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New Uganda study shows Oxygen Access increase among neonates & children in Hospitals

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A new study in Uganda has shown a significant increase in oxygen access and pulse oximetry among neonates and children in health facilities.

Preliminary findings published in The Lancet, the world’s highest-impact medical and academic journal show the positive impact of a diverse oxygen systems strengthening intervention on diagnosis, oxygen therapy use, and mortality rates.

Titled; “Improving Effective Coverage of Medical Oxygen Services for Neonates and Children in Health Facilities in Uganda: A Before-After Interventional Study,” the study shows that large-scale improvements in hospital oxygen services are achievable in a relatively short timeframe and have great potential for impact.

The study was led by Dr. Freddie Ssengooba, an Associate Professor of Health Policy Planning and Management, at the School of Public Health and Dr. Freddy Eric Kitutu, a Senior Lecturer of Health Systems Pharmacy both co-chairs of the Lancet Global Health Commission on Medical Security. Other researchers on the study include Hamish Graham from the University of Melbourne, Yewande Kamuntu, Blasio Kunihira, Santa Engol, Jasmine Miller, Absolom Zisanhi, Dorcas Kemigisha, Lorraine Kabunga and Felix Lam all from Clinton Health Access Initiative, Dr. Charles Olaro from Uganda’s Ministry of Health and Dr. Harriet Ajilong from the Uganda Paediatric Association.

From June 2020 to June 2022, an intervention study assessed neonates and children at 31 government health facilities in Uganda’s Busoga and North Buganda regions, located at altitudes of 1100-1400 meters. The primary outcome measured the proportion of patients with documented pulse oximetry on admission.

Secondary outcomes included patients with severe hypoxaemia (SpO2 < 90%) receiving oxygen, overall oxygen usage, and appropriate oxygen usage. The study’s primary effectiveness analysis compared pulse oximetry coverage before and after the intervention, incorporating a 4-month washout period. The analysis utilized mixed-effects logistic regression, adjusting for clustering at individual facilities, age (child versus neonate), and sex (male versus female).

Pulse oximetry and oxygen coverage over time with major intervention timings.
Pulse oximetry and oxygen coverage over time with major intervention timings.

Researchers analyzed 64,562 patients (25% neonates) and observed a significant rise in pulse oximetry coverage during the intervention period, increasing from 24% to 88% with an adjusted odds ratio of 40.1 (95% confidence interval: 37.4 to 42.9).

They also observed better oxygen coverage for children and neonates with low oxygen levels, increasing from 40% to 71%, with an adjusted odds ratio of 3.81 (95% confidence interval: 3.26 to 4.46).

Additionally, there was a slight increase in overall oxygen usage, rising from 8% to 11%, with an adjusted odds ratio of 1.95 (95% confidence interval: 1.79 to 2.13).

“Improvements were relatively greater in smaller facilities and for children (versus neonates). We estimated additional patients served and lives saved in the post-intervention period using observed effect estimates in this and other studies,” reads the study.

With these findings, researchers are calling on governments in low-income and middle-income countries to create oxygen plans and invest in proven solutions, like incorporating pulse oximetry in regular hospital care, and providing clinical as well as biomedical mentorship and support.

For all age groups, medical oxygen is essential for both acute and chronic health problems. Scientific evidence suggests access to medical oxygen services that are safe, economical, and appropriate is essential for improving overall health and achieving Sustainable Development Goals. Unfortunately, inadequate or inconsistent oxygen supplies present challenges for many low- and middle-income nations, particularly for small medical facilities in underserved areas.

WHO Representative to Uganda, Dr Yonas (blue tie) and the Danish Ambasador to Uganda H.E Nicolaj Petersen (black mask) hand the cylinders over to the Minister of Health Dr Jane Ruth Aceng ©WHOUganda 2022/Edmond Mwebembezi
WHO Representative to Uganda, Dr Yonas (blue tie) and the Danish Ambasador to Uganda H.E Nicolaj Petersen (black mask) hand the cylinders over to the Minister of Health Dr Jane Ruth Aceng ©WHOUganda 2022/Edmond Mwebembezi

Disruptions in the oxygen supply during the COVID-19 pandemic caused excessive deaths, which predominantly affected countries with low to middle incomes. According to a 2021 study, half of the COVID-19 patients who died in 64 critical care units across ten African countries did not receive the required medical oxygen.

The study was funded by a grant from the Bill and Melinda Gates Foundation (BMGF) and ELMA Philanthropies to the Clinton Health Access Initiative (CHAI) and approval from Makerere University School of Health Sciences Research and Ethics Committee, and the Uganda National Council of Science and Technology.

Available at SSRN: https://ssrn.com/abstract=4676954 or http://dx.doi.org/10.2139/ssrn.4676954

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Makerere University Research shows challenges facing Forcibly Displaced Persons (FDPs) with Chronic Disease in Northern Uganda

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Left to Right: Dr. Esther Nanfuka Kalule, a postdoc fellow on this study; Emma Ikwara, a researcher at CHDC; PhD student Onesmus Kamacooko at CHDC and Dr. Ritah Nakanjako interacting after the colloquium.

By Agnes Namaganda

Preliminary findings from a study by Child Health and Development Centre (CHDC) -Makerere University have revealed several challenges faced by Forcibly Displaced Persons (FDPs) with chronic diseases like diabetes, hypertension and cardiovascular diseases. This study is specifically looking at FDPs in northern Uganda. Accessing food, water, medicine, clothing, toilet facilities, privacy and support is a challenge for healthy FDPs but for those with chronic diseases, these provisions may mean the difference between life and death.

According to Drs, Ritah Nakanjako and Esther Nanfuka Kalule, who are post-doc fellows at Makerere University, FDPs with chronic diseases are unable to access facilities with medicines. Speaking at the February monthly colloquium of CHDC, Dr. Nanfuka said, “Medicines and medical forms are sometimes forgotten by these patients yet some do not know the names of their medicines. For others, these medicines get finished along the way due to the abrupt movements.” These disturbances in the continuity of care affects their health and wellbeing.

Left to Right: Dr. Esther Nanfuka, Dr. Ritah Nakanjako, Dr. Godfrey Siu who is giving the presenters feedback about their presentation and Dr. Aggrey Dhabangi.
Left to Right: Dr. Esther Nanfuka, Dr. Ritah Nakanjako, Dr. Godfrey Siu who is giving the presenters feedback about their presentation and Dr. Aggrey Dhabangi.

As an example, she referred to the constant need to monitor blood pressure or blood sugar for these FDPs. “Even when facilities are available, you may not have the money to refill medicines or you may not remember the name of the medicine.” She added that the stress and trauma of this kind of situation usually exacerbates these conditions.

Speaking about the rationale for doing this research, Dr. Nakanjako said that non-communicable diseases (NCDs) are largely unrecognized and inadequately addressed in humanitarian settings, something which the Red Cross calls ‘a neglected crisis’.  Yet, studies conducted among refugees and asylum seekers across the world report a high burden of NCDs. Uganda hosts over 1.5m refugees, the highest proportion in sub-Saharan Africa with the majority comeing from South Sydan.

“The objective of this study is to examine the experiences of FDPs- which will contribute to knowledge on innovative ways of chronic disease care. This will also contribute to the management of NCDs in humanitarian, low resource settings,” Dr. Nakanjako explained.

Dr. Godfrey Siu (Left) and Dr. David Kyaddondo who is the Principal Investigator of this project interacting with other members of CHDC after the CHDC monthly colloquium which takes place every last Wednesday of the month.
Dr. Godfrey Siu (Left) and Dr. David Kyaddondo who is the Principal Investigator of this project interacting with other members of CHDC after the CHDC monthly colloquium which takes place every last Wednesday of the month.

This 5-year study that started in 2022 will run till 2026 and is funded by the Novo Nordisk Foundation under the Mobility-Global Medicine and Research Fund. It is a collaboration between three institutions; Makerere University, the University of Copenhagen, Denmark and the Sudan Centre for Strategic and Policy Studies in South Sudan. This research is taking place in Nyumanzi Reception Center in Adjumani district; Nyumanzi Refugee Settlement also in Adjumani district; IDP Settlements in South Sudan; and the Bidi Bidi Refugee Settlement in Yumbe District.

Other challenges revealed by the FDPs with chronic diseases include the fear of drinking recommended amounts of water before or during travel to manage urine and to avoid stop-overs for security reasons.

After arrival at Nyumanzi Reception Centre in Uganda, these FDPs with chronic diseases do not receive any special care. It is only those with communicable diseases like TB. Cholera or Covid19 that get special care. Other challenges include; “a limited range of drugs, maintenance of cold chains for insulin, rationed water, lack of drinking water, lack of sanitary facilities and the congestion.

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Water, Sanitation and Hygiene (WASH) Short Course 2024

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Some of the 22 participants that successfully completed the Water, Sanitation and Hygiene (WASH) certificate course joined by course facilitators and administrators show off their certificates in July 2022 at MakSPH. Makerere University School of Public Health, New Mulago Hospital Complex, Kampala Uganda, East Africa.

Did you know that with just a Uganda Advanced Certificate of Education (UACE) or its equivalent, along with at least 1 year of working experience in WASH, you qualify to join our Short Course in Water, Sanitation and Hygiene?

The Department of Disease Control and Environmental Health at Makerere University School of Public Health brings you yet another opportunity to enhance your skills and knowledge in Water, Sanitation, and Hygiene from for the 2024 intake, scheduled to run from 20th May to 12th July 2024.

Designed to equip practicing individuals with the necessary attitudes, skills, and scientific knowledge for effective WASH management, this course is open to officers with limited training in WASH and Environmental Health Practitioners seeking continuous professional development. For more details and application instructions, please refer to the attached course poster or visit the course website at https://sph.mak.ac.ug/academics/water-sanitation-and-hygiene-wash.

Apply before Thursday, 28th March 2024 for a rewarding learning experience!

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Call for Abstracts: Annual Health Professions Education Scientific Conference

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The Vice Chancellor, Prof. Barnabas Nawangwe (Centre Mak tie) with participants at the Health Professions Education Conference held 11th to 12th May 2023 at Hotel Africana, Kampala Uganda.

The Health Professions Education and Training for Strengthening the Health System and Services in Uganda Project (HEPI-SHSSU) at Makerere University College of Health Sciences (MakCHS) is organizing the Annual Health Professions Education Scientific Conference.

Venue: Hotel Africana, Kampala, Uganda

Conference Dates: 10th, 11th and 12th April 2024

Theme: Advances in Health Professions Education:  Research, Innovations in Teaching and Learning, Quality Assurance

Sub-Themes

  1. Quality Assurance and Accreditation
  2. Health Professions Education Research
  3. E-Learning 
  4. Innovations in teaching and learning
  5. Graduate Education
  6. Simulation-based Learning

Abstracts are welcome in any of the above areas for oral presentations, mini-workshops, thematic poster sessions, and didactic sessions.

We welcome abstracts from all people involved in the education and training of doctors, nurses, allied health professionals, students, health providers, and other stakeholders.

Abstract Submission:

Abstracts should be structured into:

Background, Objectives, Methods, Results, Conclusion

For Education innovations: What was the problem, What was done, Results, and Conclusion (300-word limit).

Include the details of the corresponding author, the author(s), their contacts, and Affiliation.

Send your abstract to: hepishssu@gmail.com

Deadline for Submission of abstracts: Saturday 23rd March 2024

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