The East African health research journal最新文献

Background: Evidence-Based Decision-Making (EBDM) is central to quality nursing practice, yet many nurses continue to rely on intuition when making clinical decisions. In low-resource settings such as Kenya, limited access to information, knowledge-sharing barriers, and institutional constraints further hinder EBDM. Understanding the factors that influence EBDM among specialized nurses is vital for improving patient care and health system outcomes.

Methods: This study employed a concurrent nested mixed-methods design guided by the ACE Star Model. The quantitative arm utilized a cross-sectional census of 51 maternal and child health nurses from four public hospitals in Nairobi, while the qualitative arm involved two in-depth interviews with supervisors. Data were collected using a structured questionnaire and interview guide. Quantitative analysis was conducted using SPSS with logistic regression to identify factors associated with EBDM, while qualitative data were analyzed thematically.

Results: The overall response rate was 100%. Most respondents (72.5% female) were diploma holders with a median age of 30 years. Findings revealed that the predominant reliance on intuition was significantly associated with low utilization of EBDM (p=.039). Individual factors, including skills, incentives, and research literacy, were strongly associated with EBDM utilization (p=.001). Married nurses and those with higher academic qualifications demonstrated marginally lower odds of low EBDM utilisation. Institutional factors and barriers such as limited internet access, staffing constraints, and time shortages were reported but not statistically significant. Qualitative insights highlighted reliance on tacit knowledge, bounded autonomy, and workload pressures as major influences on decision-making.

Conclusion: Specialized nurses in Nairobi largely rely on tacit knowledge and intuition, with individual capacities playing a critical role in shaping EBDM. Strengthening research skills, integrating EBDM training early into nursing curricula, and creating institutional support systems are essential for enhancing evidence use in clinical practice. Strategies for capturing and translating tacit knowledge into actionable evidence should be prioritized to improve patient outcomes. Further large-scale, multidisciplinary studies are recommended to validate these findings.

Background: Anastomotic leakage is among the most common complications after bowel resection and primary anastomosis, causing considerable morbidity and mortality. As a result it tends to affect the quality of life and increase burden to the patients and caretakers. This study focused on the assessment of the predictors and outcome of anastomotic leakage among patients who underwent large bowel surgery that involved resection and primary anastomosis.

Methodology: Hospital based prospective observational study at Muhimbili National Hospital. Data of the patients who underwent colorectal resection and primary anastomosis were collected by using a structured questionnaire. Consecutive recruitment sampling technique was applied to get the required sample size and followed for 30 days. Subjects' information including age, sex, perioperative information was documented and analyzed by using Statistical Package for the Social Sciences (SPSS) version 23 software.

Results: The study included 141 participants. Among those operated, 23 (16.3%) developed anastomotic leakage with a mortality rate of 30.4%. Predictors which were statistically significantly associated with anastomotic leakage were hypertension, body mass index > 30kg/m², history of radiation therapy, female sex, high American Society of Anesthesiologists (ASA) grade III-IV score and peritonitis. Increased length of hospital stay, re-admission and re-operation rate together with high mortality are among the outcomes of anastomotic leakage found in this study. No loss to follow up event occurred.

Conclusion: Anastomotic leakage remains a considerable problem among patients undergoing large bowel surgery at Muhimbili National Hospital. From the study site, factors such as peritonitis, HIV/AIDS, hypertension, history of radiation, obesity, high ASA score (III-IV) and female sex were found to be independent predictors of anastomotic leakage. Optimization of co-morbidities conditions before surgery, choosing best surgical option such as creating temporary stoma versus primary anastomosis in dirty wound may help to reduce the rate of anastomotic leakage.

Background: Invasive squamous cell carcinoma of the urinary bladder caused by schistosomal infection is associated with aggressive complications and a poor prognosis. In schistosomiasis-endemic areas, it primarily affects adults over the age of 40 and rarely occurs in children under 15. For the first time at our hospital, we report a case of urinary bladder carcinoma associated with Schistosoma haematobium eggs in a 13-year-old child from northwestern Tanzania, a region endemic for Schistosoma haematobium.

Case presentation: A 13-year-old girl presented with left loin pain, turbid yellow urine, and upper limb pain for over a month. Multiple evaluations, including laboratory and ultrasonographic investigations, were conducted. Ultrasound findings revealed severe enlargement of both kidneys, with the left kidney being larger than the right. A computerized tomography (CT) scan showed severe bilateral hydronephrosis and hydroureter, likely due to vesicoureteral junction obstruction. A left nephrectomy was performed; however, the patient continued to experience dysuria. During cystoscopy, a tumor was identified on the left posterolateral wall of the bladder. Surgical exploration revealed adhesion of the tumor to the uterus, bladder neck, and cervix. A cystectomy was recommended, during which part of the right ureter was removed, and the remaining portion was anastomosed to the sigmoid colon. Histopathological examination of the tissue samples revealed invasive squamous cell carcinoma (Grade 1) involving the cervix and vaginal wall. Additionally, multiple active and calcified Schistosoma haematobium eggs were observed. The patient was referred to the oncology unit for radio-chemotherapy, where she continues to receive treatment.

Conclusion: Chronic inflammatory responses associated with Schistosoma haematobium eggs in the urinary bladder walls can lead to severe complications affecting the entire urogenital system, regardless of age. These inflammatory responses may contribute to the development of squamous cell carcinoma even in young individuals.

Background: Lack or inadequate implementation and enforcement of legal frameworks for accessing and benefit sharing arising from the use of traditional and indigenous knowledge is associated with sub-optimal exploitation of traditional medicine knowledge and related research outputs in many African countries.

Objectives: This study assessed the practice of protecting the rights of holders of traditional medicine knowledge, and identified challenges in regulating, registering and protecting traditional medicine based services, processes and products in Tanzania.

Methods: Practice of protecting the rights of holders of traditional medicine knowledge in Tanzania was assessed through interviews with 12 knowledge holders and practitioners of traditional medicines, and 12 key informants from national regulatory authorities, and research and high learning institutions involved in traditional medicine research and development in Tanzania.

Results: Absence of frameworks for accessing and benefit sharing arising from the use of tradition medicine knowledge, mistrust and inadequate knowledge on procedures for protection of traditional medicine based intellectual property hampers the practice of protecting the rights of holders of traditional medicine knowledge in Tanzania. Costly and bureaucratic procedures are among the challenges encountered by knowledge holders and practitioners of tradition medicine in registration of their traditional medicine products and practices. Poor network relationship between holders of traditional medicine knowledge and research community slow down the progress of traditional medicine research and development. Lack of guidelines for regulation of traditional medicine research may be the result of overlapping roles of the National Institute for Medical Research and the Council of Traditional and Alternative Medicine.

Conclusion: In Tanzania, the environment for protecting the rights of holders of traditional medicine knowledge is suboptimal. To stimulate exploitation of traditional medicine for economic growth, there is a need to develop and implement national and institutional frameworks for accessing and benefit sharing arising from the use of traditional knowledge.

Background: Child disability is a significant public health concern which impacts 1 in 20 children. Children with disabilities (CwDs) encounter deprivation of rights, biases in society, and a lack of access to necessary services, all of which are exacerbated by structural obstacles. This study assessed the coverage of child disability prevention, management and rehabilitation services in four districts of Central Uganda after two years of interventions to improve these services.

Methods: The Lot Quality Assurance Sampling (LQAS) rapid health facility assessment method was employed to assess coverage of services based on sixteen indicators. The indicators were set based on constructs of: provision of disability-related services to CwDs; use of rehabilitation services; readiness of the health facilities (HFs) to provide basic disability management and rehabilitation services; community structures for linkage to disability management and rehabilitation services; psychosocial support provision; and upholding and protecting the rights of CwDs. A district-level decision rule was set based on 80% coverage target.

Results: Despite the interventions, the services have yet to provide the desired level of benefit to CwDs and their caregivers. Out of the sixteen indicators for healthcare service coverage for CwDs, only three attained the 80% coverage target.

Conclusion: The findings suggest that greater focus by health service planners and project implementers is still needed, especially at the community and health facility levels to enhance the prevention, management and rehabilitation of CwDs. Psychosocial health services for caregivers of CwDs need special attention in order to achieve better service approaches.

Background: Treatment and outcome of Kaposi's sarcoma (KS) depend on a correct histopathological diagnosis, however, most KS cases in developing countries are diagnosed clinically without histopathological confirmation, which results in either over or under-diagnosis. Also, due to the number of histopathological mimickers in different stages of KS which include benign to fatal conditions, the histopathological diagnosis of KS is not always correct. However, the HHV-8-LANA-1 Immunohistochemical (IHC) stain is positive in nearly all KS lesions and is considered to be an important diagnostic tool to differentiate KS from its histological mimickers. This study aimed to determine the quality of Kaposi's sarcoma diagnosis at MNH and whether it can be improved by the routine of HHV-8-LANA-1 immunohistochemical stain.

Methodology: This was a retrospective cross-sectional hospital-based study of all KS cases diagnosed either by clinical, histopathological, or both in 2018. KS was diagnosed based on H&E morphology and confirmed by HHV-8-LANA-1 immunohistochemistry. The diagnosis utility of clinical and histopathology was compared with HHV-8-LANA-1 immunohistochemistry.

Results: There was almost perfect agreement between initial and reviewed histopathology for KS diagnosis (Kappa value= 0.892, p-value=.000). The clinical diagnosis concordance rate was 61% with no agreement (Kappa value -0.123, p-value=0.102). Clinical differential diagnosis included a wide range of pathological conditions ranging from less severe inflammatory to fatal malignant conditions. There was a substantial agreement between initial histopathology and HHV-8-LANA-1 IHC for KS diagnosis (Kappa=0.70, p-value .000) with a histopathology concordance rate of 88%.

Conclusion: Histopathological examination of all clinical KS suspicions and HHV-8-LANA-1 immunohistochemistry confirmation is required since the study showed that the histopathology misdiagnosis of KS at MNH was unlikely to be the result of human error. We recommend that in every clinically suspected KS case, an adequate tissue biopsy should be taken for histopathology analysis and HHV8-LANA-1 immunostaining to avoid inappropriate treatment.

The recent executive orders by President Donald Trump to withdraw the United States (U.S.) from the World Health Organization (WHO) and the Paris Climate Agreement, compounded by a 90-day freeze on U.S. Foreign Assistance, present significant challenges to global health efforts. These actions threaten to exacerbate existing health crises, undermine decades of global health and health security gains, and leave Africa and the world more vulnerable to infectious diseases and public health threats. These decisions will likely hinder future health initiatives and disrupt critical climate change mitigation efforts. This short communication examines the potential consequences of these shifts and proposes strategies to mitigate their risks.

Background: Globally, smartphone use among university students is expanding at an exponential rate, and its lingering addiction has now become a global issue, causing some emotional comprehension issues that can lead to significant consequences. Hence, this study aimed to assess the magnitude of smartphone addiction (overuse) and its predictors among health sciences students at selected universities in Kampala, Uganda.

Methodology: An online-based descriptive cross-sectional study design was employed for this study among 308 students of health sciences in Ugandan universities. A three-sectioned, pretested, and validated questionnaire was used to capture data on socio-demographic attributes and smartphone use habits from the respondents. The data were analysed using IBM SPSS version 26. The outcome variable (i.e., smartphone addiction) was transformed into a weighted aggregate score prior to dichotomisation. Analysis of variance, chi-square test of independence, and binary logistic regression analysis were employed for the study hypotheses, and the significance level was set at P ≤.05.

Results: The prevalence of smartphone addiction was found to be 53.9%. Female respondents were predominant, 179 (58.1%), and relatively three-quarters of the respondents, 237 (76.9%), were unmarried. The smartphone addiction score among the respondents was 16.13 (95% confidence interval [CI], 15.49 to 16.78) on a maximum reference scale of 30. At the multivariable model, daily time spent using a smartphone (AOR 0.40; 95% CI, 0.23 to 0.69) and the onset of smartphone use (AOR 0.55, 95% CI, 0.31 to 0.97) were identified as the significant independent predictors of smartphone addiction.

Conclusion: This study reported a high prevalence of smartphone addiction among the sampled health sciences students in Ugandan universities. The most significant predictors of smartphone addiction include the number of hours spent on a smartphone daily and the onset of smartphone use. Given the negative health outcomes that this problem may evoke, this study calls for targeted health education intervention to enhance self-control skills, and to effectively tackle smartphone addiction among university students in Uganda.

Low and middle-income countries (LMIC) in Africa face challenges in medical education. Eleven countries have no medical school, 24 countries share one medical school, and few have residency programs. This shortage means that Africa has only 1.7% of the world's physicians, yet bears 27% of the global disease burden. COVID-19 created further educational constraints, especially in emergency medicine (EM). Student and resident education opportunities were limited. Rwanda faced a shortage of available in-person EM residency instructors during the pandemic, and to support learning needs, we designed and implemented a remote teaching model to substitute in-person instruction. The objective of this study was to evaluate whether remote and pre-recorded teaching is positively received by EM learners and if it is a viable supplement in resource limited settings. Pre-recorded lectures were presented to residents, with lecturers remotely available. We evaluated the program using the first-level Kirkpatrick framework (suitability/satisfaction) via a quantitative and qualitative post-lecture survey. The survey was completed by residents in attendance. Responses were analyzed using descriptive statistics. Outcome measures included learner satisfaction, lecture quality, technological quality, and situational suitability. Qualitative and free-response data was An average of 11 Rwandan EM residents attended 18 lectures. Using a Likert scale, the composite learner satisfaction score was 4.25 (σ = 0.1), the lecture quality score was 4.2 (σ = 0.1), the technological quality score was 4.0 (σ = 0.36), and the situational suitability score was 4.25 (σ = 0.07). These results indicated overall satisfaction with the lectures. Lower scores were given regarding lecturer accents and speech rates. Qualitative feedback did not demonstrate significant dissatisfaction with quality or suitability. When in-person lecturers are unavailable, pre-recorded, remote instructional methods may be an appropriate substitute. Future directions may include piloting the project with a larger, multinational cohort or in LMICs with greater technological or resource limitations.

Not for profit health organisations (NPHOs) complement government health response efforts, hence the need for their continued functionality during pandemic situations. In this article we highlight lessons from Makerere University Walter Reed Project's (MUWRP) efforts to ensure continuity of its health mandate during the corona virus disease 2019 (COVID-19) outbreak. Our findings provide cues for other developing world NPHOs as they prepare for the next outbreak. When the first case of COVID-19 was reported in Uganda, MUWRP's leadership identified four strategic pillars of action; minimising the risk of spread of the malady, ensuring continuity of all health activities, early identification and support for casualties, and prevention. An infection prevention and control (IPC) committee was set up to lead response efforts. Innovations per pillar such as adoption of information technology to ensure virtual working and meeting, bringing vaccines to the doorsteps of interested staff, free COVID testing, alternate employee working schedules, introduction of temperature guns, and weekly IPC review meetings were implemented. Routine demographic, testing, positivity, and treatment data was exported to STATA 15.1 for analysis. By the declaration of the end of the pandemic by the WHO, the average positivity rate of COVID-19 among 196 MUWRP staff was 7%, with 95% of all cases being mild, and 94.3% cases managed through home-based care. Only three cases were referred to hospital. Overall, males 30 to 40 years were most affected. Vaccination completion was at 89%, and there were no fatalities reported. Employing the four pillars and related innovations were key to minimising the effects of COVID-19 at MUWRP and are a relevant adaptable tool for other NPHOs in the developing world, as they prepare for the next pandemic.