Faculty of Medicine

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Browsing Faculty of Medicine by Subject "Adolescents"

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    The management of osteosarcoma in children and adolescents in a resource-limited setting: quality improvement considerations to improve treatment outcomes
    (BMC Cancer, 2024) Nyeko, Richard; Geriga, Fadhil; Angom, Racheal; Kambugu, Joyce Balagadde; Heerden, Jaques van
    Background The survival rates for children and adolescents with osteosarcoma in low-income countries are poor. Insufficient data regarding the challenges of managing osteosarcoma in resource-limited settings has been published. We evaluated the treatment of osteosarcoma in children and adolescents with the aim of improving the health system and management outcomes. Methods We sourced data on children under 18 years treated for osteosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Descriptive statistics and Kaplan-Meier survival analysis were used. Results Seventy-four osteosarcoma cases were identified, with a median age of 13 years (IQR 9.8–15). Referrals were made after a median of 28 days (range 1-147). Before appropriate referral, more than a quarter (26%) had undergone invasive procedures that could compromise tumour integrity and outcome. Half (50%) of the patients had metastatic disease at diagnosis, primarily to the lungs (n=43; 92%). Only 14 (33%) patients received neoadjuvant chemotherapy. Forty-three (58.1%) patients underwent limb amputation surgery, including 25 localized tumours and 18 patients with distant metastatic disease. No metastatectomies were performed. Adjuvant chemotherapy was delayed for longer than 21 days in 26 (61%) patients. No pathology reports described the status of resection margins or the degree of chemotherapy-induced necrosis. Twenty-six (35%) patients abandoned treatment, mainly due to pending radical surgery (n=18/26; 69%). Only 18% (n=13) were still alive; 46% (n=34) had died; and 37% (n=27) had an unknown status. The median overall survival was 1.1 years, and was significantly negatively affected by disease metastasis, timing of adjuvant therapy, and treatment abandonment. Conclusions Osteosarcoma outcomes for children and adolescents at the Uganda Cancer Institute are extremely poor. The quality of care can be improved by addressing delayed referrals, high rates of prior manipulative therapy, metastatic disease, treatment abandonment, surgical challenges, and delayed resumption of adjuvant chemotherapy. Keywords Osteosarcoma, Children, Adolescents, Low- and middle-income countries, Resource-limited setting, Uganda
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    Prevalence and Factors Associated with Depression among Out-Of-School Adolescents in Ayere Village, Northern Uganda
    (International Journal of Academic Research in Progressive Education and Development, 2021) Kabunga, Amir; Nambozo, Specioza
    Globally mental health conditions account for 16% of the global burden of disease to adolescents aged 10-19 years with depression ranking as one of the leading causes of illness and disability among this age group and the burden of depression is higher in low and middle-income countries. However, little is known about how these conditions predispose to out-of-school adolescent depression. This study assessed the prevalence and factors associated with depression among out-of-school adolescents in Ayere village, northern Uganda. The study employed a cross-sectional survey carried out in November 2020 in which 164 out-of-school adolescents in Ayere village, northern Uganda were randomly selected to participate in the study. The study revealed that 34% had major depressive disorders with the majority (66%) reporting no major depressive disorders. The socio-demographics associated with depressive disorder were age, marital status, support from friends and family members, and childbearing. The prevalence of the major depressive disorder among out-of school adolescents is substantially high and was associated with orphanhood, staying with a single parent, low support, and marital status. Results from our study underscore the importance of social support concerning major depressive disorders among out-of-school adolescents.