women aged 40 years and more has a reduced forced vital capacity? The implication of parity.

The investigation of the link between reduced forced vital capacity (FVC) and risk factors and health variables in women aged ≥ 40 years is encouraged since a reduced FVC was related to all-cause mortality. The high frequency of women with a reduced FVC, observed in some studies, could be related to the impacts of parity on lung. In the literature, the association between parity and health consequences is discussed in terms of "selection pressure", and the trade-off between longevity and fertility described by scientists is termed the "longevity determination" or "biological warranty period". The respiratory system could be influenced by parity. Above all, it is the respiratory system, who endures the repercussions of the numerous physio-pathological experiences of the woman life. The probable effects of parity on lung function data, including FVC, make parity a key predictor to be stressed and evaluated. Parity is a promising original direction for physiological and pathophysiological research, particularly for low- and lower-middle- income countries. Thus, upcoming epidemiological and clinical studies of lung function data in women would need to include information about their parity status.

Cross-national examination of adolescent suicidal behavior: a pooled and multi-level analysis of 193,484 students from 53 LMIC countries.

INTRODUCTION: Suicide is a leading cause of adolescent mortality worldwide. We aimed to estimate the prevalence and identify individual-level and country-level factors which might explain the variability in suicidal behavior among students in 53 low to middle income countries. METHODS: We used data on adolescents aged 12-16 years from the Global School-based Student Health Surveys from 2009-2016. The suicidal behaviors investigated included suicide ideation, suicidal planning and suicide attempt. The prevalence was estimated for 53 countries, while a multilevel logistic regression analysis (33 countries) was used to investigate the associations of these behaviors with individual and country-level contextual risk factors. The contextual variables included the Gini Coefficient, Gross Domestic Product per capita, pupil-to-teacher ratios, population density, homicide rates, law criminalizing suicide and the night light index. RESULTS: The overall prevalence of suicide ideation, making a plan and suicide attempt were 10.4%, 10.3% and 11.0%, respectively. The highest prevalence rates reported were from the Americas. The strongest risk factors associated with suicidal behavior included anxiety, loneliness, no close friends and the substance abuse. Among the country level variables, the night light index was associated with making a suicide plan and attempting suicide. CONCLUSION: The non-significant country level findings were not entirely surprising given the mixed results from prior studies. Additional knowledge is thus achieved with regard to country level factors associated with suicidal behavior across adolescent populations.

Challenge of gastro-intestinal stromal tumor management in low-income countries: example of Benin.

BACKGROUND: GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa, there are few studies about it. Imatinib, an oral targeted therapy, has been available in Benin since 2010 and free since 2016. This study describes the diagnosis and therapeutic management of GIST in Cotonou, Benin. METHODS: This is a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Cases were identified using the registry database and the archival files of the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM). RESULTS: Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2:1 (10 males and 5 females). The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 h to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib has improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7). CONCLUSION: GISTs are rare tumors and preferentially affect the stomach in Cotonou). Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.