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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.
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%.
Major Limb Loss and Prosthesis Use in the Post Conflict era in Acholi Sub-Region, Northern Uganda
(International Journal of Science Academic Research, 2022) Okello, Tom Richard; Magada, Samuel Moses; Atim, Pamela; Campion, Alice; Moro, Emmanuel Ben; Jonathan, Hucks; Mahesan, Nirmalan
Introduction: This study assessed amputees’ residual limb stump in the post war era of Acholi sub-region for suitability of prosthetic fit use and associated challenges with their current prosthesis and psycho-socio emotional experiences. Methods: A cross-sectional clinical assessment of amputees living within the communities in Acholi sub-region was done between September 2018 to August 2019 by a team of Surgical Consultants, orthopaedic technician and prosthetic therapist. Result: The biggest proportion of amputees living in the Acholi communities were adults of 35-65yrs (mean of 43.36yrs, SD+/- 15.694) and more male were affected than females (73.4%:26.6% respectively). The negative predictors of prosthetic fit and use were advancing age, gender, increased duration of disability, high percentage of disability, but stump length and power were positive predictor. Lower limb amputees tend to suffer more psycho-socio emotional disorder like pain sensation, stress, mood and anxiety disorders, as well as sexual discrimination. Lower limb amputee experiences more prosthesis complication like excessive sweating, extremely bothersome sound, terrible fit,and terrible appearance than upper limb. Conclusion: Residual stump length and power are the most important predictor of prosthesis fit. For proper prosthetic adherence, mental health and socio-emotional support need to be included in a comprehensive rehabilitation of amputees
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.
Knowledge, Practice of Health Workers and Surgical Site Infections at Lira Regional Referral Hospital (LRRH) And Lira University Teaching Hospital (LUTH)
(International Journal of Science Academic Research, 2022) Amito, Prudence; Okello, Tom Richard
Purpose: The effect of knowledge and practice of health workers (HWs) on surgical site infection (SSI) has never been documented in our area and such knowledge gaps has made advocating for allocation of resources to tackle the vice of SSI and its menacing outcome challenging hence this study. Method: A cross-sectional descriptive study on randomly selected 60 health care workers from Lira regional referral hospital (LRRH) and Lira university teaching hospital (LUTH) was conducted for 1 month. Data was entered and analyzed descriptively and inferentially using SPSS version 23. Results: Amongst the 60 respondents enrolled, the study found that practicing infection prevention method is the single most significant predictor of SSI prevention compared to just possession of knowledge by the HWs (P value 0.003). Further to that, approximately 7.3% of health workers don’t practice measures required to prevent surgical site infections, 12.51% of them lack the requisite knowledge on prevention of SSI of which anesthetic officer and nurses were the most likely category of health employees to have poor practice 33.3% and 27.3% respectively. Conclusion: A significant number of HWs have limited knowledge and other do not practice all measure required in prevention of SSI, hence, the need for more practical sessions in training institutions
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.
Is Gastric Involvement by Strongyloides stercoralis in an Immunocompetent Patient a Common Finding? A Case Report and Review of the Literature
(Acta Parasitologica, 2021) Pecorella, Irene; Okello, Tom Richard; Ciardi, Gaia; Ogwang, David Martin
Purpose Gastric infection with Strongyloides stercoralis (SS) usually occurs in immunocompromised patients. The unexpected observation of this parasite in an otherwise healthy young lady who had undergone upper endoscopy and biopsy sampling of the gastro-duodenal mucosa, prompted us to review the literature to ascertain the conditions favouring gastric colonization by SS. Methods Pathology files of gastroduodenal biopsies received at St. Mary’s hospital, Northern Uganda, between 2007 and 2017 were reviewed. Pubmed search was performed under the headings “Strongyloides stercoralis”, “Gastric parasitosis”. Results Histology of the only gastroduodenal biopsy with SS infection showed parasite eggs, immature rhabditiform larvae, and numerous adult worms in gastric pits and rhabditiform larvae in interepithelial parasitic tunnels, causing reactive changes of the glandular epithelium. There was no significant acute inflammatory cell infiltrate surrounding the parasites. Literature review showed that gastric SS infection appears to be very uncommon and was, as expected, largely prevalent in immunodeficient individuals (84.2% of published cases). The rare gastric SS infection is a complication of systemic strongyloidiasis, either hyperinfective, or disseminated form. It is also commonly associated with duodenal infection at microscopical examination. Conclusion Involvement of gastric mucosa in the absence of duodenal strongyloidiasis appears to be quite rare and falsenegative histopathological exams are reported if only the stomach is biopsied.
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.
Prostatic Specific Antigen (PSA) Relationship to Patient Age, Prostate Volume and Prostate Histology at St. Mary’s Hospital Lacor,
(East and Central African Journal of Surgery, 2014) Okello, Tom Richard; Alema, N. O; Ogwang, David Martin
The use of PSA for the diagnosis of cancer prostate has remained controversial as well as unreliable because many factors affect PSA levels. Included amongst the many factors that can increase PSA level are riding bicycle, rectal exam, sex, age, serum calcium, prostate inflammation, increased prostate volume. This study was aimed at determining the clinic-patho-radiological finding of patients presenting with enlarged prostate and to determine the PSA profile of all patients presenting with enlarged prostate in St. Mary’s Hospital Lacor. Results: Approximate 135 patients were evaluated in the study and significantly, elderly persons constituted 64.5%, compared with Adult (34.5%) and youth 1%, (P=0.00). Most patients presented with retention of urine (30%), dribbling of urine (23%), hesitancy (16%) and dysuria (13%). When the serum PSA was classified into Low (0.1-2.4ng/ml), Moderate (2.5-3.9ng/ml) and High 4ng/ml and above, we found that 60.7% of the patients had high PSA while 9.6% had moderate and low was 29.6%. PSA correlates positively with patients age (r= 0.24, P=0.005). Prostates volume also correlates positively with serum PSA, (Pearson’s Correlation r=0.275 and P= 0.002). Age and prostate volume also had a significant relation P=0.054 but there was only a very weak relationship between PSA level and Histological diagnosis, (Pearson’s correlation r=0.1). Conclusion: Age and prostate volume significantly correlate with serum PSA, just as age and prostate volume also correlates significantly
Intestinal intussusception in an adult caused by helminthic parasitosis
(PAGEPress, Italy, Gastroenterology Insights 2016; 7:6469, 2016) Pecorella, Irene; Okello, Tom Richard; Ogwang, David Martin; Opira, Cyprian
Intestinal intussusception is an uncommon acute condition in adults and is most commonly caused by an intestinal tumor mass. Helminthic parasitosis is a widespread infection in Africa, and the load of worms is often high in individuals living in areas with inadequate sanitation. We report a case of intestinal obstruction caused by Ascaris lumbricoides infection, which was complicated by ileo-caecal intussusception and required surgical treatment in a 40-year-old Ugandan woman. This case reinforces the importance of anthelminthic prophylaxis in African rural areas.
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
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.
Invasive procedures and Hospital Acquired Infection (HAI) in A large hospital in Northern Uganda.
(East and Central African Journal of Surgery, 2014) Okello, Tom Richard; Kansiime, Jackson; Odora, J.
Background: Hospital Acquired Infection (HAI) increases morbidity, mortality and decreases quality of life of patients. It also increases the cost of patient care, both direct and indirect, through the need for additional and expensive drugs, laboratory and other diagnostic test. Lacor hospital which, carries-out on average 16 major surgical operations per day and has C/section rate of 14% could provide a conducive hub for HAI unless it strictly adheres to universal procedure and Standard precautions. Hence there is need to continuously monitor HAI rate for all invasive procedure done in the hospital. Methods: Through a across sectional descriptive study done in March 2014 on all in patients in the hospital to determine HAI rates. Using WHO standards, HAI was determined in the following invasive procedures; intravenous line sepsis, surgical site infection, urinary tract infection, Lower respiratory tract infection. Data collected was entered and analyzed using SPSS version 15. Results: Approximately 129 patients fulfilled the WHO inclusion criteria for HAI survey out of which, 18 patients (14%) were found to be having HAI as according to WHO guideline. Of the 18, 10 had been catheterized and there was a significant correlation between catheterization and HAI (r=0.319, P=0.00) but Urinary tract infection (UTI) rate in hospital was 38%. The rate of surgical site infection (SSI) was 21.9% and there was significant correlation between surgical intervention and development of HAI (P value of 0.003, r=0.259). However, only 3 (3%) of the patients with intravenous (IV) line had IV line infection and the average duration of IV line in-situ in the hospital was 2.4days. Conclusion: Overall the HAI in Lacor hospital is 14% and is comparable to the levels seen in other regional facilities. Many hospitals can monitor their rate of hospital infection rate and use it to improve quality of services. Recommendation: All health facility should have an infection control committee which monitors rates of hospital acquired infection at least once a year and disseminate for critical reflection and decision making.
Prevalence of hospital-associated infections can be decreased effectively in developing countries
(Journal of Hospital Infection, 2013) Ogwang, David Martin; Paramatti, D.; Molteni, T.; Ochola, E.; Okello, Tom Richard; Salgado, J.C.Ortiz; Kayanja, A.; Greco, C.; Kizza, D.; Gondoni, E.; Okot, J.; Praticò, L.; Granata, V.; Filia, H.; Ayugi, H.Kellar; Greco, D.
Background Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI. Aim To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital. Methods A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011. Findings The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities. Conclusion This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.
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.
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
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.
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.
Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda
(Eastand Central African Journal of Surgery, 2009) Okello, Tom Richard; Ogwang, David Martin; Kisa, P.; Komagum, P.
Background: Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people. Little is known about this condition in our country and there is yet no literature from an environment like ours (northern Uganda) where civil war has devastated the economy with most of the populace displaced into internally displaced peoples’ camp. The main objective of this study was to determine the demographics, treatment and outcome of sigmoid Volvulus cases seen at Lacor Hospital. Methods: This was both a retrospective and prospective study of patients who presented with sigmoid volvulus at St. Mary’s Hospital Lacor over a period of 61/2 years from 1stJanuary 2002 to 31st July 2008. Medical records of patients who underwent sigmoid surgery was stratified for the following measures; demographic characteristics, presentation to hospital (emergency or elective), operative finding and operative procedure, complication, co-ominous factors and outcome. Similar data was gathered from patients who were prospectively followed up. Data was analyzed using SPSS. Results: A total of 44 patients were studied. Their age ranged from 16 to 80 years with a mean of 52.2years (SD +/- 15.98) and a mode of 60years. There was a preponderance of male (84%) with a male to female sex ratio of 5.3: 1. The disease significantly affected the older males compared with females P=0.032. Approximately 77% of the patients presented acutely and had to undergo emergency surgical intervention, the rest were subacute. About 75% of the patients were treated with primary resection and anastomosis, of which 52.2% were emergency cases. Colostomy was offered to 20.5% and sigmoidoscopic derotation to 4.5%. Overall mortality rate was 15.9% and of the patients who died, 18% had primary resection and anastomosis, while 11% were offered colostomy, (P>0.05). Most of those who died were either the older ones (median age 68years) and/or had co morbid illness such as diabetes mellitus, hypertension, intra-abdominal abscess and cancer. Conclusion: Sigmoid volvulus is relatively rare in our community. It commonly affect males particularly the old. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. In viable bowel, primary resection and anastomosis of the twisted sigmoid is feasible as it may not adversely affect outcome. Nevertheless colostomy should be considered if the bowel is gangrenous or perforated. Though the disease carries a high mortality, most of the patient who die are either older and/or have co-morbid conditions.

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