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Publications

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The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey.

AUTHORS:
Tessa Clemens Frederick Oporia Erin M Parker Merissa A Yellman Michael F Ballesteros Olive Kobusingye

 

Results: A total of 1435 fatal and non-fatal drowning cases were recorded; 1009 (70%) in lakeside districts and 426 (30%) in non-lakeside districts. Of 1292 fatal cases, 1041 (81%) were identified in only one source. After deduplication, 1283 (89% of recorded cases; 1160 fatal, 123 non-fatal) unique drowning cases remained. Data completeness varied by source and variable. When demographic characteristics were known, fatal victims were predominantly male (n=876, 85%), and the average age was 24 years. In lakeside districts, 81% of fatal cases with a known activity at the time of drowning involved boating.

 

AUTHORS: Albert Ningwa Kennedy Muni Frederick Oporia Joseph Kalanzi Esther Bayiga Zziwa Claire Biribawa Olive Kobusingye

 


 

Estimating the burden of road traffic crashes in Uganda using police and health sector data sources.

BMC Health Serv Res 2020 Jul 9;20(1):634. Epub 2020 Jul 9.

Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.

Results: At the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number. At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care. Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care. Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases.

 

AUTHORS:
Kennedy Maring Muni Albert Ningwa Jimmy Osuret Esther Bayiga Zziwa Stellah Namatovu Claire Biribawa Mary Nakafeero Milton Mutto David Guwatudde Patrick Kyamanywa Olive Kobusingye


 

Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study.

Inj Prev 2020 Mar 30. Epub 2020 Mar 30.
Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda.

Results: We estimated that 25 729 crashes occurred on Ugandan roads in 2016, involving 59 077 individuals with 7558 fatalities. This is more than twice the number of fatalities reported by the police for 2016 (3502) but lower than the estimate from the 2018 Global Status Report (12 036). Pedestrians accounted for the greatest proportion of the fatalities 2455 (32.5%), followed by motorcyclists 1357 (18%).

 

AUTHORS:
Swaibu Zziwa Harriet Babikako Doris Kwesiga Olive Kobusingye Jacob A Bentley Frederick Oporia Rebecca Nuwematsiko Abdulgafoor Bachani Lynn M Atuyambe Nino Paichadze

 


 

Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research.

BMC Public Health 2019 Dec 27;19(1):1742. Epub 2019 Dec 27.

Department of Global Health, Milken Institute School of Public Health, the George Washington University, Washington, DC, USA.

Results: The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda. Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age (AOR: 0.30; 95% CI: 0.12-0.74), socioeconomic status (AOR: 2.13; 95% CI: 1.03-4.41), education level (AOR: 4.3; 95% CI: 1.34-13.91) and awareness of the participants about the rehabilitation services (AOR: 5.1; 95% CI: 2.74-9.54) at p value ≤0.05.

 

AUTHORS:
Hani Mowafi Christine Ngaruiya Gerard O’Reilly Olive Kobusingye Vikas Kapil Andres Rubiano Marcus Ong Juan Carlos Puyana Akm Fazlur Rahman Rashid Jooma Blythe Beecroft Junaid Razzak

 


 

Road safety compliance among motorcyclists in Kawempe Division, Kampala, Uganda: a cross-sectional study.

BMJ Glob Health 2019 29;4(Suppl 6):e001442. Epub 2019 Jul 29.
Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.

AUTHORS:
Margaret Ndagire Suzanne Kiwanuka Nino Paichadze Olive Kobusingye

 


 

Motorcycle taxi programme is associated with reduced risk of road traffic crash among motorcycle taxi drivers in Kampala, Uganda.

Int J Inj Contr Saf Promot 2019 Sep 11;26(3):315-321. Epub 2019 Jun 11.
a Makerere University School of Public Health , Kampala , Uganda.
Motorcyclists are vulnerable road users in Uganda and 21.7% (3912/18,016) experienced crashes in 2012. This study determined the prevalence of and factors associated with compliance to selected road safety measures (helmet use, retro-reflective jackets use, riding permit and carrying one passenger) among commercial motorcyclists in Kawempe, from April to June 2014 using interviewer administered questionnaires. Total compliance was 0.9% and 24.4% to at least 3/4 measures. Compliance by measure was; 7.6% retroreflective jackets, 28.8% riding permits, 69.4% helmet use and 86.1% carrying one passenger. The associated factors were; knowing that (training before one starts to ride prevents crashes, Adjusted-odds-ratio (AOR) = 2.38 (1.36-4.19), maintaining the motorcycle in good condition prevents crashes, AOR = 0.34 (0.15-0.77) and padding reduces impact of road traffic injury, AOR = 0.37 (0.15-0.89)). Prevalence to compliance is very low. Road safety messages should highlight the importance of all road safety measures to improve compliance.

AUTHORS:
Kennedy Muni Olive Kobusingye Charlie Mock James P Hughes Philip M Hurvitz Brandon Guthrie

 


 

Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach.

Int J Inj Contr Saf Promot 2019 Sep 10;26(3):294-301. Epub 2019 Jun 10.
a Department of Epidemiology, University of Washington , Seattle , WA , USA.
is a transportation company that provides road safety training and helmets to its motorcycle taxi drivers in Kampala. We sought to determine whether risk of road traffic crash (RTC) was lower in compared to regular (non-SafeBoda) motorcycle taxi drivers during a 6-month follow-up period. We collected participant demographic and behavioural data at baseline using computer-assisted personal interview, and occurrence of RTC every 2 months using text messaging and telephone interview from a cohort of 342 drivers. There were 85 crashes (31 in and 54 in regular drivers) during follow-up. Over the 6-month follow-up period, drivers were 39% less likely to be involved in a RTC than regular drivers after adjusting for age, possession of a driver’s license, and education (RR: 0.61, 95% CI: 0.39-0.97,  = .04). These findings suggest that the programme results in safer driving and fewer RTCs among motorcycle taxi drivers in Kampala.

 

AUTHORS:
Amber Mehmood Armaan Ahmed Rowther Olive Kobusingye Adnan A Hyder

 


 

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study.

Int J Emerg Med 2018 Nov 22;11(1):53. Epub 2018 Nov 22.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.

AUTHORS:
Frederick Oporia Angela Nakanwagi Kisakye Rebecca Nuwematsiko Abdulgafoor Mahmood Bachani John Bosco Isunju Abdullah Ali Halage Zziwa Swaibu Lynn Muhimbuura Atuyambe Olive Kobusingye

 


 

Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry.

Pan Afr Med J 2018 2;31. Epub 2018 Sep 2.
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Introduction:

Results: A total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected.

 

AUTHORS:
Nukhba Zia Amber Mehmood Rukia H Namaganda Hussein Ssenyonjo Olive Kobusingye Adnan A Hyder

 


 

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda.

Trauma Surg Acute Care Open 2019 22;4(1):e000259. Epub 2019 Feb 22.
The Milken Institute School of Public Health, George Washington University, Washington, DC, USA.

Results: Intent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.

Discussion: Unintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.

Level Of Evidence: Prospective observational study, level III.

 

AUTHORS:
Paul Bangirana Bruno Giordani Olive Kobusingye Letisia Murungyi Charles Mock Chandy C John Richard Idro

 


 

Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: results from a registry.

BMC Neurol 2019 Feb 4;19(1):18. Epub 2019 Feb 4.
Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.

Results: One hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later.

Conclusion: This first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.

 

AUTHORS:
Amber Mehmood Nukhba Zia Olive Kobusingye Rukia H Namaganda Hussein Ssenyonjo Joel Kiryabwire Adnan A Hyder

 


 

Road traffic injuries in Uganda: pre-hospital care time intervals from crash scene to hospital and related factors by the Uganda Police.

Trauma Surg Acute Care Open 2018 19;3(1):e000253. Epub 2018 Dec 19.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Results: A total of 3944 patients were included in the study with a male versus female ratio of 5.5:1 and a mean age of 28.5 years (SD=14.2). Patients had closed head injuries in 62.9% of cases. The leading causes of TBIs were road traffic crashes (58.8%) and intentional injuries (28.7%). There was no significant difference between the four discharge categories with respect to age, sex, mode of arrival, cause of TBI, place of injury, type of head injury, transport time, and RTS (p>0.05). There were statistically significant differences between the four discharge categories for a number of serious injuries, GCS on arrival, change in GCS, and KTS. In a multinomial logistic regression model, change in GCS, area of residence, number of serious injuries, and KTS were significant predictors of ED disposition.

Discussion: This study provides evidence that ED disposition of patients with TBI is differentially affected by injury characteristics and is largely dependent on injury severity and change in GCS during ED stay.

AUTHORS:
Esther Bayiga Zziwa Christine Muhumuza Kennedy M Muni Lynn Atuyambe Abdulgafoor M Bachani Olive C Kobusingye

 


Motorcycle taxi programme increases safe riding behaviours among its drivers in Kampala, Uganda.

Gutentor Advanced TextInt J Inj Contr Saf Promot 2019 Jun 12;26(2):170-175. Epub 2018 Dec 12.
a Department of Disease Control and Environmental Health , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda.
A cross-sectional survey was conducted to collect primary data prospectively on pre-hospital care time intervals of Road Traffic Crash (RTC) victims that had been rescued by the Uganda police and to determine what factors were related to those intervals. The survey was conducted between 1 May 2015 and 31 May 2015. The Police responses to 96 RTCs were recorded, but only 74 of them were considered serious enough to warrant hospital transfer, and those 74 are the subject of the analysis. Pre-hospital care time ranged between 10 and 220 min. Seventy-two per cent of the calls were completed within 1 h of call initiation. The scene to hospital transport interval was the longest with a mean of 19.07 min (SD 10.11). Activation time was the shortest interval with a mean of 4.58 min (SD 5.67). Key factors for delays included: understaffing, lack of skills and long distances. A toll-free Universal Access Number, a law mandating provision of free basic emergency medical services at every health facility and gazetting of lanes for emergency services and might decrease on pre-hospital care time and could reduce on the notification and transport time interval respectively.

AUTHORS:
Kennedy Muni Olive Kobusingye Charles Mock James P Hughes Philip M Hurvitz Brandon GuthrieGutentor Advanced Text

 


Inj Prev 2020 02 24;26(1):5-10. Epub 2018 Nov 24.
Department of Epidemiology, University of Washington, Seattle, Washington, USA.

Results: Across the two cross-sectional studies, a higher proportion of drivers than regular drivers engaged in safe riding behaviours. For instance, helmet use among compared with regular drivers was 21% points higher (95% CI 0.15 to 0.27; p<0.001) based on the CAPI and 45% points higher (95% CI 0.43 to 0.47; p<0.001) based on roadside observation. Furthermore, compared with regular drivers, drivers were more likely to report having a driver’s license (66.3% vs 33.5 %; p<0.001) and a reflective jacket (99.5% vs 50.5 %; p<0.001) and were less likely to report driving towards oncoming traffic (4% vs 45.7 %; p<0.001) in the past 30 days.

Conclusion: The programme is associated with increased safe riding behaviours among motorcycle taxi drivers in Kampala. Therefore, the promotion and expansion of such programmes may lead to a reduction in morbidity and mortality due to road injuries.

AUTHORS:
Kristin Alves Norgrove Penny John Ekure Robert Olupot Olive Kobusingye Jeffrey N Katz Coleen S Sabatini

 


 

Postgraduate training for trauma prevention, injury surveillance and research, Uganda.

BMC Musculoskelet Disord 2018 Sep 24;19(1):343. Epub 2018 Sep 24.
University of California San Francisco Department of Orthopaedic Surgery, UCSF Benioff Children’s Hospital Oakland, 747 52nd Street, OPC 1st Floor, Oakland, CA, 94609, USA.
Background: The purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital.

 

Results: Of 1513 children seen in the musculoskeletal clinic, 331 (21.9% (95% CI 19.8-24.1%)) had PIP and another 258 (17.1% (95% CI 15.2-19.0%)) had GF as their diagnosis. Of 3339 children seen during outreach for any medical complaint, 283 (8.5% (95% CI 7.6-9.5%)) had PIP and another 1114 (33.4% (95% CI 31.8-35.0%)) had GF. Of patients with GF, 53.9% were male with a median age of 10 years (50% between 7 and 12 years old). Of patients with PIP, 56.7% were male with a median age of 5 years (50% between 2 and 8 years old).

Conclusion: PIP and GF comprise over 30% of clinical visits for musculoskeletal conditions and 40% of outreach visits for any medical complaint in this area of Uganda. The high estimated prevalence in these populations suggest a critical need for research, treatment, and prevention.

AUTHORS:
Abdulgafoor M Bachani Nino Paichadze Jacob A Bentley Nazarius Mbona Tumwesigye David Bishai Lynn Atuyambe Stephen Wegener David Guwatudde Olive C Kobusingye Adnan A Hyder

 


 

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala, Uganda.

Bull World Health Organ 2018 Jun 12;96(6):423-427. Epub 2018 Apr 12.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, Maryland, 21205, United States of America (USA).

Lessons Learnt: Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme.

AUTHORS:
Charles Ssemugabo Trasias Mukama Abdullah Ali Halage Nino Paichadze Dustin G Gibson Olive Kobusingye

 


 

Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes.

Int J Inj Contr Saf Promot 2018 Dec 30;25(4):449-457. Epub 2018 May 30.
a Department of Disease Control and Environmental Health, School of Public Health , College of Health Sciences, Makerere University , Kampala , Uganda.
Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22-15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01-1.96). Older children (12-18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26-4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03-12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21-3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11-0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.

AUTHORS:
Amber Mehmood Nukhba Zia Connie Hoe Olive Kobusingye

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