Department of Surgery

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A 10 years Trend of Peptic Ulcer Disease and other Gastrointestinal Disorders in Northern Uganda
(East and Central African Journal of Surgery, 2016) Okello, Tom Richard; Ogwang, David Martin; Pecorella, Irene
Background: The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori
919 Routine Hospital Acquired Infection surveys are feasible in low income health care settings and can inform quality improvement interventions
(Oxford University Press, 2014) Ochola, Emmanuel; Okello, Tom Richard; Kansiime, Jackson; Praticò, Liliana; Greco, Donato
Background. Prevention of acquisition of infection in the health care setting is imperative for reduction in morbidity and mortality for patients and health workers and improvement health care quality. However, data is scarce on prevalence and trends of hospital acquired infections (HAI) in low income settings, unlike in developed countries. We instituted annual surveys to determine HAI prevalence and determinants in a hospital in Gulu, Northern Uganda, an area recovering from over 20 years of war. Methods. An external expert mentored local hospital staff at the request of the Board, to do HAI surveys for 2 years after which a local team continues the exercise. Using standard WHO checklists. A one-day survey is done, recruiting all patients admitted in the hospital for 48hours or more. Data is collected by doctors and nurses on demographics, new diarrhea, Urinary Tract Infections (UTI), respiratory conditions, wound infection and intravenous catheter infections that were absent during admission. Urinalysis was done to confirm UTI. Results were analysed using SPSS, reporting basic statistics and p values of chi square tests comparisons. Results. A total 1174 clients were surveyed in four years, average 293 per survey. There was a 56% decline in HAI prevalence from 28% in 2010 to 14.2% in 2011 (p < 0.0001). Prevalence of HAI was 15.1% in 2013 and 14% in 2014. In different years, the key hospital acquired infections included UTI accounting for 39% (21.5-55%) of the total HAI, intravenous line infection 27% (18.2-30.4%), respiratory tract infections, 17.5% (5.5-25.5%), and surgical wound infections, 16.0% (8.7-20%). In 2013 which had UTI at 58%, UTI was present in 53.3% of catheterized clients, compared to 14.8% in 2011. Conclusion. The HAI surveys are practical, and feasible to perform, even in poor settings. The surveys prompted the institution of the hospital infection control committee. HAI surveys can generate glaring gaps, which when intervened on, like urinary catheter overstay, poor wound care, duration of iv lines, and hand washing practices, can improve care quality. The surveys can suggest corrective actions for good care practices. Nevertheless, prevention of HAI needs continuous efforts of all health workers.
African Health Sciences Vol 12 Issue 4 December 2012518Endoscopic findings in upper gastrointestinal bleeding patients atLacor hospital, northern Uganda
(African Health Sciences, 2012) Alema, ON; Ogwang, David Martin; Okello, Tom Richard
Background: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. Objective: To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. Methods: The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. Results: A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB Conclusions: Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.
Assessment of surgical skills training: A call for quality improvement for educators in low- and middle-income countries
(East and Central African Journal of Surgery, 2019) Okello, Tom Richard; Mugabi, Patrick; Ghee, Hwang; Michelle, Sutter; Lett, Ronald
We read with keen interest the article by Tom R. Okello and colleagues on the assessment of their final-year medical students after Essential Surgical Skills training.1 We commend the authors, the training institution, and their partners for their contributions to surgical training in the region. In their article, the authors noted the need to evaluate the effectiveness of such training programmes in terms of skills acquisition and confidence among the trainees. Using a selfadministered questionnaire, they demonstrated an improvement in the trainees’ pretraining and posttraining confidence in performing a variety of essential surgical skills. Whereas confidence is required for performing surgical procedures, it is also important to assess that the taught skills have actually been acquired by the trainees in the first place. However, no measure of the actual skills acquisition was undertaken. Selfreported assessments as used in this article tend to be subjective and are prone to a number of biases. Moreover, there was no mention of the validity or reliability of the questionnaire used for assessment. The need to assess medical skills training courses cannot be overemphasized. However, such assessment needs to be conducted in an objective manner using reliable, valid, and widely accepted tools.2 Over the years, the evolution of the assessment of surgical skills training has led to development of several tools. Examples include objective structured clinical examination (OSCE), the mini-clinical evaluation exercise (mini-CEX), the System for Improving and Measuring Procedural Learning (SIMPL), and the Objective Structured Assessment of Technical Skills (OSATS), among others
Barriers and Factors Affecting Personal Protective Equipment Usage in St. Mary’s Hospital Lacor in Northern Uganda
(East and Central African Journal of Surgery, 2017) Okello, Tom Richard; Kansime, K; Odora, J; Apio, J A; Pecorella, Irene
Background: To protect health workers (HCWs) from risky occupation exposure, CDC developed the universal precautions (Ups) including Personal Protective Equipment (PPEs). However compliance to it by HCWs has remained poor even in high-risk clinical situation. The objective of this study was to identify and describe the factors that influence a HCWs’ decision to wear PPEs and the barriers that exist in preventing their use Methods: A cross-sectional survey was carried out in the St. Mary’s Hospital Lacor in all the wards to collected quantitative information as well as qualitative and observational data on PPE use Results: Out of the total 59 respondents, 2% do not know the purpose of PPE, 23.7% do not know how to don and doff PPEs, 13.6% do not use PPE even when indicated and 10% are not using an appropriate PPE. The main barriers relates to poor fitting and weak domestic gloves, few of aprons, frequent stock out and inadequate PPE as well as lack of training in PPE Conclusion: This study provides a baseline for measuring the effectiveness of interventions to improve compliance.
Bilateral proptosis as an early manifestation of juvenile myelomonocitic leukemia in an African child
(Indian Journal of Pathology and Oncology, 2021) Pecorella, Irene; Nunzia, Manna; Valeria, Calbi; Omona, Venice; Okello, Tom Richard
We report bilateral proptosis as the unusual initial presentation of juvenile myelomonocytic leukemia in a Ugandan child. Juvenile myelomonocytic leukemia was diagnosed with complete blood count and bone marrow aspiration biopsy. This is the first description of orbital involvement occurring in the setting of juvenile myelomonocytic leukemia, despite leukemic orbital infiltration is relatively common in the middle East, Asia, and Africa. In general, simultaneous neoplastic involvement of both orbits at presentation is also a rare finding, bur appears to be highly likely in leukemic children. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Case Report: Biloma gastrostomy after failed sonogram-guided percutaneous aspiration, pigtail catheter insertion and surgical drainage [version 1; peer review: 2 approved with reservations]
(AAS Open Research, 2019) Okello, Tom Richard; Ocen, Davidson; Okello, Jimmy; Pecorella, Irene; Amone, Derrick
Bilomas are rare abnormal extrabiliary accumulation of bile. This can be either intrahepatic or extrahepatic following traumatic or spontaneous rupture of the biliary tree. The commonest causes of biloma are surgery, percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, transcatheter arterial embolization and abdominal trauma. We report here a 15 year old patient whom we followed for over 10 years. His chief complaints were right hypochondriac pain, loss of appetite and vomiting. Initial clinical presentation, sonographic as well as laboratory findings suggested a liver abscess, which was drained, but the definitive diagnosis of biloma was entertained after sonographically guided percutaneous aspirations and percutaneous transhepatic cholangiography 7 years later. We also discuss the role of imaging and surgical challenges encountered that culminated into bilomo-gastrostomy. The patient is now enjoying a peaceful life.
Case Report: Swallowed toothbrush in the stomach of a 56 year female at St Mary’s Hospital Lacor, Uganda [version 1; referees: 1 approved with reservations, 1 not approved]
(AAS Open Research, 2018) Amone, Derrick; Okot, Christopher; Mugabi, Patrick; Okello, Tom Richard; Ogwang, David Martin
Toothbrush swallowing is a rare occurrence. Toothbrush swallowing presents a risk of impaction and perforation along the gastrointestinal tract. This case report describes a 56 year old female that presented to the emergency unit of St Mary’s Hospital Lacor with a 1 day history of chest pain after a toothbrush was pushed down her throat by a traditional healer who was managing her for pharyngitis. The chest pain was associated with difficulty in breathing. She also reported dull abdominal pain. There was no history of vomiting or drooling of saliva. On examination, we found that she was in pain and had respiratory distress with a respiratory rate of 32 breath/ min and was using accessory muscles. There was no oedema, aneamia or jaundice. Blood pressure of 120/80 mmHg and pulse rate of 87 beats/ min. The abdominal findings were normal, but ultrasound scan suggested that the toothbrush was in the stomach. The plain erect abdominal x-ray was inconclusive. She was admitted to the ward for conservative management. After 2 weeks we decided to do exploratory laparotomy and we found the toothbrush in the stomach, that we removed and closed the abdomen in layers. Post-operatively the patient recovered uneventfully on the ward. Toothbrush swallowing is a rare occurrence. The commonest foreign bodies ingested by adults are bones, spoons and dentures. Toothbrush ingestion occurs commonly among patients with psychiatric conditions like bulimia or anorexia nervosa, schizophrenia and bezoar. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients. Most people who swallowed their toothbrushes did so entirely without erotic intent, as with this case where the patient had the brush pushed down her throat by a traditional healer. This is the first case of toothbrush swallowing in this hospital.
Challenges Facing the Push and Pull Hybrid System in the Supply of Essential Medicines in Gulu, Northern Uganda
(American Journal of Public Health Research, 2015) Okello, Tom Richard; Mshilla, Maghanga; Olido, Kenneth
Essential medicines are supplied to the public health facilities using the pull and push system. In many countries the decision to use the pull, push or combination of both is a policy decision, but Uganda has used each of the supply system individually in past and currently is using a hybrid despite the rampant out-cry of essential medicines stock out. Challenges facing the hybrid supply system need to be examined to advise policy makers on the how efficient the system supplies medicines. A cross-sectional study was carried out in the public health facilities in Gulu to examine the major challenges affecting the hybrid system of medicines supply. A sample of 131 health workers filled a pretested coded questionnaire as respondents and the data were then entered and analysed using SPSS version 15. Approximately 27.7% (n=131) of the respondents reported that the store management in the hybrid system is unsatisfactory and inadequate. Quality of essential medicines supplied in the hybrid system to the public health facilities is unsatisfactory and inadequate as reported by 46.5% of the respondents. Collaborative linkages with the National Medical Stores (NMS) the mandated supplier of essential medicines in the country, is weak (42.9%) and quantification of essential medicines by health workers under the hybrid system is poor (33.3%). Furthermore support supervision in weak and inadequate under the hybrid system (37.6%); and personnel who dispense essential medicines are inadequate (44.3%). Approximately 30.3% patients have poor access to essential medicines. The current hybrid system is riddled with a number of challenges which requires re-dressed in order improve access and availability of essential medicines to the public.
Determinant of Essential Medicines Availability in The Public Health Facilities in Uganda
(2015) Okello, Tom Richard; Olido, K; Mshilla, M.M
This study aimed at examining the key essential medicines availability determinants in public health facilities in Gulu District, Northern Uganda. This cross-sectional study focused on stock-out rates of the six official tracer medicines listed by the Ministry of Health. Data from the health facilities at health centre II to IV levels were collected using questionnaires and interviews. It was established that quantification, ordering methods, lead-time, stock-card management, stores management, quality assurance, collaborative linkages, personnel, funds and health unit management committee were the key determinants of essential medicines availability (P-value 0.000). Stock-out rate was 85% and this was more prevalent in the lower health center IIs and IIIs under the push supply system than in the higher health center IVs which operate under the pull system. Quinine was the most commonly out-of-stock medicine in lower health units. There is a high stock-out rate in the public health facilities and addressing key determinants could improve stocks-in rates.
The Effect of Reward Practices and Health Service Delivery in Health Facilities—Kwania District Uganda
(Journal of Human Resource and Sustainability Studies, 2022) Opio, Moses; Agweta, Cosmas; Ejang, Mary; Picorella, Irene; Okello, Tom Richard
Purpose: This study aimed to examine the relationship and effect of intrinsic and extrinsic reward practices on health service delivery. Methods: Data was collected prospectively from Thirteen Government health facilities in Kwania District using a cross-sectional study design. A structured, pre-coded and pretested questionnaire of Cronbach Alpha of 0.82 was self-administered to sample of 132 health workers randomly selected from HCIV, HCIII and HCII in Kwania District between September-November 2020. Results: Health Service Delivery (HSD) correlates positively with the various reward system. In particular, HSD has a significant and positive but weak correlation with intrinsic reward (r = 0.260, p value = 0.05). On the other hand, extrinsic rewards have a very weak insignificant but positive correlation with service delivery (r = 0.126. p value > 0.05). Multiple regression: the intrinsic reward appears a significant predictor of health service delivery (p value < 0.009, β = 0.169 ), but the extrinsic reward does not significantly predict health service delivery, (β = 0.001, p value = 0.985). Conclusion: Intrinsic rewards have a significant influence on health workers’ performance and hence health service delivery while extrinsic rewards have no significant influence on these employees’ performance. Extrinsic reward becomes more important as employees’ ages increase on the job.
The Effectiveness of Post-Operative Pain Regime in C-Section Mothers, Lira Regional Referral Hospita
(IAR J. Med Ser, 2023) Oyella, Pamela; Okidi, Ronald; Ogena, Jonathan; Acire, Robin; Otim, Tom Charles; Okello, Tom Richard
Purpose: This study sought to explore the effectiveness of pain management in post-caesarian section mothers in Lira Regional Referral hospital Methods: Using a descriptive cross sectional design, data was collected from 110 randomly selected mother who underwent Caesarian section delivery in Lira regional referral hospital for a period of 2months. An interviewer administered questionnaire was used to collect data as well as review of patients’ charts to discern the analgesic drug given to the post C-section mother in the first 24hrs. Findings: Out of the 110 participants who had C-section within the study period, 65.5% suffered excruciating pain, 30.9% got severe pain and 3.6% experienced moderate pain. None of the patients who suffered excruciating pain was given strong opioids like morphine, pethidine but they were instead treated with weak opioid like tramadol (67.6%) or NSAIDs (19.7%). Those with severe pain were treated predominantly with weak opioids (58.8%), although 14.7% received strong opioids. Overall, only 79.1% of the C-section mothers reported the got effective pain control Conclusion Most mothers who undergo CS at LRRH suffer either excruciating pain or severe pain, despite that, the commonly used analgesia in Post-Operative Pain Management at the facility are weak opioids and NSAIDs irrespective of whether a mother is suffering excruciating or severe pain. Effective pain control after C-section at LRRH is achieved in only79.1%.
An Evaluation of 605 Endoscopic Examination in a Rural Setting, Lacor Hospital in Northern Uganda
(British Journal of Medicine & Medical Research, 2016) Okello, Tom Richard; Ogwang, D. M; Alema, N. O.; Pecorella, Irene
Introduction: The aim of this study was to evaluate the profile of esophagogastroduodenal (EGDS) diseases diagnosed by upper endoscopy in a rural area of Uganda in a retro-protective study of 605 patients. Results: The mean age of patients with digestive symptoms was 39.7yrs (SD +/-16.11) and female gender predominated by 60% compared to the male (P value 0.000). Peasant farmers were the commonest group with GI symptoms requiring EGDS compared to the rest 72.1% v 27.9%. Epigastric pain was the commonest indication (58%) for EGDS, followed by chest pain (11%), abdominal pain (8.8%), dyspahgia (7.6%) and hematemesis (7.3%). The commonest endoscopy finding was gastritis (47.9%) followed by esophagitis (14.4%), cancer esophagus (5.1%), esophageal varicose (4%), PUD (2.3%), gastric cancer (1%). However 19.5% of patients had normal EGDS. There was a significant correlation between the outpatient diagnosis and endoscopy finding (P value 0.01, r = 0.144) and between endoscopy finding and histology findings (P value 0.001, r = 0.236). H. pylori was positive in 53% of patients with gastritis. Conclusion: Gastritis is the commonest lesion (47.9%) of which 53% have H pylori and Cancer esophagus account for 5.1% of GI lesion in our setting. Cancer stomach is rare in our setting.
Evaluation of surgical skills training: A literature review and call to quality improvement for educators in low-and middle-income countries
(East and Central African Journal of Surgery, 2020) Okello, Tom Richard; Mugada, Samuel M; Ghee, Hwang
Background: Whereas surgical simulator skills training has been demonstrated to improve surgical skills, no gold-standard assessment tools exist for summative and formative evaluation of skills training. This study aimed to evaluate the most commonly used skills evaluation methods to determine which are most appropriate in our setting. Methods: This literature review examined the tools most used to evaluate surgical skills courses in terms of competency transfer to trainees. Many tools were evaluated: objective structured clinical examination (OSCE), the mini-Clinical Evaluation Exercise (Mini-CEX), objective structured assessment of technical skills (OSATS), the mini-Peer Assessment Tool (mini-PAT), procedure-based assessment (PBA), Surgical Direct Observation of Procedural Skills [S-DOPS], and precourse–postcourse surveys. Results: Precourse–postcourse tools had the highest reliability coefficient (0.92). Depending on the design, this tool is capable of measuring learner confidence, comfort levels, and competency, in terms of the performance of the taught skills; it can also be used to test for improvements and practice of such skills before and after training and skills acquisition. Conclusions: The precourse–postcourse self-assessment method is a reliable tool for assessing improvements in self-confidence, comfort levels, and surgical skills competency. The other available tools are most appropriate for continuous assessment in clinical clerkship and formal examination settings.
Factors affecting mortality after traumatic brain injury in a resource-poor setting
(BJS Open, 2019) Okidi, Ronald; Ogwang, Martin David; Okello, Tom Richard; Ezati, Daniel; Kyegombe, W.; Nyeko, D.; Scolding, N. J.
Background: Traumatic brain injury (TBI) is a major cause of long-term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource-poor setting. Methods: Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary’s Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In-hospital management and mortality were recorded. Severe head injury was dened as a Glasgow Coma Scale score below 9. Results: A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4⋅9 : 1). Some 30⋅9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8⋅8 per cent. Treatment was mainly conservative in 94⋅8 per cent of patients; three patients (1⋅5 per cent) had burr-holes, four (2⋅1 per cent) had a craniotomy, and three (1⋅5 per cent) had skull fracture elevation. The mortality rate was 33⋅0per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr-hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0⋅012), referral status (P = 0⋅001), respiratory distress (P = 0⋅040), severe head injury (P = 0⋅011) and pupil reactivity (P = 0⋅011). Conclusion: TBI in a resource-poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes
Five-Year Review of the Pattern and Outcome of Management of Spinal Diseases Seen at St. Mary’s Hospital Lacor in Uganda.
(East and Central African Journal of Surgery, 2015) Okello, Tom Richard; Odul, E; Opiyo, P.
Background: Spinal cord injury or lesion is a devastating event with social, psychological and physical ramifications that has dehumanizing experiences. The aim of this study was to describe the biographic, etiological factors and outcome of patients with spinal lesions cared for at St Mary’s hospital Lacor within a 5yrs period. Methods: Through a 5yrs review of data of paralyzed patients admitted and treated at St Mary’s hospital Lacor from Jan 2009 to Dec 2013, the following secondary data was extracted and analyzed using SPSS version 15: Age, sex, duration of hospitalization, type of paralysis, cause of the spinal lesion, vertebral lesion, outcome and recovery of neurological function. Results: Approximately 241 met the criteria analysis, the mean age for spinal lesion was 31 years, average duration of hospitalization was 61 days and the Male gender predominated (64.3%) compared to the females (35.7%), P-value 0.000. Paraplegia was the commonest form of neurological deficit (79.67%) followed by tetraplegia (13%), P-value 0.000. TB spine is the leading cause of spinal lesion (19%) followed by road traffic accidents (17%) and lymphoma (15.8%). In 16.6% of the patients, the etiology of the spinal cord lesion was not known. Spinal lymphoma lesion was common in pediatric age group compared to TB spine and traumatic spinal lesion (p-value 0.000). Out of the 241 cases studied, 73 (30.3%) recovered their limb function completely and were reintegrated into the community. However 39 (16.2%) died from the lesions and/or the associated complications. Conclusions and Recommendation: Spinal lesions are commonest in young male populations with a mean age of 31 years. TB Spine, RTA and falls represent the commonest etiological factors in youth and adults while lymphomas lead in children. Approximately 30% of spinal lesion recovered and 16% died. The health facilities should consider setting up spinal care units
Follicular dendritic cell sarcoma of the head and neck. Literature review and report of the tonsil occurrence in a Ugandan patient
(Pathologica, 2017) Pecorella, Irene; Okello, Tom Richard; Ciardi, G; Ochola, E; Ogwang, David Martin
We report a case of follicular dendritic cell sarcoma (FDCS) in a 60-year-old Ugandan female who presented with a 6-year history of a progressive left sided tonsillary mass. General systemic examination was unrevealing and the patient underwent left tonsillectomy. She was subsequently lost to follow-up. Grossly, the mass measured 6 cm in diameter and had a mottled appearance due to tissue microhaemorrhages. Markers specific for follicular dendritic cell differentiation (CD21, CD35 and CD23), p53 and EGFR were expressed on immunohistochemical analysis. Review of all of the 49 published reports of tonsil FDCS showed that this entity tended to occur at younger age (mean: 44.5 yrs) in women than in men (mean: 49.4 yrs). Tumour size ranged from 0.8 to 5 cm in maximum dimension (mean 2.9 cm). Only 12.2% of the patients presented with metastatic disease at initial diagnosis, all localised in the cervical lymph nodes. Local or distant recurrences occurred after a mean period of 72.5 months. In conclusion, although the pertinent literature suggests that FDCS should be considered at least of intermediate grade, our review indicates that FDCS of the tonsil region behaves as a low-grade sarcoma.
Incidence of male breast carcinoma in North Uganda A survey at Lacor Hospital, Gulu, during 2009–2016
(Advance online publication, 2021) Pecorella, Irenea; Okello, Tom Richard; Okwang, Martin David
BACKGROUND:Little information is available on male breast cancer (MBC) incidence from sub-Saharan Africa. OBJECTIVE:This is a retrospective study on MBC in rural North Uganda, based on the pathology records of a private, non-profit, missionary hospital. METHODS:All male patients that had histological diagnosis of breast carcinoma from January 2009 to December 2016 were included in this study. RESULTS:In time span of 8 years, there were 337 consecutive breast cancer presentations, including 21 MBC (6.2%). The latter patients showed advanced disease (mean symptom duration: 20.3 months; mean tumour size: 5 cm;) skin ulceration and ipsilateral lymph node metastasis: 60%). The mean age was 60.52 years (from 30 to 85 yrs). Ductal infiltrating carcinoma was the prevalent histological type in our series (65%), followed by an unusually high rate of papillary carcinomas (15%). There appeared to be a prevalence for left breasts (11 LT versus 6 RT; 64.7%), a finding also observed in the majority of MBC. CONCLUSIONS:This study is representative of the scenario in Northern Uganda, where MBC accounts for 6.2% of breast cancers, More information on the occurrence and risk factors of this unusual neoplasm in African countries may prompt prevention of chronic liver disease and early recognition and treatment of MBC.
Incidental cholecystocolonic fistula in obstructive jaundice
(Wiley, 2021) Okidi, Ronald; Ogwang, Martin David; Natumanya, Robert; Mukalazi, Abraham; Kyomuhendo, Tracy; Okello, Tom Richard
Cholecystocolonic fistula is a rare condition often diagnosed intraoperatively, requiring an adequate set of knowledge and skills to allow safe intraoperative change of prior planned surgery and alleviate significant morbidity.
The influence of internship training experience on Kenyan and Ugandan doctors’ career intentions and decisions: a qualitative study
(Global Health Action, 2024) Zhao, Yingxi; Mbuthia, Daniel; Ankomisyani, Dos Santos; Blacklock, Claire; Gathara, David; Molyneux, Sassy; Nicodemo, Catia; Okello, Tom Richard; Rutebemberwa, Elizeus; Tweheyo, Raymond; English, Mike
Background: Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market. Objectives: We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda. Methods: We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors’ internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from highincome country literature, alongside a more inductive thematic analysis. Results: Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work–life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors’ career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to ‘fill a health system gap’ when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities. Conclusion: We have shown how internship experiences shape medical doctors’ career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors’ career choices.

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